This document provides an overview of wound physiology and assessment. It discusses the causes and types of wounds, the three phases of wound healing (hemostasis, inflammation, and maturation), and how to clinically assess wounds. Key aspects of wound assessment covered include examining the general health of the patient, measuring wound dimensions and characteristics of drainage and tissue in the wound bed, and identifying environmental factors that could impact healing. The document also outlines different modes of wound healing like primary intention and skin grafts. The goal is to equip healthcare practitioners with knowledge of wound pathophysiology and best practices for thorough clinical evaluation.
Staphylococcus epidermidis is an opportunistic pathogen that commonly forms biofilms on medical devices. These biofilms make infections very difficult to treat as bacteria in biofilms are up to 1000 times more resistant to antibiotics. The document discusses various strategies to control S. epidermidis biofilms, including using antibiotic combinations to prevent resistance development, targeting mechanisms of biofilm antibiotic resistance, and exploring natural compounds and their synergistic effects with antibiotics.
This document discusses the differences between the T-test, Z-test, and F-test. The T-test is used to compare the means of two samples, the Z-test compares the means of two normally distributed populations, and the F-test compares the variances of two normally distributed populations. The document provides an overview of hypothesis testing and when each statistical test is appropriately used.
This document provides an overview of Streptococcus pneumoniae (pneumococcus). It is a gram-positive lance-shaped diplococcus that is a normal inhabitant of the upper respiratory tract. It causes pneumonia and other respiratory infections. Key characteristics include being bile soluble, optochin sensitive, and having a polysaccharide capsule that allows for serotyping. It is treated with penicillin but antibiotics resistance is a concern. Vaccines can help prevent pneumococcal disease.
1) The document discusses different types of fungal spores, including sexual spores (ascospores, zygospores, basidiospores) and asexual spores (blastospores, arthrospores, chlamydospores, conidiospores).
2) It describes different types of superficial fungal infections of the skin, hair, and nails, known as dermatophytoses or ringworm, which are caused by dermatophyte fungi of the genera Trichophyton, Microsporum, and Epidermophyton.
3) Key characteristics are provided for diagnosing dermatophyte infections microscopically and through fungal culture techniques.
The document discusses antibiotics, including their sources, roles, classification, and mechanisms of action. It focuses on several classes of antibiotics that act by inhibiting bacterial cell wall synthesis or protein synthesis. It describes how penicillins and cephalosporins inhibit the final stage of peptidoglycan synthesis in bacterial cell walls. It also discusses how other drugs like glycopeptides, fosfomycins, and aminoglycosides act on bacterial cell components and physiological processes. The classification, mechanisms of action and spectra of several classes of protein synthesis inhibitors are outlined as well.
LIVESTOCK WASTE DISPOSAL AND MANAGEMENTimrantoqeer
Livestock waste can be disposed of and utilized in several ways. It includes liquid waste like urine and wash water as well as solid waste like feces and bedding. Livestock waste can be applied directly to crop land as fertilizer, used to feed animals, or processed to produce energy and biogas. Common waste disposal systems include combining liquid and solid waste to apply to fields, separating wastes with solids stored in pole or pit structures, and treating waste in lagoons for microbial breakdown. Livestock waste is also used in biogas plants to produce methane gas for cooking and electricity generation.
The document provides information on gynecological case taking and diagnosis. It discusses that the ideal gynecological diagnosis includes an etiological, anatomical, and functional component. It then outlines the various components of history taking in gynecology including personal history, complaints, menstrual history, obstetric history, past history, family history, and present history. The document also discusses the components of clinical physical examination including general, abdominal, and local gynecological exams. It provides details on specific exams and clinical tests.
Staphylococcus epidermidis is an opportunistic pathogen that commonly forms biofilms on medical devices. These biofilms make infections very difficult to treat as bacteria in biofilms are up to 1000 times more resistant to antibiotics. The document discusses various strategies to control S. epidermidis biofilms, including using antibiotic combinations to prevent resistance development, targeting mechanisms of biofilm antibiotic resistance, and exploring natural compounds and their synergistic effects with antibiotics.
This document discusses the differences between the T-test, Z-test, and F-test. The T-test is used to compare the means of two samples, the Z-test compares the means of two normally distributed populations, and the F-test compares the variances of two normally distributed populations. The document provides an overview of hypothesis testing and when each statistical test is appropriately used.
This document provides an overview of Streptococcus pneumoniae (pneumococcus). It is a gram-positive lance-shaped diplococcus that is a normal inhabitant of the upper respiratory tract. It causes pneumonia and other respiratory infections. Key characteristics include being bile soluble, optochin sensitive, and having a polysaccharide capsule that allows for serotyping. It is treated with penicillin but antibiotics resistance is a concern. Vaccines can help prevent pneumococcal disease.
1) The document discusses different types of fungal spores, including sexual spores (ascospores, zygospores, basidiospores) and asexual spores (blastospores, arthrospores, chlamydospores, conidiospores).
2) It describes different types of superficial fungal infections of the skin, hair, and nails, known as dermatophytoses or ringworm, which are caused by dermatophyte fungi of the genera Trichophyton, Microsporum, and Epidermophyton.
3) Key characteristics are provided for diagnosing dermatophyte infections microscopically and through fungal culture techniques.
The document discusses antibiotics, including their sources, roles, classification, and mechanisms of action. It focuses on several classes of antibiotics that act by inhibiting bacterial cell wall synthesis or protein synthesis. It describes how penicillins and cephalosporins inhibit the final stage of peptidoglycan synthesis in bacterial cell walls. It also discusses how other drugs like glycopeptides, fosfomycins, and aminoglycosides act on bacterial cell components and physiological processes. The classification, mechanisms of action and spectra of several classes of protein synthesis inhibitors are outlined as well.
LIVESTOCK WASTE DISPOSAL AND MANAGEMENTimrantoqeer
Livestock waste can be disposed of and utilized in several ways. It includes liquid waste like urine and wash water as well as solid waste like feces and bedding. Livestock waste can be applied directly to crop land as fertilizer, used to feed animals, or processed to produce energy and biogas. Common waste disposal systems include combining liquid and solid waste to apply to fields, separating wastes with solids stored in pole or pit structures, and treating waste in lagoons for microbial breakdown. Livestock waste is also used in biogas plants to produce methane gas for cooking and electricity generation.
The document provides information on gynecological case taking and diagnosis. It discusses that the ideal gynecological diagnosis includes an etiological, anatomical, and functional component. It then outlines the various components of history taking in gynecology including personal history, complaints, menstrual history, obstetric history, past history, family history, and present history. The document also discusses the components of clinical physical examination including general, abdominal, and local gynecological exams. It provides details on specific exams and clinical tests.
This document is a PowerPoint presentation about wound dressings. It discusses different types of wound dressings including primary and secondary dressings, classifications of dressings into 7 categories like films and hydrogels. It provides details on specific dressing materials like gauze, tulles and film. It also covers topics like chronic wounds, venous stasis ulcers, arterial ulcers, pressure ulcers, diabetic wounds and negative pressure wound therapy.
Concise discussion on essential clinical and microbiological aspects of Candia, Pneumocystis and Aspergillus infections in HIV and other immunocompromised patients.
Max Bush presented on new dressings for wound management. He discussed the phases of wound healing and challenges that can impede the process. The moist wound healing paradigm emphasizes keeping wounds moist to facilitate healing rather than letting them dry out. A variety of modern dressings were presented that aim to maintain a moist environment including honey-based dressings, calcium alginate, and vacuum-assisted closure which uses negative pressure. The key is selecting a dressing matched to the characteristics of the individual wound.
Uterine fibroid - Case scenarios and DiscussionHaynes Raja
This presentation is prepared to meet out the undergraduate medical student needs especially to understand the practical aspects of uterine fibroid and to rapidly revise some important viva questions.
Dedicated to my Great Teachers in the Dept. of Obstetrics & Gynaecology Dr. Lavanya Kumari and Dr. Sangeereni, Inspiring Friends Dr. Paulin Benedict, Dr. Jeyakumar Meyyappan and Dr. Hannah Jane and our REVELLIONZ 08’ batch.
Infection characterized by severe local inflammation, usually with pus formation, generally caused by one of the pyogenic bacteria.
Sepsis:The term sepsis covers numerous and diverse pyogenic infections which includes superficial skin infections,wound infections,infection of burns,infection of eyes,peritonitis and abscesses.
Pus is an exudate typically white yellow or yellow formed at the site of inflammation during infection.
Abscesses are localized collection of pus composed of living and dead WBC, components of tissue break down.
70% of tissue infection is mainly caused by
Staphylococcus aureus.
Etymology:
Greek word, pyon meaning pus, genein, meaning to produce
Pus is a fluid composed of : dead & dying WBC, dead & dying bacteria (in bacterial cause of pus),tissue debris, edema, fibrin, lipid and nucleic acid.
Pus cells : it is degranulated wbc, neutrophils.
The body responds to invasion by a wide variety of bacteria by an increased blood supply to the area and by an outpouring of serous fluid and white blood cells.
This is the typical inflammatory response.
The white cells which pass from the blood into the infected tissues attempt to ingest the bacteria (phagocytosis), many cells die and the resultant material consisting of both living and dead white cells (leucocytes or pus cells) and bacteria, together with damaged local tissues and blood proteins, constitutes PUS.
Infections in which pus is produced are known as pyogenic, i.e. pus-producing infections.
Pus may be present as a localised collection deep in the tissues—an ABSCESS, it may be produced on a surface, e.g. the mucosa of the pharynx, the mucosa of the bladder, the méninges, indeed any body surface, it is then known as a PURULENT EXUDATE.
Alternatively infection may spread evenly through the tissues causing a diffuse inflammation :CELLULITIS.
The type of pus production will depend on the organism causing the infection, on the tissue in which the infective process is taking place, and also on the body resistance to the infection.
Although the pyogenic infections have very similar appearances whatever the causative organism, different sites of the body have a tendency to be infected with particular species of bacteria.
Always submit two swabs so that Gram stain can be performed.
Limit swab sampling to wounds that are clinically infected or those that are chronic and are not healing.
To minimize contamination, it is important to cleanse the wound to remove superficial debris by thorough irrigation and cleansing with non-bacteriostatic sterile saline.
If the wound is relatively dry, collect the specimen with two cotton-tipped swabs moistened with sterile non-bacteriostatic saline. Gently roll the swab over the surface of the wound approximately five times, focusing on an area where there is evidence of pus or inflamed tissue.
Penicilliosis is an infection caused by Penicillium marneffei that predominantly affects HIV-positive individuals in Southeast Asia. It is characterized by fever, skin lesions, anemia, lymphadenopathy and hepatomegaly. Laboratory diagnosis involves examining specimens such as blood, bone marrow and tissue under a microscope to identify the characteristic yeast and mold forms. Treatment involves antifungal medications such as amphotericin B or oral itraconazole.
An obstetric history should include details of the current pregnancy, past obstetric and medical history, family history, social history, and review of systems. The examination involves evaluation of vital signs, general appearance, breast and abdominal exams to assess size and position of the uterus and fetus. Fetal heart rate and engagement should be determined. [/SUMMARY]
Pilonidal sinus is a condition where one or more non-infected openings form in the midline of the natal cleft overlying the coccyx. Hair can become trapped in these openings, leading to infection or abscess. It is more common in males after puberty, and in individuals with dark hair. Symptoms include intermittent discharge, pain, swelling, and abscess formation. Diagnosis is usually clinical but MRI may help with extensive cases. Treatment involves cleaning and removing hair from openings, antibiotics for infection, and surgery to excise sinus openings and flatten the natal cleft to prevent further hair implantation and recurrence.
This document discusses upper gastrointestinal bleeding (GI bleed), including its causes, clinical presentation, and common causes of different types of bleeding presentations. The main causes of upper GI bleed are peptic ulcers, gastric erosions from conditions like gastritis, esophagitis from GERD or other irritants, esophageal varices, and neoplasms of the esophagus or stomach. Bleeding can present as hematemesis (vomiting blood), melena (black tarry stool), hematochezia (rectal bleeding), occult bleeding, or symptoms of blood loss. Common causes of hematemesis include ruptured esophageal varices, gastric/duodenal ulcers,
This document discusses wound physiology and assessment. It begins by outlining the causes of wounds and the wound healing process, which involves three phases: haemostasis, inflammation, and tissue repair/remodeling. It then describes how to clinically assess wounds, including examining the patient's general health and wound characteristics like appearance, drainage, and dimensions. Environmental and local factors that can influence wound healing are also assessed. The document provides guidance on classifying wound types and stages to help determine appropriate treatment and evaluate healing progress.
Endometriosis is a medical condition where endometrial tissue grows outside the uterus, commonly in the ovaries, fallopian tubes, and pelvic lining. It affects 6-10% of women and causes pain, irregular bleeding, and infertility. The exact cause is unknown but theories include retrograde menstruation, genetic factors, and environmental toxins. Diagnosis involves a medical history, physical exam, ultrasound, MRI, and laparoscopy to visualize lesions. Stages range from minimal to severe based on location, size, and depth of implants. Treatment focuses on pain management and hormone therapy to suppress menstruation. Differential diagnoses include pelvic inflammatory disease, ovarian cysts, and uterine fibroids.
This document provides an overview of case history in paediatric dentistry. It discusses collecting biographical data, chief complaints, history of present illness, past medical history, natal history, habits, and conducting extraoral and intraoral examinations. The examinations provide information to make provisional, differential and final diagnoses. Investigations like radiographs may be used. A treatment plan is then formulated considering urgency, medical conditions, and preventive, corrective and maintenance phases. The goal is a stepwise, evidence-based approach to the patient's well-being.
This document provides an overview of cysts that can occur in the oral and maxillofacial tissues. It defines cysts and discusses their classification, pathogenesis, clinical examination, and specific types such as odontogenic cysts, inflammatory cysts, dentigerous cysts, and odontogenic keratocysts. The pathogenesis involves initiation, cyst formation, and enlargement. Clinical examination includes symptoms, signs, radiographic features, and biopsy for diagnosis. Treatment depends on the type and size of the cyst.
ueda2012 predictors of diabetic foot ulcer-d.walaaueda2015
This document summarizes a study examining predictors of outcome for diabetic foot ulcers at Assiut University Hospital in Egypt. The study prospectively followed 100 patients with diabetic foot ulcers for up to one year to determine factors associated with complete healing within that time period. So far, data has been collected on 50 patients. Preliminary results found that 68% of patients were female, with a mean age of 50.76 years. Factors examined included demographics, medical history, foot examination findings, ulcer characteristics, and lab results. The aim is to identify baseline characteristics that can predict poorer outcomes like non-healing of the ulcer.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: October CasesSean M. Fox
This document provides a summary of 4 pediatric orthopedic imaging case studies involving femur fractures in patients aged 5 to 17 years old. It then reviews key anatomy, techniques for reading x-rays systematically, and classifications and management of pediatric femur fractures. The cases include femoral head, shaft, spiral and Salter-Harris fractures from injuries like gunshots, motor vehicle collisions and falls. The document emphasizes the importance of anatomy and assessing integrity of soft tissues and neurovascular status. Treatment options like casting or intramedullary nailing are discussed.
The document discusses the process of diagnosis in endodontics. It emphasizes that an accurate diagnosis requires synthesizing information from the patient's history, clinical examination findings, radiographs, and pulp testing results. The diagnostic process involves assembling available facts, interpreting clues to discover genuine factors in the case, generating a differential diagnosis, and reaching a working diagnosis. A proper diagnosis relies on the chief complaint as well as objective findings from visual examination, percussion, palpation, periodontal probing, and radiographs to assess pulpal and periapical tissues.
This document discusses diagnosis in endodontics. It begins by defining diagnosis as identifying a disease through investigation of symptoms and history. An accurate diagnosis requires synthesizing knowledge, experience, intuition and common sense. The diagnostic process involves assembling available facts, interpreting clues, making a differential diagnosis, and determining a working diagnosis. Key parts of diagnosis include understanding the chief complaint, performing clinical and radiographic examinations, and comparing findings to known conditions to determine the operational diagnosis. Diagnosis is crucial for developing an appropriate treatment plan.
This topic is under the General Principles of Surgery for MBBS Students. It also deals with Scars & Contractures. The student should know to differentiate between Hypertrophic Scar & Keloid..
Bed sore ppt by ramniwas aiims mangala giriMedicineAIIMS
The document discusses questions and answers about pressure ulcers (bed sores). It begins by asking why they occur frequently in hospitals and ICUs, noting it may be because caregivers focus on other illnesses rather than the skin. It then addresses that immobility is the most common reason patients develop pressure ulcers. Risk factors like incontinence, impaired mobility, and malnutrition are examined. Prevention strategies involve regular repositioning, managing moisture, and relieving pressure on bony areas.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Diabetes, Peripheral Neuropathy & How to ConductTrevor Perkes
Discussion of the relationship between diabetes and peripheral neuropathy and loss of protective sensation. How to perform a monofilament sensory test to detect a loss of protective sensation
Learn more at ProhealthcareProducts.com
This document is a PowerPoint presentation about wound dressings. It discusses different types of wound dressings including primary and secondary dressings, classifications of dressings into 7 categories like films and hydrogels. It provides details on specific dressing materials like gauze, tulles and film. It also covers topics like chronic wounds, venous stasis ulcers, arterial ulcers, pressure ulcers, diabetic wounds and negative pressure wound therapy.
Concise discussion on essential clinical and microbiological aspects of Candia, Pneumocystis and Aspergillus infections in HIV and other immunocompromised patients.
Max Bush presented on new dressings for wound management. He discussed the phases of wound healing and challenges that can impede the process. The moist wound healing paradigm emphasizes keeping wounds moist to facilitate healing rather than letting them dry out. A variety of modern dressings were presented that aim to maintain a moist environment including honey-based dressings, calcium alginate, and vacuum-assisted closure which uses negative pressure. The key is selecting a dressing matched to the characteristics of the individual wound.
Uterine fibroid - Case scenarios and DiscussionHaynes Raja
This presentation is prepared to meet out the undergraduate medical student needs especially to understand the practical aspects of uterine fibroid and to rapidly revise some important viva questions.
Dedicated to my Great Teachers in the Dept. of Obstetrics & Gynaecology Dr. Lavanya Kumari and Dr. Sangeereni, Inspiring Friends Dr. Paulin Benedict, Dr. Jeyakumar Meyyappan and Dr. Hannah Jane and our REVELLIONZ 08’ batch.
Infection characterized by severe local inflammation, usually with pus formation, generally caused by one of the pyogenic bacteria.
Sepsis:The term sepsis covers numerous and diverse pyogenic infections which includes superficial skin infections,wound infections,infection of burns,infection of eyes,peritonitis and abscesses.
Pus is an exudate typically white yellow or yellow formed at the site of inflammation during infection.
Abscesses are localized collection of pus composed of living and dead WBC, components of tissue break down.
70% of tissue infection is mainly caused by
Staphylococcus aureus.
Etymology:
Greek word, pyon meaning pus, genein, meaning to produce
Pus is a fluid composed of : dead & dying WBC, dead & dying bacteria (in bacterial cause of pus),tissue debris, edema, fibrin, lipid and nucleic acid.
Pus cells : it is degranulated wbc, neutrophils.
The body responds to invasion by a wide variety of bacteria by an increased blood supply to the area and by an outpouring of serous fluid and white blood cells.
This is the typical inflammatory response.
The white cells which pass from the blood into the infected tissues attempt to ingest the bacteria (phagocytosis), many cells die and the resultant material consisting of both living and dead white cells (leucocytes or pus cells) and bacteria, together with damaged local tissues and blood proteins, constitutes PUS.
Infections in which pus is produced are known as pyogenic, i.e. pus-producing infections.
Pus may be present as a localised collection deep in the tissues—an ABSCESS, it may be produced on a surface, e.g. the mucosa of the pharynx, the mucosa of the bladder, the méninges, indeed any body surface, it is then known as a PURULENT EXUDATE.
Alternatively infection may spread evenly through the tissues causing a diffuse inflammation :CELLULITIS.
The type of pus production will depend on the organism causing the infection, on the tissue in which the infective process is taking place, and also on the body resistance to the infection.
Although the pyogenic infections have very similar appearances whatever the causative organism, different sites of the body have a tendency to be infected with particular species of bacteria.
Always submit two swabs so that Gram stain can be performed.
Limit swab sampling to wounds that are clinically infected or those that are chronic and are not healing.
To minimize contamination, it is important to cleanse the wound to remove superficial debris by thorough irrigation and cleansing with non-bacteriostatic sterile saline.
If the wound is relatively dry, collect the specimen with two cotton-tipped swabs moistened with sterile non-bacteriostatic saline. Gently roll the swab over the surface of the wound approximately five times, focusing on an area where there is evidence of pus or inflamed tissue.
Penicilliosis is an infection caused by Penicillium marneffei that predominantly affects HIV-positive individuals in Southeast Asia. It is characterized by fever, skin lesions, anemia, lymphadenopathy and hepatomegaly. Laboratory diagnosis involves examining specimens such as blood, bone marrow and tissue under a microscope to identify the characteristic yeast and mold forms. Treatment involves antifungal medications such as amphotericin B or oral itraconazole.
An obstetric history should include details of the current pregnancy, past obstetric and medical history, family history, social history, and review of systems. The examination involves evaluation of vital signs, general appearance, breast and abdominal exams to assess size and position of the uterus and fetus. Fetal heart rate and engagement should be determined. [/SUMMARY]
Pilonidal sinus is a condition where one or more non-infected openings form in the midline of the natal cleft overlying the coccyx. Hair can become trapped in these openings, leading to infection or abscess. It is more common in males after puberty, and in individuals with dark hair. Symptoms include intermittent discharge, pain, swelling, and abscess formation. Diagnosis is usually clinical but MRI may help with extensive cases. Treatment involves cleaning and removing hair from openings, antibiotics for infection, and surgery to excise sinus openings and flatten the natal cleft to prevent further hair implantation and recurrence.
This document discusses upper gastrointestinal bleeding (GI bleed), including its causes, clinical presentation, and common causes of different types of bleeding presentations. The main causes of upper GI bleed are peptic ulcers, gastric erosions from conditions like gastritis, esophagitis from GERD or other irritants, esophageal varices, and neoplasms of the esophagus or stomach. Bleeding can present as hematemesis (vomiting blood), melena (black tarry stool), hematochezia (rectal bleeding), occult bleeding, or symptoms of blood loss. Common causes of hematemesis include ruptured esophageal varices, gastric/duodenal ulcers,
This document discusses wound physiology and assessment. It begins by outlining the causes of wounds and the wound healing process, which involves three phases: haemostasis, inflammation, and tissue repair/remodeling. It then describes how to clinically assess wounds, including examining the patient's general health and wound characteristics like appearance, drainage, and dimensions. Environmental and local factors that can influence wound healing are also assessed. The document provides guidance on classifying wound types and stages to help determine appropriate treatment and evaluate healing progress.
Endometriosis is a medical condition where endometrial tissue grows outside the uterus, commonly in the ovaries, fallopian tubes, and pelvic lining. It affects 6-10% of women and causes pain, irregular bleeding, and infertility. The exact cause is unknown but theories include retrograde menstruation, genetic factors, and environmental toxins. Diagnosis involves a medical history, physical exam, ultrasound, MRI, and laparoscopy to visualize lesions. Stages range from minimal to severe based on location, size, and depth of implants. Treatment focuses on pain management and hormone therapy to suppress menstruation. Differential diagnoses include pelvic inflammatory disease, ovarian cysts, and uterine fibroids.
This document provides an overview of case history in paediatric dentistry. It discusses collecting biographical data, chief complaints, history of present illness, past medical history, natal history, habits, and conducting extraoral and intraoral examinations. The examinations provide information to make provisional, differential and final diagnoses. Investigations like radiographs may be used. A treatment plan is then formulated considering urgency, medical conditions, and preventive, corrective and maintenance phases. The goal is a stepwise, evidence-based approach to the patient's well-being.
This document provides an overview of cysts that can occur in the oral and maxillofacial tissues. It defines cysts and discusses their classification, pathogenesis, clinical examination, and specific types such as odontogenic cysts, inflammatory cysts, dentigerous cysts, and odontogenic keratocysts. The pathogenesis involves initiation, cyst formation, and enlargement. Clinical examination includes symptoms, signs, radiographic features, and biopsy for diagnosis. Treatment depends on the type and size of the cyst.
ueda2012 predictors of diabetic foot ulcer-d.walaaueda2015
This document summarizes a study examining predictors of outcome for diabetic foot ulcers at Assiut University Hospital in Egypt. The study prospectively followed 100 patients with diabetic foot ulcers for up to one year to determine factors associated with complete healing within that time period. So far, data has been collected on 50 patients. Preliminary results found that 68% of patients were female, with a mean age of 50.76 years. Factors examined included demographics, medical history, foot examination findings, ulcer characteristics, and lab results. The aim is to identify baseline characteristics that can predict poorer outcomes like non-healing of the ulcer.
Dr. Kelsey Lena’s CMC Pediatric Orthopedic X-Ray Mastery Project: October CasesSean M. Fox
This document provides a summary of 4 pediatric orthopedic imaging case studies involving femur fractures in patients aged 5 to 17 years old. It then reviews key anatomy, techniques for reading x-rays systematically, and classifications and management of pediatric femur fractures. The cases include femoral head, shaft, spiral and Salter-Harris fractures from injuries like gunshots, motor vehicle collisions and falls. The document emphasizes the importance of anatomy and assessing integrity of soft tissues and neurovascular status. Treatment options like casting or intramedullary nailing are discussed.
The document discusses the process of diagnosis in endodontics. It emphasizes that an accurate diagnosis requires synthesizing information from the patient's history, clinical examination findings, radiographs, and pulp testing results. The diagnostic process involves assembling available facts, interpreting clues to discover genuine factors in the case, generating a differential diagnosis, and reaching a working diagnosis. A proper diagnosis relies on the chief complaint as well as objective findings from visual examination, percussion, palpation, periodontal probing, and radiographs to assess pulpal and periapical tissues.
This document discusses diagnosis in endodontics. It begins by defining diagnosis as identifying a disease through investigation of symptoms and history. An accurate diagnosis requires synthesizing knowledge, experience, intuition and common sense. The diagnostic process involves assembling available facts, interpreting clues, making a differential diagnosis, and determining a working diagnosis. Key parts of diagnosis include understanding the chief complaint, performing clinical and radiographic examinations, and comparing findings to known conditions to determine the operational diagnosis. Diagnosis is crucial for developing an appropriate treatment plan.
This topic is under the General Principles of Surgery for MBBS Students. It also deals with Scars & Contractures. The student should know to differentiate between Hypertrophic Scar & Keloid..
Bed sore ppt by ramniwas aiims mangala giriMedicineAIIMS
The document discusses questions and answers about pressure ulcers (bed sores). It begins by asking why they occur frequently in hospitals and ICUs, noting it may be because caregivers focus on other illnesses rather than the skin. It then addresses that immobility is the most common reason patients develop pressure ulcers. Risk factors like incontinence, impaired mobility, and malnutrition are examined. Prevention strategies involve regular repositioning, managing moisture, and relieving pressure on bony areas.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Diabetes, Peripheral Neuropathy & How to ConductTrevor Perkes
Discussion of the relationship between diabetes and peripheral neuropathy and loss of protective sensation. How to perform a monofilament sensory test to detect a loss of protective sensation
Learn more at ProhealthcareProducts.com
gyanaecology.endometriosis and adenomyosis.(dr.salama)student
The document summarizes endometriosis and adenomyosis. Endometriosis occurs when endometrial tissue grows outside the uterus, most commonly on the ovaries, uterine ligaments and pelvis. It causes pain and infertility. Adenomyosis involves endometrial tissue in the uterine wall. Both can be diagnosed by laparoscopy and treated through drugs or surgery, with hysterectomy providing definitive treatment for severe adenomyosis.
The document discusses several medical cases:
1. A case of lissencephaly with findings of absent cerebral convolutions and enlarged ventricles, associated with Miller-Dieker syndrome.
2. A case of tuberous sclerosis seen on CT with subependymal calcifications consistent with the condition and associated with angiomyolipomas.
3. Uses and complications of PICC lines including thrombosis, fracture, embolism, infection, leakage and DVT are discussed.
The document summarizes a seminar on the skeletal system presented by Mr. Arvind Joshi. It covers the embryology, anatomy, physiology and classification of bones. It also discusses diagnostic criteria and common medical treatments for skeletal issues like fractures, club foot, congenital hip dysplasia, osteomyelitis, and polydactyly/syndactyly. Nursing management is outlined for various conditions and treatments involving casting, traction, splinting and bracing. Recent advances in treating skeletal issues are also mentioned.
Definition
Type of Hernia
risk factor
pathophysiology
diagnostic procedure
physical assessment
management for hernia
Nursing Diagnosis
Health Education
ERYTHROPOIETIC PORPHYRIA WITH ADENOMATOID ODONTOGENIC TUMOUR AS AN INCIDENTAL...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Endometriosis and adenomyosis are common gynecological conditions where endometrial tissue grows outside or inside the uterus respectively. Endometriosis occurs when endometrial tissue implants itself in areas like the ovaries or pelvic wall, causing pain and infertility. Adenomyosis involves the growth of endometrial tissue deep in the uterine wall. Both are estrogen-dependent and resolve after menopause. Treatment options include medication to induce amenorrhea and reduce symptoms, or surgery for severe cases or women who have completed childbearing. Hysterectomy provides the only cure for adenomyosis.
Child trauma development, attachment and assessmentgnivri1666
This document discusses trauma-informed child development and assessment. It covers several key topics:
- Attachment theory and how early attachment experiences shape neural development and affect outcomes after trauma exposure. Insecure attachment is a risk factor.
- Developmental considerations for assessing PTSD in children, including a pre-school subtype in DSM-5 that reflects their cognitive abilities.
- The importance of a comprehensive trauma history and assessing functioning, trauma-related difficulties, and common co-occurring disorders like depression and anxiety.
- Attachment styles that can develop from early experiences, including secure, avoidant, resistant, and disorganized attachments.
This document discusses various interventions for children and adolescents exposed to trauma. It covers several key considerations for treatment, including safety, the therapeutic relationship, and using a strengths-based approach. Two evidence-based trauma-focused therapies are described in detail: trauma-focused cognitive behavioral therapy (TF-CBT) and child-parent psychotherapy (CPP). TF-CBT uses psychoeducation, parenting skills, relaxation techniques, cognitive processing, and exposure. CPP focuses on improving the relationship between the child and caregiver through play and dyadic sessions.
This document outlines the assignments for the Social Work Skills A course at Charles Darwin University. It includes three assignments:
1. A 1500-word essay due at a specified date, analyzing a case study from an ABC documentary focusing on one client and discussing effective communication, tensions in the social worker's role, and contextual impacts. It will be graded on evidence of understanding key concepts, depth of discussion, critical analysis, and academic writing standards.
2. A 15-minute role-play recording due at a specified date, where students conduct an initial meeting with a client. It will be graded on demonstration of skills like rapport building, questioning, and ending the session appropriately.
3. A 2000-word
2017 Australian Psychological Associationgnivri1666
The APS is Australia's largest professional organization for psychology, providing advice, guidance and support to over 22,400 members and 3,000 student members. It advocates for the field of psychology and promotes the contribution of psychology through various initiatives. The APS offers many resources and benefits for students and early career psychologists to support their professional development and networking opportunities.
This document provides information on ergonomic workstation setup. It discusses common ergonomic problems like neck, back, and eye strain that can result from improper workstation setup. It then provides guidance on lifestyle factors, posture, chair adjustment, monitor height, keyboard and mouse placement, and use of laptops to help reduce strain. The goal is to understand ergonomic principles, conduct a self-assessment of one's workstation, and make adjustments to promote comfort, movement and productivity. Users are advised to revisit their setup over time and seek additional help if issues persist.
This document discusses wound dressings and wound bed preparation techniques. It provides information on the aims of wound dressings, factors to consider in product selection, and different types of wound debridement techniques including sharp, surgical, mechanical, enzymatic, autolytic, and biodebridement. It also summarizes various wound dressing products including films, foams, hydrogels, hydrocolloids, alginates, hydrofibres, zinc pastes, nanocrystalline silver dressings and honey/cadexomer iodine dressings. Application techniques and important considerations are described for each dressing type.
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Wound physiology cf for pp
1. Dr Clare Fenwick, 2010
Wound Physiology and Assessment
Dr. Clare Fenwick
2010
2. Dr Clare Fenwick, 2010
Aspects of wound care?
What causes wounds (pathophysiology)?
Can I eliminate the cause?
How do wounds heal (healing physiology)?
What am I looking for (clinical assessment)?
How will I treat the wound (product
knowledge)?
What skills do I need (clinical knowledge)?
Did it work (evaluation)? If not, why not
3. Dr Clare Fenwick, 2010
What causes/exacerbates wounds?
Wounds are generally classified as acute or chronic
Trauma/Surgery
Underlying conditions
Medications
Lifestyle risks
5. Dr Clare Fenwick, 2010
Haemostasis
Vasoconstriction response: Arteries, arterioles
and capillaries spasm to cease bleeding
Platelet response: Damaged endothelium
exposes collagen fibres, platelets adhere
resulting in a plug
Biochemical response: Clotting factors released
causing clot formation, retraction and breakdown
6. Dr Clare Fenwick, 2010
Haemostasis
Vasoconstriction response: Arteries, arterioles
and capillaries spasm to cease bleeding
Platelet response: Damaged endothelium
exposes collagen fibres, platelets adhere
resulting in a plug
Biochemical response: Clotting factors released
causing clot formation, retraction and breakdown
7. Dr Clare Fenwick, 2010
Tissue Repair - inflammation
Inflammation stage (0-5 days)
Capillaries spasm, a clot forms and the wound
becomes ischemic
Histamine is released causing vasodilation in
surrounding tissue
Oedema and pressure initiates the pain
pathway
Defence cells migrate protecting from bacteria
and clearing debris
8. Dr Clare Fenwick, 2010
Tissue Repair - inflammation
HEAT
OEDEMA
ERYTHEM
A
PAIN
9. Dr Clare Fenwick, 2010
Tissue Repair - reconstruction
Reconstruction stage (2-24 days): a time of
cleaning and healing
Defence cells continue to clean up bacteria and
clear debris
Granulation or angiogenesis appears (bumpy
red new tissue)
Contraction occurs
Epithelialisation commences
13. Dr Clare Fenwick, 2010
Tissue Repair - maturation
Maturation stage (24days – 1 year)
Remodelling of the wound occurs.
Previously laid collagen fibres are broken down
and new stronger collagen fibres are laid down
Rosy pink scar is still remodelling; scar similar
to the surrounding skin has finished this stage
A scar has only 80% of strength and elasticity
(Myers, 2004)
15. Dr Clare Fenwick, 2010
Stage I – Nonblanchable erythema of intact
skin
Stage II – Partial thickness, involving loss of
the epidermis and/or dermis
Stage III – Full thickness, involving loss of
the epidermis, dermis and subcutaneous
Stage IV – Full thickness, involving loss of
the epidermis, dermis, subcutaneous and
exposing muscle bone or supporting
structures
Wound staging
16. Dr Clare Fenwick, 2010
Stage I – Nonblanchable erythema of intact
skin
Stage II – Partial thickness, involving loss of
the epidermis and/or dermis
Stage III – Full thickness, involving loss of
the epidermis, dermis and subcutaneous
Stage IV – Full thickness, involving loss of
the epidermis, dermis, subcutaneous and
exposing muscle bone or supporting
structures
Wound staging
STAGE I
17. Dr Clare Fenwick, 2010
Stage I – Nonblanchable erythema of intact
skin
Stage II – Partial thickness, involving loss of
the epidermis and/or dermis
Stage III – Full thickness, involving loss of
the epidermis, dermis and subcutaneous
Stage IV – Full thickness, involving loss of
the epidermis, dermis, subcutaneous and
exposing muscle bone or supporting
structures
Wound staging
STAGE ISTAGE II
18. Dr Clare Fenwick, 2010
Stage I – Nonblanchable erythema of intact
skin
Stage II – Partial thickness, involving loss of
the epidermis and/or dermis
Stage III – Full thickness, involving loss of
the epidermis, dermis and subcutaneous
Stage IV – Full thickness, involving loss of
the epidermis, dermis, subcutaneous and
exposing muscle bone or supporting
structures
Wound staging
STAGE ISTAGE IISTAGE III
19. Dr Clare Fenwick, 2010
Stage I – Nonblanchable erythema of intact
skin
Stage II – Partial thickness, involving loss of
the epidermis and/or dermis
Stage III – Full thickness, involving loss of
the epidermis, dermis and subcutaneous
Stage IV – Full thickness, involving loss of
the epidermis, dermis, subcutaneous and
exposing muscle bone or supporting
structures
Wound staging
STAGE ISTAGE IISTAGE IIISTAGE IV
21. Dr Clare Fenwick, 2010
What am I looking for?
General client assessment
Assessment of the wound
Assessment of environmental
and local factors
22. Dr Clare Fenwick, 2010
General client assessment
Overall health
Co-morbidities
Mobility status
Nutritional status
Sensory functioning status
Psychosocial status
Pain
Current medication
23. Dr Clare Fenwick, 2010
General client assessment
Overall health
Co-morbidities
Mobility status
Nutritional status
Sensory functioning status
Psychosocial status
Pain
Current medication
24. Dr Clare Fenwick, 2010
Assessment of the wound
Wound aetiology
Wound location
Wound dimensions
Wound bed
Wound drainage
Wound temperature
Wound infection
Peri-wound
38. Dr Clare Fenwick, 2010
Wound Bed: Five tissue colours
Pearly pink colour – Epithelial tissue
Beefy red colour – Granulating tissue
Stringy yellow colour – Sloughy tissue
Hard black colour – Necrotic tissue
Pus green colour – Infected tissue
EPITHELIASING TISSUE
39. Dr Clare Fenwick, 2010
Wound Bed: Five tissue colours
Pearly pink colour – Epithelial tissue
Beefy red colour – Granulating tissue
Stringy yellow colour – Sloughy tissue
Hard black colour – Necrotic tissue
Pus green colour – Infected tissue
EPITHELIASING TISSUE
GRANULATING TISSUE
SLOUGHY TISSUE
NECROTIC TISSUE
INFECTED TISSUE
40. Dr Clare Fenwick, 2010
Wound Bed: Five tissue colours
Pearly pink colour – Epithelial tissue
Beefy red colour – Granulating tissue
Stringy yellow colour – Sloughy tissue
Hard black colour – Necrotic tissue
Pus green colour – Infected tissue
EPITHELIASING TISSUE
GRANULATING TISSUE
SLOUGHY TISSUE
NECROTIC TISSUE
41. Dr Clare Fenwick, 2010
Wound Bed: Five tissue colours
Pearly pink colour – Epithelial tissue
Beefy red colour – Granulating tissue
Stringy yellow colour – Sloughy tissue
Hard black colour – Necrotic tissue
Pus green colour – Infected tissue
EPITHELIASING TISSUE
GRANULATING TISSUE
SLOUGHY TISSUE
42. Dr Clare Fenwick, 2010
Wound Bed: Five tissue colours
Pearly pink colour – Epithelial tissue
Beefy red colour – Granulating tissue
Stringy yellow colour – Sloughy tissue
Hard black colour – Necrotic tissue
Pus green colour – Infected tissue
EPITHELIASING TISSUE
GRANULATING TISSUE
43. Dr Clare Fenwick, 2010
Wound Bed: Five tissue colours
Pearly pink colour – Epithelial tissue
Beefy red colour – Granulating tissue
Stringy yellow colour – Sloughy tissue
Hard black colour – Necrotic tissue
Pus green colour – Infected tissue
EPITHELIASING TISSUE
44. Dr Clare Fenwick, 2010
Wound drainage
Exudate is assessed by;
Type
Amount
Colour
Consistency
Odour
45. Dr Clare Fenwick, 2010
Wound Temperature
Wounds heal best at constant temperatures of
37 - 38 º C
Wounds left to cool down take about 3- 4
hours to restore to healing temperature (Shultz
2002)
Keep it warm, keep it moist
46. Dr Clare Fenwick, 2010
Peri-wound
Attached or unattached
Indistinct or well defined
Macerated or dry
Thickened and calloused
Irregular or round
Red, white or blue
48. Dr Clare Fenwick, 2010
Assessment of environmental
and local factors
INTRINSIC
(inherent to the person)
EXTRINSIC
(control from outside person)
Age Pressure, friction, shearing
Underlying disease processes Temperature
Nutritional status Infection
Gender Hydration
Psychological state Foreign bodies
55. Dr Clare Fenwick, 2010
References
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain
Foundation.
Coleman, K. (2004). Wonderful World of Wounds. In C. Fenwick (Ed.).
Gold Coast.
Hand-Surgical Approaches, Skin Flaps. (2003). Retrieved 17 February,
2004, from http://www.orthoteers.co.uk/Nrujp~ij33lm/Images9/flaps3.jpg
Edwards, S. L. (1998). High Temperature. Professional Nurse, 13(8),
521-526.
Fierer, J., & Goldberg, C. (2002). Gangrene of the hand. Retrieved 2004,
2 February, from http://medicine.ucsd.edu/Clinicalimg/extremities-
diabetic-foot-infection.html
Helmerd, D. (2003). Brown Recluse Spider Bite. In C. Fenwick (Ed.).
Gold Coast.
56. Dr Clare Fenwick, 2010
References
Morgan, S. (1990). A comparison of three methods of managing fever in
the neurologic patient. Journal of Neuroscience Nursing, 22(1), 19-24
Myers, B. A. (2004). Wound Management Principles and Practice. New
Jersey: Prentice Hall.
Shultz, M. (2002). Wound Care. Retrieved 17 February, 2004, from
http://www.medpharm.co.za/sapj/2002/july/wound.html
SpinalNet. (2004). Skin and Wound Healing. Retrieved February 4,
2004, from
http://www.spinalnet.co.uk/EEndCom/GBCON/Homepage.nsf/0/98BEE0
4F593CFD2D00256C46004B1D74?OpenDocument
Surgeries & Procedures, Skin Grafts. (2003). Retrieved 17 February,
2004, from http://health.allrefer.com/health/skin-graft-skin-graft.html
Wound Assessment. (2000). Retrieved 13 February, 2004, from
http://www.medpharm.co.za/nursing/2000/sec2000/wound.html
Editor's Notes
Introduction
Never forget this is a whole person we are discussing although it will appear at times that we are only focusing on the wound.
If you become distracted try to at least remember this fact; keep it warm, keep it moist
Familiar with the nursing process or a plan of management
Enquiring mind, what do you need to be asking yourself
What causes wounds (pathophysiology)?Can I eliminate the cause?
How do wounds heal (healing physiology)?
What am I looking for (clinical assessment)?
This will be discussed in the next group of wound lectures
How will I treat the wound (product knowledge)?.
What skills do I need (clinical knowledge)?
Did it work (evaluation)? If not, why not!
Trauma – gunshot, MVA, falls, stabbing
We have all sustained some small traumatic injury within our lives
Surgery – major, minor
Most requires some form of incision or invasive process
Underlying conditions
Pressure – Elderly and immobile at great risk
Malnutrition - various nutrients are essential to wound healing. Carbohydrates are required to fuel the cells, if none is available they will burn off the protein. Protein is needed for repair. Vitamin C collagen synthesis and infection reduction (lack of fruit will cause vitamin C deficiency) Vitamin A for epithelization etc.
Obesity – adipose tissues is poorly vascularised
Diabetes – Diabetics develop calcification of the arterial walls, this affects the oxygen and nutritional exchange. High blood sugar impairs wound healing including collagen synthesis, angiogenesis, tensile strength, and infection response (elevated glucose levels encourages bacterial growth)., consider the stress response
Stress response - Stress response – release of adrenalin causes activation of adrenocorticotrophic hormone (ACTH) which stimulates adrenal cortex hormones. ACTH regulates glucocorticoids, cortisol, and hydrocortisone. Glucocorticoids cause breakdown of body stores of glucose, raising BSL, reducing mobility of granulocytes/macrophages impeding their migration to wound bed. This suppresses immune system and hinders the inflammatory response, rate of healing slows and infections rise
Cardiovascular disease – poor blood flow (ineffective pump, anaemia, venous/arterial insufficiency) leads to diminished nutrients reaching the site and reduced oxygenation
Respiratory disease - O2 is required for all areas of wound healing
Immunocompromised – Aids, HIV, cancer, increasing age.
Increasing age
Fragile thinning skin
Reduction in oil/sweat glands causing dryness and barrier breakdown
Pain perception is diminished increasing injury risk
Inflammatory response is slowed, vasoconstriction and dilatation are not as fast as they used to be
Immune defences become impaired.
Medications
Steroids impair all stages of wound healing (suppress inflammation & immune systems, affect the wound contraction and tensile strength)
Chemotherapy agents (immunosuppression)
NSAID do not suppress wound healing (no evidence to support that)
Lifestyle risks
Alcohol abuse – malnutrition, impaired judgement, less likely to self care
Smoking abuse – Vasoconstriction and reduced oxygenation, Increased platelet aggregation, reduced oxygenation
Vasoconstriction response:
Arteries, arterioles and capillaries spasm to cease bleeding
Platelet response:
Damaged endothelium exposes collagen fibres, platelets adhere resulting in platelet aggregation. Serotonin and prostaglandins are released enhancing vascular spasm. Phospholipids and adenosine diphosphate (ADP) are released attracting more platelets
Biochemical response:
Clotting factors are released causing clot formation, retraction and (fibrinolysis) breakdown
Vasoconstriction response:
Arteries, arterioles and capillaries spasm to cease bleeding
Platelet response:
Damaged endothelium exposes collagen fibres, platelets adhere resulting in platelet aggregation. Serotonin and prostaglandins are released enhancing vascular spasm. Phospholipids and adenosine diphosphate (ADP) are released attracting more platelets
Biochemical response:
Clotting factors are released causing clot formation, retraction and (fibrinolysis) breakdown
Inflammation stage (0-5 days)
Depends on the individual and text book
Inflammation is NOT infection
Capillaries spasm, clot form, wound becomes ischemic
Histamine released, vasodilation occurs in surrounding tissue causing redness and heat
Swelling results from fluid collection (blood) in the tissue as well as vasodilation.
Pressure exerted will compress peripheral nerve endings setting off the pain pathway
Defence cells migrate from the permeable blood vessels into the wound area.
Neutrophils arrive releasing enzymes to breaking up devitalised tissue and destroy bacteria, they have a short lifespan, they die after they phagocytose (these make up pus)
Monocytes are activated ingested foreign bodies then transforming into macrophages. Macrophages long life span and produce a large number of substances which aid in wound healing processes i.e. growth factors that will stimulate growth of new tissue.
Inflammation stage (0-5 days)
Depends on the individual and text book
Inflammation is NOT infection
Capillaries spasm, clot form, wound becomes ischemic
Histamine released, vasodilation occurs in surrounding tissue causing redness and heat
Swelling results from fluid collection (blood) in the tissue as well as vasodilation.
Pressure exerted will compress peripheral nerve endings setting off the pain pathway
Defence cells migrate from the permeable blood vessels into the wound area.
Neutrophils arrive releasing enzymes to breaking up devitalised tissue and destroy bacteria, they have a short lifespan, they die after they phagocytose (these make up pus)
Monocytes are activated ingested foreign bodies then transforming into macrophages. Macrophages long life span and produce a large number of substances which aid in wound healing processes i.e. growth factors that will stimulate growth of new tissue.
Reconstruction phase (2-24 days)
Defence Cells
Neutrophils and macrophages continue to digest the bacteria and clean up the wound.
Macrophages also stimulate fibroblastic cells to make collagen (protein for connective tissue that provides strength to tissues) becoming part of the granulation phase
Granulation or Angiogenesis
Angiogenesis is activated by tissue hypoxia from the disruption of blood flow at the time of injury.
Angiogenesis are the new capillaries that sprout from the vessel walls of existing capillaries within 36 hours of initial damage.
Growth factors released by macrophages stimulate these endothelial cells lining the walls of capillaries near the injured area, to divide and branch out forming new capillary loops.
At the same time fibroblasts start to divide and collect at the wound margin producing a latticework of collagen fibres that provide strength to the wound
Fibroblasts are dependent on an adequate intake of Vitamin C, iron and copper from the diet.
Granulation is a good indicator effective wound bed healing.
In wounds healing by primary intention (suture lines) collagen formation usually reaches its peak at approx 6 –7 days.
Contraction
Fibroblasts become myofibroblasts (similar properties to smooth muscle cells and fibroblasts) drawing the wound edges reducing the surface area of the wound, thereby reducing the amount of tissue replacement required.
Contraction is dependant on the size and depth of the wound as it has a limited function
Square, rectangular wounds contract the fastest and circular wounds the slowest
Epithelialisation
The growth of new epithelial cells across the surface of the wound occurs during the final stages of healing.
Epithelial cell migration occurs granulating the wound bed, this appears as a thin translucent film across the wound bed.
Epithelial cells are easily dislodged by abrasive cleaning hence why we do it gently
Epithelial cells (keratinocytes) will not migrate over deoxygenated non viable tissue.
To migrate over nonviable areas, the epithelial cells secrete enzymes breaking down debris in their path. Hence the rationale behind wound bed preparation
Reconstruction phase (2-24 days)
Defence Cells
Neutrophils and macrophages continue to digest the bacteria and clean up the wound.
Macrophages also stimulate fibroblastic cells to make collagen (protein for connective tissue that provides strength to tissues) becoming part of the granulation phase
Granulation or Angiogenesis
Angiogenesis is activated by tissue hypoxia from the disruption of blood flow at the time of injury.
Angiogenesis are the new capillaries that sprout from the vessel walls of existing capillaries within 36 hours of initial damage.
Growth factors released by macrophages stimulate these endothelial cells lining the walls of capillaries near the injured area, to divide and branch out forming new capillary loops.
At the same time fibroblasts start to divide and collect at the wound margin producing a latticework of collagen fibres that provide strength to the wound
Fibroblasts are dependent on an adequate intake of Vitamin C, iron and copper from the diet.
Granulation is a good indicator effective wound bed healing.
In wounds healing by primary intention (suture lines) collagen formation usually reaches its peak at approx 6 –7 days.
Contraction
Fibroblasts become myofibroblasts (similar properties to smooth muscle cells and fibroblasts) drawing the wound edges reducing the surface area of the wound, thereby reducing the amount of tissue replacement required.
Contraction is dependant on the size and depth of the wound as it has a limited function
Square, rectangular wounds contract the fastest and circular wounds the slowest
Epithelialisation
The growth of new epithelial cells across the surface of the wound occurs during the final stages of healing.
Epithelial cell migration occurs granulating the wound bed, this appears as a thin translucent film across the wound bed.
Epithelial cells are easily dislodged by abrasive cleaning hence why we do it gently
Epithelial cells (keratinocytes) will not migrate over deoxygenated non viable tissue.
To migrate over nonviable areas, the epithelial cells secrete enzymes breaking down debris in their path. Hence the rationale behind wound bed preparation
Reconstruction phase (2-24 days)
Defence Cells
Neutrophils and macrophages continue to digest the bacteria and clean up the wound.
Macrophages also stimulate fibroblastic cells to make collagen (protein for connective tissue that provides strength to tissues) becoming part of the granulation phase
Granulation or Angiogenesis
Angiogenesis is activated by tissue hypoxia from the disruption of blood flow at the time of injury.
Angiogenesis are the new capillaries that sprout from the vessel walls of existing capillaries within 36 hours of initial damage.
Growth factors released by macrophages stimulate these endothelial cells lining the walls of capillaries near the injured area, to divide and branch out forming new capillary loops.
At the same time fibroblasts start to divide and collect at the wound margin producing a latticework of collagen fibres that provide strength to the wound
Fibroblasts are dependent on an adequate intake of Vitamin C, iron and copper from the diet.
Granulation is a good indicator effective wound bed healing.
In wounds healing by primary intention (suture lines) collagen formation usually reaches its peak at approx 6 –7 days.
Contraction
Fibroblasts become myofibroblasts (similar properties to smooth muscle cells and fibroblasts) drawing the wound edges reducing the surface area of the wound, thereby reducing the amount of tissue replacement required.
Contraction is dependant on the size and depth of the wound as it has a limited function
Square, rectangular wounds contract the fastest and circular wounds the slowest
Epithelialisation
The growth of new epithelial cells across the surface of the wound occurs during the final stages of healing.
Epithelial cell migration occurs granulating the wound bed, this appears as a thin translucent film across the wound bed.
Epithelial cells are easily dislodged by abrasive cleaning hence why we do it gently
Epithelial cells (keratinocytes) will not migrate over deoxygenated non viable tissue.
To migrate over nonviable areas, the epithelial cells secrete enzymes breaking down debris in their path. Hence the rationale behind wound bed preparation
Reconstruction phase (2-24 days)
Defence Cells
Neutrophils and macrophages continue to digest the bacteria and clean up the wound.
Macrophages also stimulate fibroblastic cells to make collagen (protein for connective tissue that provides strength to tissues) becoming part of the granulation phase
Granulation or Angiogenesis
Angiogenesis is activated by tissue hypoxia from the disruption of blood flow at the time of injury.
Angiogenesis are the new capillaries that sprout from the vessel walls of existing capillaries within 36 hours of initial damage.
Growth factors released by macrophages stimulate these endothelial cells lining the walls of capillaries near the injured area, to divide and branch out forming new capillary loops.
At the same time fibroblasts start to divide and collect at the wound margin producing a latticework of collagen fibres that provide strength to the wound
Fibroblasts are dependent on an adequate intake of Vitamin C, iron and copper from the diet.
Granulation is a good indicator effective wound bed healing.
In wounds healing by primary intention (suture lines) collagen formation usually reaches its peak at approx 6 –7 days.
Contraction
Fibroblasts become myofibroblasts (similar properties to smooth muscle cells and fibroblasts) drawing the wound edges reducing the surface area of the wound, thereby reducing the amount of tissue replacement required.
Contraction is dependant on the size and depth of the wound as it has a limited function
Square, rectangular wounds contract the fastest and circular wounds the slowest
Epithelialisation
The growth of new epithelial cells across the surface of the wound occurs during the final stages of healing.
Epithelial cell migration occurs granulating the wound bed, this appears as a thin translucent film across the wound bed.
Epithelial cells are easily dislodged by abrasive cleaning hence why we do it gently
Epithelial cells (keratinocytes) will not migrate over deoxygenated non viable tissue.
To migrate over nonviable areas, the epithelial cells secrete enzymes breaking down debris in their path. Hence the rationale behind wound bed preparation
Maturation stage
Remodelling of the wound occurs.
Previously laid collagen fibres are broken down and new stronger collagen fibres are laid down
Rosy pink scar is still remodelling; scar similar to the surrounding skin has finished this stage
A scar has only 80% of strength and elasticity as it previous had
Image
Myers, B. A. (2004). Wound Management Principles and Practice. New Jersey: Prentice Hall, photo C5 )
This image shows a wound in both the reconstruction stage and the maturation stage.
This wound, located anteriorly below the patella, is actively contracting toward the center while the perimeter is remodeling.
Near the wound edge, less granulation tissue has been formed and the scar is less mature and more pink in color, farther out, the scar is closer to the patient’s natural
Maturation stage
Remodelling of the wound occurs.
Previously laid collagen fibres are broken down and new stronger collagen fibres are laid down
Rosy pink scar is still remodelling; scar similar to the surrounding skin has finished this stage
A scar has only 80% of strength and elasticity as it previous had
Image
Myers, B. A. (2004). Wound Management Principles and Practice. New Jersey: Prentice Hall, photo C5 )
This image shows a wound in both the reconstruction stage and the maturation stage.
This wound, located anteriorly below the patella, is actively contracting toward the center while the perimeter is remodeling.
Near the wound edge, less granulation tissue has been formed and the scar is less mature and more pink in color, farther out, the scar is closer to the patient’s natural
Stage I
Nonblanchable erythema of intact skin
Stage II
Partial thickness, involving loss of the epidermis and/or dermis
Presents as an ulcer, abrasion or blister
Stage III
Full thickness, involving loss of the epidermis, dermis and subcutaneous
Extends to the fascia but not through it
Presents as a deep crater, often with undermining
Stage IV
Full thickness, involving loss of the epidermis, dermis, subcutaneous
Exposing muscle, bone or supporting structures
Stage I
Nonblanchable erythema of intact skin
Stage II
Partial thickness, involving loss of the epidermis and/or dermis
Presents as an ulcer, abrasion or blister
Stage III
Full thickness, involving loss of the epidermis, dermis and subcutaneous
Extends to the fascia but not through it
Presents as a deep crater, often with undermining
Stage IV
Full thickness, involving loss of the epidermis, dermis, subcutaneous
Exposing muscle, bone or supporting structures
Stage I
Nonblanchable erythema of intact skin
Stage II
Partial thickness, involving loss of the epidermis and/or dermis
Presents as an ulcer, abrasion or blister
Stage III
Full thickness, involving loss of the epidermis, dermis and subcutaneous
Extends to the fascia but not through it
Presents as a deep crater, often with undermining
Stage IV
Full thickness, involving loss of the epidermis, dermis, subcutaneous
Exposing muscle, bone or supporting structures
Stage I
Nonblanchable erythema of intact skin
Stage II
Partial thickness, involving loss of the epidermis and/or dermis
Presents as an ulcer, abrasion or blister
Stage III
Full thickness, involving loss of the epidermis, dermis and subcutaneous
Extends to the fascia but not through it
Presents as a deep crater, often with undermining
Stage IV
Full thickness, involving loss of the epidermis, dermis, subcutaneous
Exposing muscle, bone or supporting structures
Stage I
Nonblanchable erythema of intact skin
Stage II
Partial thickness, involving loss of the epidermis and/or dermis
Presents as an ulcer, abrasion or blister
Stage III
Full thickness, involving loss of the epidermis, dermis and subcutaneous
Extends to the fascia but not through it
Presents as a deep crater, often with undermining
Stage IV
Full thickness, involving loss of the epidermis, dermis, subcutaneous
Exposing muscle, bone or supporting structures
Three main aspects to wound assessment
General patient assessment
Assessment of the actual wound
Assessment of the environmental factors
General patient assessment
This assessment is done regardless of wounds, it is something you will develop over time.
Critically observe people to notice health status and determine the things that will effect the achievement or maintenance of this health status.
Overall health
State the obvious
ABC
Traumatic injury sustained to the right gluteus maximus
Gender (assumption this is a male)
Age (older we are the less well things work)
General appearance, clean, mentally intact, other obvious injuries
Co-morbidities
What sort of diseases will impact on this injury
Endocrine diseases – Diabetes (poor vascular supply, sugar load in wound)
Neuromuscular disease - motor-neuron disease (reduced sensation, immobility)
Psychiatric illnesses – schizophrenia, psychosis (self care issues)
Cardiovascular disease – CHF, venous/arterial insufficiency, anaemia (poor blood supply and oxygenation)
Gastrointestinal disease – malnutrition, anorexia related to other illnesses, malabsorption (poor nutrition)
Genitourinary disease – CRF(uraemia retards wound granulation), incontinence
Integumentary disease – Friability of the skin, lesions, abrasions (breech in the barrier)
Musculoskeletal disease – immobility, arthritis (steroids)
Respiratory disease – COAD (poor oxygenation)
Mobility status
Immobility elevates the risk of poor wound healing due to pressure and deoxygenation
This client will be a high risk due to extensive muscle damage especially to a weight bearing muscle
Nutritional status
Wound healing needs adequate nutritional intake. This client appears well fed.
Obesity can impair healing due to the poorly vascularized adipose tissue and wound dehiscence
Anorexia can significantly lack the essential vitamins required for healing.
Know what foods are available to your client.
Central Australian Aboriginal people lack zinc (zinc comes from seafood, organ meats, mushrooms, soybeans) it is required for the proliferation stage
Sensory functioning status
Impaired eyesight leads to falls
Hearing impairment leads to miscommunication
Diminished peripheral sensation such as in diabetes leads to undetected injury
Rare condition where pain sensation is absent – poor life expectancy
Psychosocial status
Social determinants you would have learnt in health promotion
Support systems, individual coping styles
Living/home environment
Work environment
Education level
Developmental level
Cultural preferences
Lifestyle choices (smoking, drugs, alcohol)
Pain
Next week we will explore pain physiology
Would this be painful?
What type of pain would the client be experiencing
Current medication
What types of drugs could hamper the client’s healing abilities
Corticosteroids (impair the immune and inflammatory response)
Anti-neoplastic (prevent cell growth)
Anti-coagulants (prevent clot formation)
Chemotherapeutics (impair the immune system)
Anti-prostaglandins (prostaglandin is part of the inflammatory process)
Penicillin (penicillamine released from penicillin prevents collagen cross-linking hence reduces wound strength)
Radiation therapy (destroys health cells as well as malignant)
Wound aetiology
How did it happen?
Type of wound (acute, chronic)
What are the appropriate treatments?
Could it be prevented?
General patient assessment
This assessment is done regardless of wounds, it is something you will develop over time.
Critically observe people to notice health status and determine the things that will effect the achievement or maintenance of this health status.
Overall health
State the obvious
ABC
Traumatic injury sustained to the right gluteus maximus
Gender (assumption this is a male)
Age (older we are the less well things work)
General appearance, clean, mentally intact, other obvious injuries
Co-morbidities
What sort of diseases will impact on this injury
Endocrine diseases – Diabetes (poor vascular supply, sugar load in wound)
Neuromuscular disease - motor-neuron disease (reduced sensation, immobility)
Psychiatric illnesses – schizophrenia, psychosis (self care issues)
Cardiovascular disease – CHF, venous/arterial insufficiency, anaemia (poor blood supply and oxygenation)
Gastrointestinal disease – malnutrition, anorexia related to other illnesses, malabsorption (poor nutrition)
Genitourinary disease – CRF(uraemia retards wound granulation), incontinence
Integumentary disease – Friability of the skin, lesions, abrasions (breech in the barrier)
Musculoskeletal disease – immobility, arthritis (steroids)
Respiratory disease – COAD (poor oxygenation)
Mobility status
Immobility elevates the risk of poor wound healing due to pressure and deoxygenation
This client will be a high risk due to extensive muscle damage especially to a weight bearing muscle
Nutritional status
Wound healing needs adequate nutritional intake. This client appears well fed.
Obesity can impair healing due to the poorly vascularized adipose tissue and wound dehiscence
Anorexia can significantly lack the essential vitamins required for healing.
Know what foods are available to your client.
Central Australian Aboriginal people lack zinc (zinc comes from seafood, organ meats, mushrooms, soybeans) it is required for the proliferation stage
Sensory functioning status
Impaired eyesight leads to falls
Hearing impairment leads to miscommunication
Diminished peripheral sensation such as in diabetes leads to undetected injury
Rare condition where pain sensation is absent – poor life expectancy
Psychosocial status
Social determinants you would have learnt in health promotion
Support systems, individual coping styles
Living/home environment
Work environment
Education level
Developmental level
Cultural preferences
Lifestyle choices (smoking, drugs, alcohol)
Pain
Next week we will explore pain physiology
Would this be painful?
What type of pain would the client be experiencing
Current medication
What types of drugs could hamper the client’s healing abilities
Corticosteroids (impair the immune and inflammatory response)
Anti-neoplastic (prevent cell growth)
Anti-coagulants (prevent clot formation)
Chemotherapeutics (impair the immune system)
Anti-prostaglandins (prostaglandin is part of the inflammatory process)
Penicillin (penicillamine released from penicillin prevents collagen cross-linking hence reduces wound strength)
Radiation therapy (destroys health cells as well as malignant)
Wound aetiology
How did it happen?
Type of wound (acute, chronic)
What are the appropriate treatments?
Could it be prevented?
Wound aetiology
How did it happen?
Mechanism of injury is a really important point. How did the elderly woman sustain a skin tear at home is as important as knowing how the child sustained a head injury. As both may be preventable.
How long has the wound been there?
Duration of wound provides an indication of acuity and chronicity cycles
What are the appropriate treatments?
Always consider at the start how you will be treating this wound, it lays the foundation of a wound lifespan plan
Brown recluse spider bite
Day 4 of a bite injury
Day 6 of a bite injury
Day 10 of a bite injury
Wound aetiology
How did it happen?
Mechanism of injury is a really important point. How did the elderly woman sustain a skin tear at home is as important as knowing how the child sustained a head injury. As both may be preventable.
How long has the wound been there?
Duration of wound provides an indication of acuity and chronicity cycles
What are the appropriate treatments?
Always consider at the start how you will be treating this wound, it lays the foundation of a wound lifespan plan
Brown recluse spider bite
Day 4 of a bite injury
Day 6 of a bite injury
Day 10 of a bite injury
Wound aetiology
How did it happen?
Mechanism of injury is a really important point. How did the elderly woman sustain a skin tear at home is as important as knowing how the child sustained a head injury. As both may be preventable.
How long has the wound been there?
Duration of wound provides an indication of acuity and chronicity cycles
What are the appropriate treatments?
Always consider at the start how you will be treating this wound, it lays the foundation of a wound lifespan plan
Brown recluse spider bite
Day 4 of a bite injury
Day 6 of a bite injury
Day 10 of a bite injury
Wound aetiology
How did it happen?
Mechanism of injury is a really important point. How did the elderly woman sustain a skin tear at home is as important as knowing how the child sustained a head injury. As both may be preventable.
How long has the wound been there?
Duration of wound provides an indication of acuity and chronicity cycles
What are the appropriate treatments?
Always consider at the start how you will be treating this wound, it lays the foundation of a wound lifespan plan
Brown recluse spider bite
Day 4 of a bite injury
Day 6 of a bite injury
Day 10 of a bite injury
Wound location
Try to use anatomical terms
Location gives insight to the type of wound
Pressure ulcers occur over bony prominences
Arterial ulcers occur at the distal ends of toes
Peripheral wounds will be slower to heal
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
Wound size
Indicator of improvement or deterioration of the wound, wound progress
Wound debridement might provide measurements that increase the wound size
Direct measurement
Measure the length and width and depth of the wound
12 o’clock measurements are used for depth measurements
Easy inexpensive quick
To measure the depth, place a moist cotton tip into the wound and mark on the stick the level
Other measurements
Wound tracings – easy to use, kept as a clinical record, very abstract in interpretation
Photographic record – take a photo at various stages, photos are real images
Volumetric record – Using a wound moulds can be painful and unsure about damage done to wound bed. Inserting saline into the wound cover it with opsite then withdraw fluid; can be inaccurate and contradicted in sinus wounds
Body Surface Area – discuss this with the burns lecture
Dead space or dead space
Where the wound edges have come away from the wound base, it appears grey/purplish in colour and should be probed carefully to determine the extent of the undermining. Use the clockwise method to determine the breadth of tunnelling
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation Page 46 explains the clock measurement
The wound bed tissue reveals the phase and progress of wound healing.
Five main tissue colours pink, red, yellow, black and green.
Epithelial TissuePartial-thickness wounds heal by epithelialisation. Deeper, full-thickness wounds heal by contraction, filling with granulation tissue, and epithelial migration from the wound edges. Epithelial tissue is "pearly pink" in colour.
Granulation TissueClassical "shiny, beefy, red" granulation tissue is a healthy sign. Tissue that appears grey or purple indicates an inadequate blood supply.
Sloughy Tissue
Yellow or tan coloured stringy mucous material called slough, is non viable tissue or yellow necrosis
Necrotic TissueNecrosis delays healing and is a focus for infection. It must be removed by debridement, thick, hard, black necrotic material is called eschar.
Infected Tissue
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
Wound swabs or cultures are only useful in confirming one’s clinical diagnosis.
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
The area and depth of a wound cannot be properly assessed until this debris is cleared.
The wound bed tissue reveals the phase and progress of wound healing.
Five main tissue colours pink, red, yellow, black and green.
Epithelial TissuePartial-thickness wounds heal by epithelialisation. Deeper, full-thickness wounds heal by contraction, filling with granulation tissue, and epithelial migration from the wound edges. Epithelial tissue is "pearly pink" in colour.
Granulation TissueClassical "shiny, beefy, red" granulation tissue is a healthy sign. Tissue that appears grey or purple indicates an inadequate blood supply.
Sloughy Tissue
Yellow or tan coloured stringy mucous material called slough, is non viable tissue or yellow necrosis
Necrotic TissueNecrosis delays healing and is a focus for infection. It must be removed by debridement, thick, hard, black necrotic material is called eschar.
Infected Tissue
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
Wound swabs or cultures are only useful in confirming one’s clinical diagnosis.
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
The area and depth of a wound cannot be properly assessed until this debris is cleared.
The wound bed tissue reveals the phase and progress of wound healing.
Five main tissue colours pink, red, yellow, black and green.
Epithelial TissuePartial-thickness wounds heal by epithelialisation. Deeper, full-thickness wounds heal by contraction, filling with granulation tissue, and epithelial migration from the wound edges. Epithelial tissue is "pearly pink" in colour.
Granulation TissueClassical "shiny, beefy, red" granulation tissue is a healthy sign. Tissue that appears grey or purple indicates an inadequate blood supply.
Sloughy Tissue
Yellow or tan coloured stringy mucous material called slough, is non viable tissue or yellow necrosis
Necrotic TissueNecrosis delays healing and is a focus for infection. It must be removed by debridement, thick, hard, black necrotic material is called eschar.
Infected Tissue
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
Wound swabs or cultures are only useful in confirming one’s clinical diagnosis.
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
The area and depth of a wound cannot be properly assessed until this debris is cleared.
The wound bed tissue reveals the phase and progress of wound healing.
Five main tissue colours pink, red, yellow, black and green.
Epithelial TissuePartial-thickness wounds heal by epithelialisation. Deeper, full-thickness wounds heal by contraction, filling with granulation tissue, and epithelial migration from the wound edges. Epithelial tissue is "pearly pink" in colour.
Granulation TissueClassical "shiny, beefy, red" granulation tissue is a healthy sign. Tissue that appears grey or purple indicates an inadequate blood supply.
Sloughy Tissue
Yellow or tan coloured stringy mucous material called slough, is non viable tissue or yellow necrosis
Necrotic TissueNecrosis delays healing and is a focus for infection. It must be removed by debridement, thick, hard, black necrotic material is called eschar.
Infected Tissue
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
Wound swabs or cultures are only useful in confirming one’s clinical diagnosis.
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
The area and depth of a wound cannot be properly assessed until this debris is cleared.
The wound bed tissue reveals the phase and progress of wound healing.
Five main tissue colours pink, red, yellow, black and green.
Epithelial TissuePartial-thickness wounds heal by epithelialisation. Deeper, full-thickness wounds heal by contraction, filling with granulation tissue, and epithelial migration from the wound edges. Epithelial tissue is "pearly pink" in colour.
Granulation TissueClassical "shiny, beefy, red" granulation tissue is a healthy sign. Tissue that appears grey or purple indicates an inadequate blood supply.
Sloughy Tissue
Yellow or tan coloured stringy mucous material called slough, is non viable tissue or yellow necrosis
Necrotic TissueNecrosis delays healing and is a focus for infection. It must be removed by debridement, thick, hard, black necrotic material is called eschar.
Infected Tissue
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
Wound swabs or cultures are only useful in confirming one’s clinical diagnosis.
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
The area and depth of a wound cannot be properly assessed until this debris is cleared.
The wound bed tissue reveals the phase and progress of wound healing.
Five main tissue colours pink, red, yellow, black and green.
Epithelial TissuePartial-thickness wounds heal by epithelialisation. Deeper, full-thickness wounds heal by contraction, filling with granulation tissue, and epithelial migration from the wound edges. Epithelial tissue is "pearly pink" in colour.
Granulation TissueClassical "shiny, beefy, red" granulation tissue is a healthy sign. Tissue that appears grey or purple indicates an inadequate blood supply.
Sloughy Tissue
Yellow or tan coloured stringy mucous material called slough, is non viable tissue or yellow necrosis
Necrotic TissueNecrosis delays healing and is a focus for infection. It must be removed by debridement, thick, hard, black necrotic material is called eschar.
Infected Tissue
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
Wound swabs or cultures are only useful in confirming one’s clinical diagnosis.
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
The area and depth of a wound cannot be properly assessed until this debris is cleared.
Exudate/Wound DrainageExudate is rich in white blood cells and growth factors that facilitate healing.
When drainage increases or has a foul odour and purulent appearance it is problematic, signifying bacterial growth, and a inhibited inflammatory response delaying healing.
Dry wounds don’t heal well. Epithelizing cells need a crust free environment to migrate
Type of exudate
Serous (clear straw coloured)
Haemoserous (slight blood stained)
Sanguineous (heavy blood stained)
Purulent (pus laden, infected)
Amount of exudate
None
Minimal (normal)
Moderate (normal)
Copious (infective, especially if not proportion to wound size)
The body weeps to rid itself of foreign bodies
Colour
Clear (normal)
Pale Yellow (normal)
Red (fresh blood)
Dark brown (old blood)
Blue-green (Pseudomonas Aeruginosa)
Consistency
Thin watery (normal)
Thick (probable infected)
Odour
Is subjective and should only be documented as present or absent
Proteus infections smell ammonia-like
Pseudomonas infections have a sickly sweet smell
Wounds heal best at constant temperatures of 37 - 38 º C
Wounds left to cool down take about 3- 4 hours to restore to healing temperature (Shultz 2002)
If you remember nothing from this lecture at least take away this message, keep it warm and keep it moist
Peri-wound
Attached or unattached
Attached edges generally mean good vascularisation and wound healing is rapid
Unattached edges are usually seen in deep wounds and will have slowed healing times. Observe unattached edges as they can discolour, indicating non-viable tissue.
Indistinct or well defined
Superficial wounds generally have blurred indistinct edges where the wound moulds into good skin
Well defined wounds are usually partial or full thickness wounds
Macerated or dry
Dry wounds heal slower, if exposed to the air a crust will form within 2-3 hours. The epithelial cells need the crust to be broken down by enzymes before it can progress its migration.
Maceration is where the wound edges are allowed to become too moist, this area is very fragile and can lead to widening the wound edges
Thickened and calloused
Usually indicate a chronic wound, often seen in diabetic ulcers and peripheral neuropathies
Irregular or round
Irregular shaped wounds on the lower peripheries are usually venous ulcers
Round or regular shaped wounds on the lover peripheries are usually arterial ulcers
Red, white or white
Red wound edges can indicate wound infection
White edges can indicate maceration
Bluey grey edges can indicate non viable unattached edges
Assessment of environmental and local factors explores the different intrinsic and extrinsic factors that effect healing
Intrinsic means within the organ (human body)
Extrinsic means outside of the organ
Age
Physiological changes already discussed
Polypharmacy
Increased chance of co-morbidities
Reduced mobility
Reduced financial resources, possibly effecting nutritional status
Underlying disease processes
What other diseases are taking up valuable resources for wound healing?
A wound needs a blood supply to carry nutrients, oxygen and various cells to enable healing
Nutritional Status
What type of nutritional intake is there?
Does the client have teeth?
Are they obese or cachexic?
What cultural influences is there on the clients nutritional intake?
Do they have the finances to buy nutritional food?
Carville, K. (2001). Wound Care Manual. Western Australia: Silver Chain Foundation.Page 38 and 104-105 for further reading
Gender
Females are less likely to injure themselves compared to males
Males are more likely to be risk takers and take a ‘she’ll’ be right attitude
Psychological state
Altered body image – client can suffer depression and poor self esteem, reducing the motivation to get well and keep well
Socialisation issues – client can become isolated due to the wound’s appearance, odour or effect on activity. Isolation can result in depression
Availability of health care – not everybody is afford equality of health or access
Compliance – What goals have been mutually set between you and the client to achieve healing? What motivates the client to be well. Compliance is about giving purpose to actions and empowerment back to the client
Pressure, friction, shearing
Pressure, friction and shearing all contribute to wound aetiology
Temperature
The importance of maintaining wound temperature has been previously discussed
If you have a client with an elevated systemic temperature (hyperpyrexia) there is usually an underlying infective process
NB Hyperthermia is not caused by infection but related to a damage hypothalamus or an inability to lose heat normally
A body temp of 40.9 ºC will kill pneumococci and gonococci organisms (Edwards, 1998)
A body temp of 38 - 40 ºC activates phagocytes and leukocytes and prevent vial cell replication (Edwards, 1998)
A body temp of 41 – 43 ºC causes nerve damage, coagulation, convulsions and death (Edwards, 1998)
Always prevent shivering as it can accelerate the body temp to four times the normal rate (Morgan 1990)
Infection
Bacteria lives normally on the human body
All wounds are contaminated, this does not mean infection.
Infection occurs when an imbalance of normal flora numbers occurs and the body’s normal defences cannot confine or control them.
A wound is considered infected if there is 100 000 (105) organisms per gram of tissue (Carville, 2001)
Infection is indicated by pain, oedema, heat, erythema, exudate (purulent) at the wound site and an elevated temp and WBC
Hydration
Exudate is rich in white blood cells and growth factors that facilitate healing.
Dry wounds don’t heal well. Epithelizing cells need a crust free environment to migrate
Too much exudate can cause maceration of wound edges.
Moisture can provide a covering to exposed nerve endings thus reducing pain. Think of when you get burnt and you place your hand under cold water. The cold water not only cools the area but the seal of water protects the exposed nerves reducing pain allow it to dry out and the pain recommences.
Foreign bodies
Foreign bodies can include sutures, dirt, innate objects, dressing products such as cotton wool and wound debris. Foreign bodies will initiate the infective process
References
Edwards, S. L. (1998). High Temperature. Professional Nurse, 13(8), 521-526.
Morgan, S. (1990). A comparison of three methods of managing fever in the neurologic patient. Journal of Neuroscience Nursing, 22(1), 19-24.
Primary Intention
Simplest and fastest way of healing
Primary intention is when the wound edges can be physically approximated
Secondary Intention
A wound that doesn’t have wound edges to join so that healing will occur through wound bed granulation
Tertiary Intention
Also known as delayed primary closure. This is when a wound has approximated edges but there is a concern foreign bodies or an infection is present. Closure is delayed for 3-5 days
Skin Graft
Skin Flap
Primary Intention
Simplest and fastest way of healing
Primary intention is when the wound edges can be physically approximated
Secondary Intention
A wound that doesn’t have wound edges to join so that healing will occur through wound bed granulation
Tertiary Intention
Also known as delayed primary closure. This is when a wound has approximated edges but there is a concern foreign bodies or an infection is present. Closure is delayed for 3-5 days
Skin Graft
Skin Flap
Primary Intention
Simplest and fastest way of healing
Primary intention is when the wound edges can be physically approximated
Secondary Intention
A wound that doesn’t have wound edges to join so that healing will occur through wound bed granulation
Tertiary Intention
Also known as delayed primary closure. This is when a wound has approximated edges but there is a concern foreign bodies or an infection is present. Closure is delayed for 3-5 days
Skin Graft
Skin Flap
Primary Intention
Simplest and fastest way of healing
Primary intention is when the wound edges can be physically approximated
Secondary Intention
A wound that doesn’t have wound edges to join so that healing will occur through wound bed granulation
Tertiary Intention
Also known as delayed primary closure. This is when a wound has approximated edges but there is a concern foreign bodies or an infection is present. Closure is delayed for 3-5 days
Skin Graft
Skin Flap
Primary Intention
Simplest and fastest way of healing
Primary intention is when the wound edges can be physically approximated
Secondary Intention
A wound that doesn’t have wound edges to join so that healing will occur through wound bed granulation
Tertiary Intention
Also known as delayed primary closure. This is when a wound has approximated edges but there is a concern foreign bodies or an infection is present. Closure is delayed for 3-5 days
Skin Graft
Skin Flap
Primary Intention
Simplest and fastest way of healing
Primary intention is when the wound edges can be physically approximated
Secondary Intention
A wound that doesn’t have wound edges to join so that healing will occur through wound bed granulation
Tertiary Intention
Also known as delayed primary closure. This is when a wound has approximated edges but there is a concern foreign bodies or an infection is present. Closure is delayed for 3-5 days
Skin Graft
Skin Flap