The document defines wounds and classifies them into different types such as lacerated, incised, punctured, and contaminated wounds. It also discusses the phases of wound healing which include inflammatory, proliferative, and remodeling phases. Factors that affect wound healing include blood supply, nutrition, lifestyle, medications, and infection status which should be considered in managing patients with wounds.

1. Wounds
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2.  Define wounds
 Classify wounds
 Explain the healing process
 Discuss Factors that affect wound healing
 Describe the management of patients with
wounds

3.  A wound is just an injury to an organ or
tissue of the body that results in a disruption
of the normal continuity of that organ or
tissue.
 or
 A wound is a cut or break in the continuity of
any tissue caused by injury or operation.

4.  Lacerated wound: This that type of injury that
has rough or jagged edges e.g. that which is
sustained in an RTA, barbed wire injury etc.
 Incisional wounds: These are types of
injuries made by sharp objects. They have
edges that are evenly separated e.g. those
wounds made by surgeons during surgery.

5.  Punctured wounds: These are wounds that
are caused by sharp pointed objects causing
a small opening through the skin. These are
commonly caused by such objects such as
nails, knives, gun shots etc. they appear small
superficially but involving deeper structures
such as nerves, blood vessels or viscera
which may be damaged and contamination
carried into deeper tissues.

6.  Contused wounds: These are a type of wounds
that involve superficial injuries without damage
to the skin surface. They are commonly caused
by blunt surface forces and are characterized by
a considerable soft pad. These are known
common causes of haematomas(collection of
blood outside the blood vessels).
 Poisoned wounds: These wounds are those type
of wounds that involve direct contamination by
the source of the injury such as snake bites,
insect bites, dog bites especially where rabies
organisms exists.

7.  Concussions: These are a type of wounds that
result from vigorous shaking such as the
severe shaking of the head causing brain
function derangement without structural
damage.
 Abraisions: These are wounds that result
from rubbing a body tissue especially the
skin against a rough surface leading to loss
of superficial tissue due to friction. These are
characteristically painful and superficial.

8.  Contaminated Wounds
 These are wounds which are exposed to
excessive amounts of bacteria. These wounds
have a higher risk of infection e.g.
unprepared colon surgery, dirty laceration
etc.
 Infected Wounds
 These are wounds that have infected material
in them. They usually have pus or slough on
their surfaces. Common infecting organisms
include streptococci, staphylococci etc.

9.  Clean Wounds
 These are wounds that have been rendered
clean by cleaning with the use of
disinfectants such as savlon, povidone iodine,
methylated spirit, etc.
 Debrided Wounds
 These are wounds whose top infected
(necrotic tissue and pus) tissue has been
removed surgically by a process known as
SLOUGHECTOMY or DEBRIDEMENT.

10.  PHASES OF WOUND HEALING FIRST PHASE
 INFLAMMATORY PHASE-starts immediately
after injury and lasts 3-6 days or 4-6 days.
2 major processes occur during this phase …
 HEMOSTATIS AND PHAGOCYTOSIS
 Hemostatis- blood vessels constrict,
platelets aggregates and bleeding stops,
scabs forms, preventing entry of infectious
organisms

11.  phagocytosis
 Inflammation-increase blood flow, to wound
resulting localized redness and edema,
attracts WBC and wound growth factors.
WBC arrive-clear debris from wound.

12.  SECOND PHASE PROLIFERATIVE PHASE
 extends from day 3 to about 21 day post
injury. collagen synthesis , establishment of
new capillaries ,creation of granulation tissue
, wound contraction , epitheliazation.
 THIRD PHASE REMODELLING OR MATURATION
PHASE -final healing stage may continue for I
year or more. Remodeling of scar tissue to
provide wound strength.

13.  FIRST INTENTION HEALING
 partial thickness wounds. a clean incision is
made with primary closure, minimal scarring
expected when the edges of clean surgical
incisions are sutured together, tissue loss is
minimal or absent if the wound is not
contaminated with microorganism. -e.g.-
abrasion or skin tear.

14.  SECOND INTENTION HEALING
 granulation accompanies traumatic open
wounds with tissues loss or wounds with a
high microorganisms count.Go through a
process involving scar tissue formation, heal
slowly because of the volume of tissue
needed to fill the defect. -e.g.-contaminated
surgical wound, pressure ulcer

15.  Healing By Third Intention or Secondary Suture
 Also called healing by Tertiary Intention is a
type of wound healing which occurs when
there is delayed suturing of a wound or if
there is a breakdown of the initial suture with
massive infection and loss of tissue. Two
opposite granulation tissues are brought
together with the result of a deeper wider scar.

16.  Developmental considerations (healthy
children and adults)
 Blood supply
 Nutrition
 Lifestyle
 Medications
 Contamination and infection

17.  As a wound heals many elements such as
adequate nutrition, cleanliness, rest, and
position determine how quickly the process
occurs. Although post operative dressings are
initially changed by a member of the surgical
team, subsequent dressing changes in the
immediate post operative period are usually
done by a nurse.

18.  A dressing is applied to a wound for one or
more of the following reasons;
 To provide a proper environment for wound
healing
 To absorb excessive drainage
 To splint or immobilise the wound
 To protect new epithelial tissue from
mechanical injury

19.  To protect the wound from bacterial
contamination and from soiling by faeces,
vomitus, and urine etc.
 To promote haemostasis, as in a pressure
dressing
 To provide mental and physical comfort of
the patient

20.  Wound dressing is done according to the
immediate assessment, the state of the
wound, and objective of the surgeon
concerned. Thus dressings may be described
as;
 Wet dressings
 Moisture retentive dressings
 Occlusive dressings
 Pressure dressings
 Medicated dressings

21.  HEMORRRHAGE -risk of hemorrhage is greatest
during the first 48 hours after surgery .it is an
emergency
 INFECTION -surgical infection is apparently 2-11
days post operatively. Observe for presence of
changed in wound color, pain or drainage-culturing
of the wound.
 DEHISCENCE WITH POSSIBLE EVISCERATION -may
occur 4-5 days postoperatively. -involves an
abdominal wound in which the layers below the skin
separates. Observe for an increase in flow of
serosanguinous drainage into the dressing can
indicate impending dehiscence

22.  Wound are as a result of trauma to tissues
 Their severity depends on the trauna
sustained to the tissue .
 You need to understand the classification of
wound in order to manage them .
Understanding the factors promoting and
delaying wound healing will be of importance
in the management of wounds

23.  What is a wounds ?
 Mention 5 types of wounds
 List 4 factors affecting wound healing.
 What are the phases of wound healing?

24. Miss Catherine Chanda aged 28 years old sustained
burns of the anterior trunk, posterior trunk and left
leg. She has developed some inflammation and the
attending Doctor admitted her to female surgical
ward where you working from.
1. Explain two (2) types of inflammation
10%.
2. Explain the pathophysiology of inflammation.
20%
3. Discuss the nursing care of Ms. Chanda
during her stay in hospital. 50%
4. Outline five (5) complications that Ms Chanda
may develop 20%