Nutrition is essential for wound healing. A lack of proteins, carbohydrates, fats, water, vitamins, and minerals can impair wound healing and cause delays. Chronic wounds especially require careful nutritional assessment and management to optimize healing. Vascular disease reduces blood supply and can cause hard to heal lower limb ulcers. Diagnostic tests like pulses, Doppler ultrasound, and ankle-brachial pressure index measurements evaluate arterial function and blood flow.
wound management briefing training course including wounds, wound healing & wound types, wound closure, wound covers, wound dressings and marketing plan for new product launch, wound assessment types and measures.
for HCP , wound care specialists, nursing, and wound care and health associations
VAC therapy also known as negative pressure wound therapy (NPWT) is a method of delayed wound closure, where in primary closure is not possible. this PPT details the make & model of the device, its modifications, principle , mechanism , advantages and disadvantages
Triage Meditech is one of the leading Indian medical technology companies acquired a respectable position in Advanced Wound Care arena. We are the leading manufacturers and suppliers of Negative Pressure Wound Therapy (NPWT) products in Indian subcontinent. We have further enhanced our portfolio with Advance Wound Dressings, Colostomy Products, Solutions for Venous Insufficiency, and Surgical Disposables and Consumables. Our R&D team is dedicated to continuous advancement in offerings to create effective products at an affordable cost and helping healthcare professionals and caregivers to offer best practice solutions to their patients. Triage Meditech is an ISO 9001:2008, 13485:2003 certified and DCGI regulated company. We follow WHO Good Manufacturing Practice (GMP) and our products are CE Certified. We have Pan India presence through direct and dealers network and currently we export our products to more than 11 countries.
Negative pressure wound therapy: A promising weapon in the therapeutic wound ...KETAN VAGHOLKAR
Negative pressure wound therapy or vacuum assisted wound therapy is an excellent therapeutic option for chronic wounds which are just refusing to heal. The principles and practical applications of this optio are discussed in the article.
EWMA 2013-Ep447-EFFECTS OF TISSUE-TOLERABLE PLASMA ON CHRONIC WOUND TREATMENT...EWMAConference
EFFECTS OF TISSUE-TOLERABLE PLASMA ON CHRONIC WOUND TREATMENT COMPARED TO A MODERN CONVENTIONAL LIQUID ANTISEPTIC
Bernhard Lange-Asschenfeldt1, Jürgen Lademann1, Christin Ulrich1,
Franziska Kluschke1, Staffan Vandersee1, Alexa Patzelt1, Viktor Czaika1, Heike Richter1, Adríenne Bob1, Johanna Von Hutten1, Axel Kramer2
1Charité Berlin, Department of Dermatology (Berlin, Germany);
2University of Greifswald, Department for Hygiene and environmental medicine (Greifswald, Germany).
wound management briefing training course including wounds, wound healing & wound types, wound closure, wound covers, wound dressings and marketing plan for new product launch, wound assessment types and measures.
for HCP , wound care specialists, nursing, and wound care and health associations
VAC therapy also known as negative pressure wound therapy (NPWT) is a method of delayed wound closure, where in primary closure is not possible. this PPT details the make & model of the device, its modifications, principle , mechanism , advantages and disadvantages
Triage Meditech is one of the leading Indian medical technology companies acquired a respectable position in Advanced Wound Care arena. We are the leading manufacturers and suppliers of Negative Pressure Wound Therapy (NPWT) products in Indian subcontinent. We have further enhanced our portfolio with Advance Wound Dressings, Colostomy Products, Solutions for Venous Insufficiency, and Surgical Disposables and Consumables. Our R&D team is dedicated to continuous advancement in offerings to create effective products at an affordable cost and helping healthcare professionals and caregivers to offer best practice solutions to their patients. Triage Meditech is an ISO 9001:2008, 13485:2003 certified and DCGI regulated company. We follow WHO Good Manufacturing Practice (GMP) and our products are CE Certified. We have Pan India presence through direct and dealers network and currently we export our products to more than 11 countries.
Negative pressure wound therapy: A promising weapon in the therapeutic wound ...KETAN VAGHOLKAR
Negative pressure wound therapy or vacuum assisted wound therapy is an excellent therapeutic option for chronic wounds which are just refusing to heal. The principles and practical applications of this optio are discussed in the article.
EWMA 2013-Ep447-EFFECTS OF TISSUE-TOLERABLE PLASMA ON CHRONIC WOUND TREATMENT...EWMAConference
EFFECTS OF TISSUE-TOLERABLE PLASMA ON CHRONIC WOUND TREATMENT COMPARED TO A MODERN CONVENTIONAL LIQUID ANTISEPTIC
Bernhard Lange-Asschenfeldt1, Jürgen Lademann1, Christin Ulrich1,
Franziska Kluschke1, Staffan Vandersee1, Alexa Patzelt1, Viktor Czaika1, Heike Richter1, Adríenne Bob1, Johanna Von Hutten1, Axel Kramer2
1Charité Berlin, Department of Dermatology (Berlin, Germany);
2University of Greifswald, Department for Hygiene and environmental medicine (Greifswald, Germany).
Varicose veins and compression stockingsJacinta911
This month we are talking about Varicose Veins and Compression Stockings. Many women and men suffer from leg pain and varicose veins and don't realize what is behind the problem or how it can be fixed.
The Circulatory System, Cardiovascular, Lesson PowerPoint, Heat, Blood and morewww.sciencepowerpoint.com
The is the cardiovascular system / circulatory system lesson PowerPoint that follows my human body systems unit from the website www.sciencepowerpoint.com. This is one small part of my 13 part 8,500 slide Human Body Systems and Health Topics Unit. This lesson includes homework bundle, lesson notes, worksheets, and much more.
EWMA 2013 - Ep519 - DIFFERENTIAL DIAGNOSIS OF LEG ULCERS - ULCERS OF RARE ETI...EWMAConference
András Kovács L.¹, Zsolt Kádár¹, Éva Varga¹, Iván Péter¹, Mehdi Moezzi¹, Imre Schneider¹, Endre Kálmán², Krisztián Molnár³, Dalma Várszegi¹
Department of Dermatology¹, Department of Pathology², Department of Radiology³ University of Pécs, Medical School, Pécs, Hungary
Ultrasound: Arterial Stent Complications by Ali Mian - Yale University - *Awa...Ali Mian, MD
Here we discuss broadly applicable principles for ultrasound imaging of arterial stents, emphasizing recognition of the most common and serious complications.
Importance of Arterial Pump Compression & Decompression RatesACI Medical, LLC
This short presentation is a shoot-off of "Preventing Amputation with an Arterial Compression Pump." It goes into greater detail as to why rapid cuff inflation and deflation MUST occur in under 0.5 seconds in order to promote successful therapy.
As always, the number one goal is maximizing blood flow to the lower extremities so that diseased tissues can heal faster with the help of nutrient- and oxygen-rich blood.
"Movement is the essence of life." - Bernd Heinrich
It is a malignant disease of a blood forming organs. The common feature of leukemia is an unregulated proliferation of white blood cells (WBCs) in the bone marrow.
complete information about the fluid resuscitation in burn patients, types of care given to the patient in the hospital after burning accidents, fluid replacement therapy, medical management, nursing management.
Presentations from the Stop the Pressure Lincoln event held for 500 student nurses and caremakers at The Engine Shed, Lincoln on 15 October 2013
This event supports Stop the Pressure, a campaign to raise awareness of pressure ulcers
The hashtag used at this event was #stopthepressurelincoln
Imbalances of fluids occurs when body’s compensatory mechanisms are unable to maintain a homeostatic state.
hypovolemia (fluid volume deficit)
hypervolemia (fluid volume excess)
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism
WHAT ARE THE BEST MEASURES TO REDUCE THE EFFECTS OF HOUSE-DUST MITES ON ASTHMATIC PATIENTS?
DUST MITES PROTECTION IN ASTHMA
are very small, insect-like pests that feed on dead human skin cells and thrive in warm, humid settings. Any swelling (also called inflammation) of the nasal passages caused by dust mites is considered a dust allergy.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation
In the United States, an estimated 1.2 million Americans are living with chronic Hepatitis B and 3.2 are living with chronic Hepatitis C
Many do not know they are infected
Each year an estimated 21,000 persons become infected with Hepatitis A; 35,000 with Hepatitis B, and 17,000 with Hepatitis C
Hepatitis A – fecal/oral, contaminated food, vaccine available
Hepatitis B – blood, semen, vertical (mother-child), vaccine available
Hepatitis C – blood (IV drug use, transfusion, organ donation, unsterile injecting equipment, sexual intercourse)
Hepatitis D – survives only in cells co-infected with hepatitis B
Hepatitis E* – contaminated food or water, fecal/oral
*causes short-term disease and is not a chronic carrier state
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
FA is a very rare, genetic, recessive disease, affecting 1/50,000 people.
Originates from mutations in the “coding” of the mitochondria.
Discovered by Nicholaus Friedreich in the early 1860’s.
Both parents must have the dominant trait for a 25% chance of an offspring possessing the disease.
Not necessarily a disease that kills you, but eventually a wheelchair and regular assistance will be required.
Onset before age 20-25 year.
Propranolol is the most common beta-blocker involved in severe beta-blocker poisoning. It is nonselective and can lead to CNS depression, seizures, and prolongation of the QRS complex.
Beta blocker toxicity is notably distinguished by bradycardia, low respiratory
rate and hypoglycemia
Seizures and other CNS effects can occur with beta blockers that can cross the blood brain barrier (more rarely with the other beta blockers)
Overdoses of beta blockers with a combination of other drugs can have wide
ranging systemic effects
If within a short time after ingestion, give activated charcoal
Treat with glucagon to raise blood glucose levels
Widely used treatment is currently Atropine though it is considered less effective
Treat bronchospasm with beta agonists like Albuterol
Treat Seizures with Benzodiazepines like Valium
If the patient is still unresponsive or the condition is still deteriorating, treat with epinephrine
More than 5.7 million new cases of TB (all forms, both pulmonary and extra-pulmonary) were reported to the World Health Organization (WHO) in 2013; 95% of cases were reported from developing countries
Latest figures from 20151 indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400 000 HIV positive).
Of further concern is that 480 000 cases of multidrug-resistant (MDR) TBa and a further 100 000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period.
The most common non-cancerous tumours in women .
The most common indication for hysterectomy.
Apparent in up to 25% of women.
More common in a higher body mass index women.
3 times more common in black American women than white women.
Asian women have a lower incidence .
Symptoms appear at age of 30s or 40s .
The incidence increases with age up to the menopause.
Women over the age of 30 are commonly affected by fibroid uterine.
50% of all women are affected by fibroid uterine.
Most common solid pelvic tumors.
Develop in 20~25% of women during reproductive years.
Multiple pregnancies consists of two or more fetuses ,there are exceptions to this such as twins gestations made of a singleton viable fetus & a complete mole.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
• The Facial nerve is the 7th of twelve paired cranial nerves.
• It is a mixed nerve with motor and sensory roots.
• It also supplies pre-ganglionic parasympathetic fibres to several
head and neck ganglia
Branches
1. Greater superficial petrosal – arises from the geniculate ganglion.
2. Branches within the facial canal:
• i) nerve to stapedius
• ii) Chorda tympani
3. After exit from stylomastoid foramen:
• i) Posterior auricular
• ii) Nerve to posterior belly of digastric
• iii) Nerve to stylohyoid.
4. On the face - Five major branches:
• i) Temporal
• ii) Zygomatic
• iii) Buccal
• iv) Marginal mandibular
• v) Cervical
The stomach J-shaped. It has two surfaces (the anterior & posterior), two curvatures (the greater & lesser), two orifices (the cardia & pylorus). It has fundus, body and pyloric antrum.
Blood supply
The left gastric artery
Right gastric artery
Right gastro-epiploic artery
Left gastro-epiploic artery
Short gastric arteries
Stomach cancer begins when cancer cells form in the inner lining of your stomach. These cells can grow into a tumor. Also called gastric cancer, the disease usually grows slowly over many years.
It could be:
malignant or benign
primary or secondary
What is a Pet Scan : Nuclear 3-D imaging test that uses a radioactive substance called a tracer to look for disease in the body.
Shows how organs and tissues are working at a molecular and cellular level. Scan is non-invasive, but does involve exposure to ionizing radiation.
Best known for its role in detecting cancer imaging.
A small amount of a radioactive sugar molecule, 18 fluoro-2-deoxyglucose (FDG), is injected into the bloodstream (can also be inhaled as gas or swallowed in pill form).
A PET Scan is used to detect and generate images that indicate areas of high FDG uptake.
Many cancers require more energy than normal cells, and the FDG tracer accumulates in these cells.
This allows cancers to be seen on the Pet images as hot spots.
Use focusing Shock Waves to breakdown
a stone into small pieces.
Shock waves are acoustic pulses.
Pass through better in water and solid but
not in air.
Introduce in 1980 by Dornier which is a supersonic aircraft company
Somatoform disorders
A disorder in which people have physical illnesses or complaints that cannot be fully explained by actual medical conditions
Dissociative disorders
A personality disorder marked by a disturbance in the integration of identity, memory, or consciousness.
Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis
in psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms
"schizophrenia" "split mind" but it refers to a disruption of the usual balance of emotions and thinking.
Schizophrenia is chronic and a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior .
Breast cancer :-
is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.
Breast cancer can begin in different parts of the breast:
1- Lobule (the glands that produce milk).
2- Ducts (tubes that carry milk to the nipple).
3- Connective tissue (which consists of fibrous and fatty tissue)( surrounds and holds everything together) .
*Most breast cancers begin in the ducts or lobules.
*Breast cancer can spread outside the breast through blood vessels and lymph vessels.
Zika virus disease is a mosquito-borne viral infection that primarily occurs in tropical and subtropical areas of the world.
It is related to other pathogenic vector borne flaviviruses including dengue, West-Nile and Japanese encephalitis viruses but produces a comparatively mild disease in humans
Genre: Flavivirus
Vector: Aedes mosquitoes (which usually bite during the morning and late afternoon/evening hours)
Reservoir: mosquitoes (gut, blood, saliva )
human ( blood, prostate, semen and testes )
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...
chronic wound
1. 2nd part
Prepared by : MUSTAFA KHALIL IBRAHIM
THE ABNORMAL HEALING PROCESS
CHRONIC WOUND HEALING
2. NUTRITION AND WOUND HEALING
• Good nutrition is essential for wound healing. A person’s nutritional status is a good
indicator of the individual’s ability to heal as malnutrition can significantly impair all
aspects and phases of wound healing leading to delayed healing times. The longer a
wound takes to heal the more likely it is to become infected or become complex in
nature.
• Although many patients with a poor nutritional status develop non-complicated
wounds that go on to heal without any attention to their diet, Many patients with
chronic and/or complex wounds and/or conditions will require through assessment
and attention to their nutritional intake to optimize healing rates.
• A good diet will consist of nutrients that will include protein, carbohydrates, fat,
water, vitamins and minerals,
3.
4.
5. • Proteins – contain amino acids that are the building blocks of protein, which is essential for tissue repair and
regeneration.
• Carbohydrates – provide the energy in the form of glucose needed to power the repair and regeneration
process described above.
• Fats – are essential in providing an energy source when the carbohydrate sources have been depleted. It is
also required to help with thermoregulation (insulation) and it carries fat-soluble vitamins A, E and K, required
for wound healing.
• Water – A dehydrated patient will lead to a dehydrated wound. A dehydrated wound will delay wound
healing as the migration of granulation tissue across the wound bed depends on a fluid environment, which
also aids cell functioning. Additionally, the patient will require an increased fluid intake over and above the
normal requirement of 40–60 mL of water per kilogram of body weight per day, in order to prevent
dehydration.
• Vitamins (A, C, K, B complex, E) :
• Vitamin A is essential for healthy skin and epithelial integrity.
• Vitamin C is essential for building and maintaining healthy tissues and it assists the body in absorbing iron.
• Vitamin K is essential for blood clotting,
• B complex vitamins are a group of eight vitamins required for normal immune functioning and energy
metabolism. They aid in white blood cell function and resistance to infection.
• Vitamin E is an antioxidant that helps prevent cellular damage; it decreases the inflammatory phase of wound
healing; it enhances immune function and decreases platelet adhesion.
6. • Minerals (zinc, iron, copper and magnesium, calcium and phosphorus) – all are important to
the wound healing process; zinc is an antioxidant vital to cell processes and normal immune
function; iron is an essential part of haemoglobin and is required for oxygen transportation to
cells to maintain life; copper is required for haemoglobin synthesis and iron absorption and
transportation and increases the strength of collagen fibres; magnesium is essential to all
living cells and plays an important role in the transportation of calcium and ions across cell
membranes, important for muscle contraction, nerve impulse conduction and normal cardiac
rhythm; calcium is essential for bone formation, remodelling and muscle contraction, for fibrin
syntheses and blood clotting; phosphorus is essential for normal metabolism and is an
essential component of many enzyme systems.
7. NUTRITIONAL ASSESSMENT
• A dehydrated patient will be at greater risk of wound complications such as
wound dehiscence (primary intention), delayed healing rates, wound infection,
sepsis and even death. It is therefore essential that routine assessments and
reassessments, including weight measurements, are carried out on a patient
with a wound in order to ensure that they are receiving an optimum diet and
fluids that is sufficient for their wound healing requirements. A nutritional risk
assessment tool must be used in order to assist the practitioner in establishing
a risk level, but this must not be used in isolation and the practitioner should
therefore not replace clinical judgement.
8. CLINICAL CHARACTERISTICS OF MALNUTRITION
• The clinical characteristics of malnutrition and dehydration
that the practitioner must be aware of are obesity,
transparent skin, pallor, broken blood vessels in the skin,
pale eye membranes, missing teeth or poor dentition,
bleeding gums and recent changes in body weight
(increase or decrease).
9. CLINICAL CHARACTERISTICS OF THE WOUND
• caused by malnutrition In cases where the patient
is poorly nourished the wound may present with
prolonged healing rates including chronic wounds,
repeat ulcerations, pressure ulcer formation,
neuropathic ulcer formation .
10. MEDICAL CONDITIONS THAT COULD LEAD TO
• Malnutrition There are many medical conditions that
make it more probable that the patient will develop
malnutrition for examples:
• Diabetes mellitus; intestinal conditions;
malabsorption conditions (e.g. coeliac disease);
cancer; HIV/AIDS; obesity and any patient receiving
parental nutrition.
11. WHAT IS INCONTINENCE?
• Incontinence is the inability to control bladder and/or
bowel functions. It affects people of all ages; however,
females are twice as likely as males to develop
incontinence. When such a problem exists it can impact
not only on the quality of the individual’s life.
12. THE AFFECTS OF INCONTINENCE
• Many people with urinary incontinence will restrict their fluid intake
believing this will better control the problem. Unfortunately this will lead to
dehydrated skin, which will be weaker than it would be if it was well
hydrated and so will experience damage easier than it would do
otherwise. Additionally, dehydration can also lead to urinary tract
infections, which in turn result in worsened urinary incontinence (and
sweating) thereby resulting in increased risk of moisture damage.
13. MOISTURE LESION OR A PRESSURE ULCER ?
• Very often moisture lesions are mistaken for pressure ulcers,
particularly early-onset pressure ulcers (i.e. Grades 1 or 2), as
they can look very similar in appearance ( figure ).
16. PREVENTION IS BETTER THAN CURE
• As always, prevention is better than cure. Therefore, to begin with, as far as possible, it is vital to
address the cause of the incontinence (or sweating, or both). This may include instigating a regular
toileting regime (e.g. 2–3 hourly, the following care must be provided to avoid moisture lesions:
• 1 instigate a 2–3 hourly toileting regime
• 2 instigate a repositioning regime (a and b can be achieved
• together)
• 3 use of appropriate size and type of continence pad; these must be
• fitted to the conformity of the body and should not be placed as
• a sheet under the patient
• 4 good standards of personal hygiene; keeping the patient clean
• and dry
• 5 the use of an appropriate moisture barrier creams/sprays that
• will assist in preventing moisture sitting next to the skin
• 6 ensure adequate nutrition and hydration.
17. VASCULAR DISEASE
• Vascular disease, also known as arterial insufficiency, is the lack of
adequate arterial blood supply to a certain organ(s) or part(s) of the
body, which can result in reduced tissue viability or tissue death. The
most common type of vascular disease seen in wound care is
ulceration to the lower limbs due to vascular insufficiency, where
limb pain and ulceration may occur due to this lack of blood supply;
however, similar problems can develop in the upper limbs.
• Lower limb ulcers (arterial ulcers) are the most common type of
chronic wound, as many will either be very slow to heal or will not
heal at all due to varying degrees of reduced or no blood supply to
the limb, or parts of the limb.
19. ADDITIONAL FACTORS THAT MUST BE CONSIDERED
• Due consideration must be given to the possible presence of generalized vascular
disease in patients who have had a cerebra-vascular accident (stroke) (by the
development of a clot in the brain), those with vascular dementia, cardiovascular disease
(e.g. angina and coronary artery disease), those who are given certain drugs, such as
inotropes, that are commonly used in critically ill patients, and those with vascular
diseases of vital organs such as the kidneys. Although in these conditions arterial
insufficiency is usually restricted to the specific arteries, there is a possibility that the
condition may be widespread affecting other arteries and capillaries. If for example a
major artery is occluded due to hypertension (resulting in a stroke), it is possible that the
smaller arteries and/or capillaries in the skin could be affected.
20. DIAGNOSTIC TESTS FOR ARTERIAL DISEASE
• The following are common tests for measuring arterial insufficiency of the extremities:
• Pulses – peripheral pulses must be assessed for all extremity wounds. However as a decreased
blood supply may be affecting the limb (causing a wound). When checking a pulse by palpation, the
rhythm, regularity and strength must be noted.
• Doppler ultrasound – this involves listening to the sound of the blood pulsating through the arteries
using a hand-held device. The sound indicates the patency of the artery. A healthy artery has 2 or 3
beats that occur as the artery expands and contracts with the flow of blood
• Ankle–brachial pressure index (ABPI) – This involves non-invasive assessment of the blood
pressures in all four limbs and each of three arteries of the feet. A calculation is carried out that
provides the ratio of the systolic blood pressure of the lower extremities compared to the upper
extremities. This establishes an ABPI measurement that indicates the amount of blood that is
travelling through each artery, or not, as the case may be. This is discussed in greater detail in a later
chapter.
• Capillary refill – this is a simple test that is a reliable indicator of surface arterial blood flow (i.e. to
the skin, tips of digits) and involves pressing on the distal tip of the toe (or finger) for 5 seconds (i.e.
emptying surface blood vessels). Capillary refill time is recorded based on the time it takes to refill
and regain its original colour. A normal refill time is 3 seconds. A delayed refill time could indicate
arterial insufficiency.