NURSING SCIENCE GNM TISSUE HEALING

1. Inflammation

18. Treatment of inflammation
• NSAIDS-
ibuprofen
naproxen
diclofenac
celecoxib
mefenamic acid
etoricoxib
indomethacin
aspirin

19. • CORTICISTEROIDS
Corticosteroids, often known as steroids, are an
anti-inflammatory medicine. They’re prescribed
for a wide range of conditions.
They’re a synthetic version of hormones,
normally produced by the adrenal glands.

21. ANTIHISTAMINE

22. HOT AND COLD THERAPY

25. Phase 1: Hemostasis Phase
• Hemostasis, the first phase of healing, begins at the
onset of injury, and the objective is to stop the
bleeding.
• In this phase, the body activates its emergency repair
system, the blood clotting system, and forms a dam to
block the drainage.
• During this process, platelets come into contact with
collagen, resulting in activation and aggregation.
• An enzyme called thrombin is at the center, and it
initiates the formation of a fibrin mesh, which
strengthens the platelet clumps into a stable clot

26. Phase 2: Defensive/Inflammatory
Phase
• If Phase 1 is primarily about coagulation, the
second phase, called the
Defensive/Inflammatory Phase, focuses on
destroying bacteria and removing debris—
essentially preparing the wound bed for the
growth of new tissue.

27. • During Phase 2, a type of white blood cells
called neutrophils enter the wound to destroy
bacteria and remove debris.
• These cells often reach their peak population
between 24 and 48 hours after injury,
reducing greatly in number after three days.
• As the white blood cells leave, specialized cells
called macrophages arrive to continue clearing
debris.

28. • These cells also secrete growth factors and
proteins that attract immune system cells to
the wound to facilitate tissue repair.
• This phase often lasts four to six days and is
often associated with edema, erythema
(reddening of the skin), heat and pain

29. Phase 3: Proliferative Phase
• Once the wound is cleaned out, the wound
enters Phase 3, the Proliferative Phase, where
the focus is to fill and cover the wound.
• The Proliferative phase features three distinct
stages: 1) filling the wound; 2) contraction of
the wound margins; and 3) covering the
wound (epithelialization).

30. • During the first stage, shiny, deep red granulation
tissue fills the wound bed with connective tissue,
and new blood vessels are formed.
• During contraction, the wound margins contract
and pull toward the center of the wound.
• In the third stage, epithelial cells arise from the
wound bed or margins and begin to migrate
across the wound bed in leapfrog fashion until
the wound is covered with epithelium. The
Proliferative phase often lasts anywhere from
four to 24 days

31. Phase 4: Maturation Phase
• During the Maturation phase, the new
tissue slowly gains strength and flexibility. Here,
collagen fibres reorganize, the tissue remodels
and matures and there is an overall increase in
tensile strength (though maximum strength is
limited to 80% of the pre-injured strength).
• The Maturation phase varies greatly from wound
to wound, often lasting anywhere from 21 days to
two years

32. • The healing process is remarkable and
complex, and it is also susceptible to
interruption due to local and systemic factors,
including moisture, infection, and maceration
(local); and age, nutritional status, body type
(systemic).
• When the right healing environment is
established, the body works in wondrous ways
to heal and replace devitalized tissue

33. STRESS AND ADAPTATION
• Stress is any emotional, physical, social, economic or other
factor that requires a response or change.
• Stress can lead to a variety of psychological responses, the
most common of which is anxiety.
• Anxiety can be defined as a feeling of apprehension,
uneasiness, uncertainty or dread.
• The source of the anxiety may be real and easily identified
or it may be a perceived threat.
• It may be experienced on four different levels: mild,
moderate, severe and panic level. It can be classified as
normal, acute or chronic and has the potential to affect the
person at a very deep level and to a point where self-
esteem can be seriously eroded

34. • A stressor is the stimulus that precipitates
stress. Stressors can be classified as physical
or psychological.
• Physical stressors include bodily trauma such
as injury or surgery, blood loss, pain, infection
and illness.
• Psychological stressors can be defined as any
stimuli that the person interprets as
challenging, demanding or threatening.

35. • Stressors can also be classified as internal or external.
• Internal stressors arise from within the person. They
include hunger, thirst, fatigue, fever and the effects of
pregnancy or menopause. Internal stressors also include
strong emotions such as embarrassment, shame or guilt.
• External stressors are those that originate outside a person
and include environmental conditions such as exposure to
overly high or low temperatures, overcrowding, noise and,
of course, the traumatic effects of accidents or natural
disasters such as fires, floods, hurricanes and earthquakes.
External stressors also include issues such as peer group
pressure, social isolation and the demands of study, family
or work

36. PHYSIOLOGICAL ADAPTATION
• Concerns how the central nervous system and the
immune system work as an integrated whole to
maintain homeostasis, a state of healthy balance
within the body.
• In the case of trauma, physical illness or prolonged
stress the homeostatic responses may struggle to
adapt and fail to restore normal concentrations of
gases, nutrients and ions, body temperature and blood
pressure to within normal limits.
• Medical interventions such as fluid replacement,
oxygen therapy and nutritional measures can assist

37. • The physiological response to acute stress is
known as the fight-or-flight response. It begins
when people are faced with a threat or stressful
situation.
• The fight-or-flight response is vital to defend
against and tolerate danger. However, continued
unresolved stress results in a chronic stress
condition that impacts on the body and may
produce any of a wide range of diseases and
disorders.

38. • Prolonged stress may also lower the
threshold at which the body responds to
threats.

39. • A range of anxiety disorders - panic disorder,
acute stress disorder (ASD) and post-traumatic
stress disorder (PTSD)
• Recurrent and prolonged stress causes a range of
effects on mood, cognition and behaviour in
addition to physical responses.
• Overwhelming stress or distress - interfere with
mental wellbeing and can cause the person to
lose contact with what is real or not real.
• Disorganised and/or delusional thoughts and
hallucinations.

40. INDICATORS OF STRESS
• Abdominal pain/distension
• Dry mouth
• Nausea/vomiting
• Dizziness
• Shakiness and tremors
• Chest discomfort
• Dyspnoea
• Hyperventilation
• Palpitations
• ‘Butterflies’
• Diarrhoea
• Urinary frequency
• Faintness
• Muscle tension
• Diaphoresis
• Flushing

41. Psychological Cognitive Behavioural
Sadness Confusion Unable to sleep
Depression Forgetfulness Under- or over-eating
Labile mood Inability to concentrate Talking rapidly/loudly
Irritability Decision making is difficult Stammering
Quick to anger Comprehension impaired Inability to sit still
Finger tapping
Constant pulling at hair
Constant pumping of leg up
and down
Inability to control tear

42. General Adaptation Syndrome (GAS)
General adaptation syndrome (GAS) describes
the physiologic changes your body goes through
as it responds to stress. These changes occur in
stages:
• An alarm reaction (also called fight-or-flight)
• A resistance phase (in which your body
recovers)
• A period of exhaustion

44. The 3 Stages of General Adaptation Syndrome
General adaptation syndrome was first
described by Hans Selye in 1936, but it wasn't
until the 1950s that his research defined the
three stages of GAS:
• Alarm reaction
• Resistance
• Exhaustion

45. Alarm Reaction Stage
• The alarm reaction stage of general
adaptation syndrome is the body’s initial
response to stress.
• The sympathetic nervous system is activated
by the sudden release of hormones.

46. • The sympathetic nervous system part of the
autonomic nervous system, which regulates
the functions of heart, stomach, bladder, and
intestines, as well as your muscles.
• When the sympathetic nervous system is
activated, it stimulates the adrenal glands.
The glands, in turn, trigger the release of
certain hormones,
including adrenaline and noradrenaline.

47. • The hormone release causes physical symptoms, such
as increased heart rate, breathing rate, and blood
pressure.
Physical signs of being in the alarm response stage
include:
• Dilated pupils
• Increased heart rate
• Rapid breathing
• Trembling
• Pale or flushed skin
• Heightened senses

48. • According to Selye, most of the symptoms of
the alarm response stage disappear or are
reversed in the next stage (resistance), then
reappear in the final stage of exhaustion.

49. Resistance Stage
• The resistance stage is governed by a part of
the ANS called the parasympathetic.
• The parasympathetic branch of the ANS tries
to return the body to normal by reducing the
amount of cortisol produced. The heart rate
and blood pressure begin to return to normal.
• If the stressful situation comes to an end,
during the resistance stage, the body will then
return to normal.

50. • However, if the stressor remains, the body
will stay in a state of alert, and stress
hormones continue to be produced.
• This physical response can lead to a person
struggling to concentrate and becoming
irritable.

51. Exhaustion stage
• After an extended period of stress, the body
goes into the final stage of GAS, known as the
exhaustion stage.
• At this stage, the body has depleted its energy
resources by continually trying but failing to
recover from the initial alarm reaction stage.

52. Once it reaches the exhaustion stage, a person’s
body is no longer equipped to fight stress. They
may experience:
• tiredness
• depression
• anxiety
• feeling unable to cope

53. • If a person does not find ways to manage
stress levels at this stage, they are at risk of
developing stress-related health conditions.