1. V I J Y A L A X M I M A K W A N A
T U T O R , D E M O N S T R A T O R
S C O N
MEETINGS NEEDS OF PERIOPERATIVE
PATIENTS

3. WOUNDS
DEFINITION
 A wound is break or cut down in the
continuity of any body structure internally
or externally cause by physical needs.

4. CLASSIFICATION
Open wounds
Destruction of skin and
mucous membrane and
exposing the underlying
tissue of open air.
CAUSE: trauma by
sharp object
Close wounds
No break in the
continuity of the skin
or mucous
membrane.
CAUSE: Unusual
twisting

5. Types of Open Wound
Incised Wounds
 They are caused by clean, sharp edged objects i.e. knife,
razor. Incisions which involve only the epidermis are
classified as cuts rather than wounds.
Lacerations:
 These are irregular wounds caused by blunt impact to
soft tissues that lies over hard tissues e.g., skin covering
skull

7.  Abrasions:
 These are superficial wounds in which epidermis is scraped
off. Often caused by sliding fall onto a rough surface.
 Puncture Wounds:
 It is piercing wound that causes a small hole in the tissues by
objects such as nail or needle.
 Penetration Wound:
 They are caused by objects such as a knife or gun shot.
Types of Open Wound

10. Types of Closed Wound
 Contusions:
 They are caused by blunt force trauma that damages tissues
under the skin.
 Hematomas: These are caused by damage to a blood vessel
that in turn causes blood to collect under the skin.
 Crushing Injuries:
 They are caused by a great or extreme amount of force
applied over a long period of time.

12. Causes of wounds
Un-
intentional
wounds
Intentional
wounds

13. Severity of Injury
1)Superficial wounds: Only epidermal layer of skin
involved. Friction i.e:child fall down.
2)Penetrating wounds: Epidermis, dermis &
Deeper tissue or organs. e.g. Bullets
3)Perforating wounds: Foreign objects cuts open
the whole thickness of the wall of cavity or organ.
Gunshot wounds.
4)Puncture wounds: Small opening on the surface.
Bite of animals.

14. Types of Wound Exudates
Sr.
No.
Exudates Components Occurrence Description
1. Sanguineou
s
Red Blood
Cells
Incisions
Bruises
Open wounds
Dark to bright
red
Watery
drainage
2. Fibrous Fibrin Acute inflammation Clear sticky
membranous
(like glue)
3. Serous Serum Irritation of membranes
of:
Meninges, pleura,
peritoneum
Watery with
cells as fibrin

15. Types of Wound Exudates
Sr.
No.
Exudates Components Occurrence Description
4. Catarrhal Mucus Trauma or
irritation to
mucus
membrane
Clear to
whitish
drainage
containing
mucus
5. Purulent Serum
containing
leukocytes,
neurotic
tissue and
bacteria
Boils
abscesses
Color and
consistency
depend on
causative
agents

16. WOUND HEALING PROCESS
1)INFLAMMATORY PHASE
2)DESTRUCTIVE PHASE
3)PROLIFERATIVE PHASE
4) MATURATION PHASE

17. WOUND HEALING PROCESS
Involves integrated physiological process. Healing occurs in 4
stages:
1)Inflammatory phase: Within few seconds after injury,
inflammation begins& lasts for about 3 days.
 Injured tissue secrets histamines resulting vasodilatation of
surrounding capillaries.
 Increased blood volume
 Decreased speed of blood flow
 Leucocytes reach to wound sites

18. WOUND HEALING PROCESS
1)Inflammatory phase:
 Neutrophil begins to ingest bacteria. It is die in few days,
leaving enzyme exudates attack bacteria or inference with
tissue repair.
 Monocytes transfer into macrophages clean wound of
bacteria, dead cells
 Continuous process for about 48 hrs &thin layer of
epithelial tissue forms over wounds
 Growth hormones released by platelets

19. WOUND HEALING PROCESS
2)Destructive Phase:
 Begins before inflammatory phase ends & lasts for
about 2 to 5 days.
 Macrophages continue cleaning process & stimulate
fibroblasts & synthesize collagen. The leukocytes starts
disappearing .

20. WOUND HEALING PROCESS
3)Proliferative phase:
 Begins with appearance of the new blood vessels & last
from 3 to 24 days.
 Fibroblasts appears alongside the capillaries.
 Cells forming surface & cover wounds.
 Reconstruction progresses . Collagen continues to be
deposited.

21. WOUND HEALING PROCESS
4)Maturation phase:
 Lasts for several months .
 The wound shrinks and contracts.
 Scar formation by fibroblast. The scar tissue thus
formed is acellular, avascular collagen tissue. It will
not tan with sunlight nor sweat nor produce hair.

24. Types of wound healing
 Healing by first intention (Primary Union)
 Healing by second intention (Granulation)
 Healing by third intention (Tertiary healing)

25. Healing by first
intention
(Primary Union)
• Occurs with
surgical wounds; all
layers of the wound
are closely
approximated by
suturing.
Healing by second
intention (Granulation)
• It occurs when a
wound heals by filling
in the area from the
bottom. The wound is
open with increased
chances of infection
and heals slowly with
considerable scarring.
Types of wound healing

26.  HEALING BY THIRD INTENTION (TERTIARY HEALING)
 The wound is sutured several days after wounding. This may occur if
the wound was dirty and had to be cleaned before suturing or if a
surgical wound breaks open after several days. The wound is more
contaminated than with primary intention so scarring is greater but
less than with secondary intention.
Types of wound healing

28. Factors affecting healing process
1) Favourable Factors:
 Young age
 Adequate blood supply
 Stamina
 Nutrition
 Absence of infection
 Use of anti infective agents
 Immobilization
 Rest to injured part

29. Factors affecting healing process
2)Unfavorable factors:
Old age
Inadequate blood supply
Poor health
Malnutrition
Presence of infection

30. Abscess formation
Cellulites
Necrosis
Keloids
Pain
Delayed wound closures.
Hemorrhages
Haematoma
Wound infection
Wound dehiscence
Wound evisceration
Fistula
Fluid collection
COMPLICATIONS

35. “Just a friendly suggestion…next time you do a dressing change, don’t say,
OH MY GOD, WILL YOU LOOK AT THAT!”

36. CARE OF THE WOUNDS
Protect wounds with dressing
Use sterile techniques
Isolate patient
Use antibiotics
Immobilized injured part by bandages,
splints.

37.  Identify bleeding points
 Apply water proof ointments
 Medication apply
 Supply essential nutrients
 Keep environments free from dust
 Avoid visiting person.
CARE OF THE WOUNDS

38. DRESSING
DEFINITION:
 Dressing is done to cover the particular area with
or without any medication.
 It is a sterile protective surgical covering, applied
to a wound/incision with aseptic technique, with
or without medication.

39. Purpose
 To prevents infection
 To promote wound granulation and healing
process
 To prevents the bleeding
 To apply sterile protecting covering.
 To apply medications to the wound.
 To absorb fluid and medication.
 To provide comfort.

40. AGENTS USED FOR DRESSING
Savlon 5%
Cetavlon 1%
Hydrogen peroxide 1.5 to 3%
Ether

41. Types Of Dressing
 Types of dressing used depends on:
 The location, size and type of the wound.
 Type and amount of exudate.
 Whether the wound is infected.
 Frequency of changing the dressing.

42. Gauze Dressing:
 These are most commonly used dressings. They do not
interact with wound tissues and thus cause little wound
irritation.
Wet Dressing:
 These are preferred in treating wounds that require
debridement. This moistens the dressing, increasing the
gauze’s ability to collect exudates and wound debris.
Types Of Dressing

43. Self- Adhesive Transparent Dressing:
 It is ideal for small superficial wounds that do not require
debridement.
Types Of Dressing

44. Hydrocolloid And Hydrogel Dressing:
 These types of dressings are occlusive with following
advantages:
 Absorb drainage through use of exudate absorbers.
 Maintain wound humidity.
 Slowly liquefy necrotic debris.
 Provide protective cushioning.
Types Of Dressing

45. Pressure Dressing:
 It helps in promoting hemostasis. It exerts pressure over
an actual bleeding site. It also helps wounds to heal
normally.
 Once pressure dressing is used, the nurse should keep
constant observation for skin color, and pulse in distant
extremities.
Types Of Dressing

46. General Instructions
 Maintain a strict aseptic technique to prevent cross-
infection, to and from the wound. All the materials
touching the wound should be sterile.
 All articles should be disinfected thoroughly.
 Wash hands thoroughly before and after the procedure.
 One set of instruments should be used for one dressing.

47.  Use mask, sterile gloves and gown to minimize wound
contamination.
 Dressing should not be done immediately after
sweeping and dusting; wait at least for 15- 20
minutes.
 Use individually wrapped sterile dressing and
equipment for the wound.
General Instructions

48. ARTICLES
Sterile tray
• Sponge holding
forceps
• Dressing towel
• Scissors
• Dissecting forceps
• Plan forceps
• Toothed forceps
Sterile tray
• Artery forceps
• Tissue forceps
• Skin retractor
• Suture needles
• Needle holder
• Probe &sinus forceps
• Syringe 20ml with
bowl

49. ARTICLES
 Unsterile tray:
 Spirit ,N.S
 Local anaesthetics-lignocaine
 Dressing materials
 Bandages, scissors
 Kidney tray
 Makintosh &towel.

50. Procedure
PREPARATORY PHASE:
 Wash hands
 Wear mask, gown and gloves.
 Place dressing, supplies or articles on a clean flat
surface.

51.  Place disposable bags nearby to collect soiled dressing.
 Determine the type of dressing.
 Open the dressing tray by peeling apart the edges of the
package.
 Wash hands
Procedure

52. Preparation of Patient and Environment:
 Identify the patient and position him
comfortably.
 Explain the procedure and provide privacy.
 Drape the patient.
 Offer bed pan or urinal prior dressing.
Procedure

53.  Put off the fan to prevent draughts.
 Protect the bed with mackintosh and a
treatment towel.
 Expose the part as necessary.
 Untie the bandage or adhesive.
Procedure

54. Steps of Procedure
 Screen and drape the patient
 Wash hands
 Collect required articles to the bed side.
 Loosen all adhesive tapes of the old
dressing but do not remove the dressing.
 Wash hands

55.  Put on mask, gown and gloves
 Open the sterile tray
 Remove the sorted dressing with the
dissecting forcep.
 Clean the wound from the center to
periphery.
 Use one gauze for one stroke from up to
downwards.
Steps of Procedure

56. Steps of Procedure
 After thorough cleaning of the wound dry
it with a dry gauze piece.
 Apply medications if ordered.
 Cover the wound with a sterile gauze piece
and then with cotton pads.
 Reinforce the dressing on the dependent
part where drainage may get collected.

57.  Discard the artery forceps and dissecting
forceps in the bowl of antiseptic lotion.
 Remove the gloves and secure the dressing
with bandage or adhesive tapes.
 Make the patient comfortable and remove
all articles from bedside.
Steps of Procedure

58. After Care of Patient and Article
 Remove the mackintosh and treatment towel.
 Take all the articles to the treatment room.
 Discard the soiled dressing in the covered
container and send it for incineration.
 Remove the instruments and other articles from
the disinfected solution and clean them
thoroughly.

59.  Dry them and reset the tray and send it for
autoclaving.
 Replace the bed linen.
 Wash hands.
 Record the procedure.
After Care of Patient and Article

60. CARE OF DRAINAGE
 Most contaminated sites. Wound has been cleansed from
cleanest area to contaminated area.
 Shorting or removal of the drains: Physician often places
a pin or clip though the drain to prevent slipping further into
wound.
Nurses role:
 Check placement of drain, condition of collecting apparatus .
 Observe location of drain
 Measure volume of drainage
 If evacuation device not available to maintain a vaccume
 Change the drainage tubes