Anatomy of the skin wound healing Wound care as a concept Wound Dressing vs. Wound care Nursing management Treatments of wounds Challenges and recommendation conclusion

1. Wound Care
Reconstructive Plastic
Surgery and Burns Center
Korlebu Teaching Hospital
Presented By Abdulsalam Mohammed
Nursing Officer//06.june.2013
WOUND CARE

2. Importance of
Presentation
Platform for assessment
and re-evaluation of our
nursing activities and
duties
Period of transfer of
experience among us
Assertiveness Training
Highlight new trends in
the nursing profession
NOTE: Gone are the days
when nursing were not
considered a profession
Today nursing has a body
of knowledge
Is dynamic and rest on the
shoulders of constant
reading, researching
RPS/BC Cant be left
out

3.  Introduction and Background
 Objectives
 Definition of terms
 Anatomy of the skin
 wound healing
 Wound care as a concept
 Wound Dressing vs. Wound care
 Nursing management
 Treatments of wounds
 Challenges and recommendation
 conclusion

4. Wound care is a very vital issue affecting nursing worldwide
It is a concern that transcends medical ,surgical as well as
all others departments of health service.
In RPS/BC about 100% of all patients have wounds of one
sort or the other
Dressing items are very expensive
However, when care is not taken wound will deteriorate
rather than heal at the hands of health professionals
Hence wound management is an integral process and care
providers must constantly upgrade skills and knowledge
appropriately.

5. Wound…. A break in the integrity of the skin
or any tissue
E.g. Pressure ulcer, Burns , Buruli ulcer,
Avulsion injury surgical incision, Carcinoma
ulceration, Cellulitis wound, ulceration of boil
etc
It may or may not include underlying tissues
May be Acute ( Expected to heal) or chronic
May be surgical or traumatic
May be clean or infected.

6. The skin is the largest organ of the body,
making up 16% of body weight.
It has several vital functions, which include;
immune function, temperature regulation,
sensation and vitamin production.
 Skin is a dynamic organ in a constant state of
change; cells of the outer layers are
continuously shed and replaced by inner cells
moving to the surface.

7. Epidermis:
 outer layer .
 comprised of
epithelial cells
 avascular
 0.04mm thick
 Regenerated
every
 2-4weeks,
 receives nutrients
from the dermis
below
comprised of 4 to 5
layers depending on
the body location
Hypodermis:
 inner most layer
(subcutaneous layer)
 supports the dermis and
epidermis
 varies in thickness and
depth
 comprised of adipose
tissue, connective tissue
and blood vessels
 store lipids, protect
underlying organs, provide
insulation and regulate
temperature
 Skin Appendages:
Includes Sweat glands,
hair, nails and sebaceous
glands which are all
considered epidermal
 Dermis:
middle layer
 0.5mm thick
 o made of two
layers
 very vascular
 contains nerves,
connective tissue,
collagen, elastin
and specialized
cells such as
fibroblasts and
mast cells
 Responsible for
inflammatory
reactions
 o receptors for
heat, cold, pain,
pressure, itch and
tickle

9.  Phase 1 - INFLAMMATORY PHASE (0-3 Days) the body's
normal response to injury. This phase activates vasodilatation
leading to increased blood flow causing HEAT, REDNESS, PAIN,
SWELLING, LOSS OF FUNCTION (e.g. arm swells and cannot
bend). Wound ooze may be present and this is also a normal
body response.
 Phase 2 - PROLIFERATIVE PHASE (3-24 Days) the time
when the wound is healing. The body makes new blood
vessels, which cover the surface of the wound. This phase
includes reconstruction and epithelialization. The wound will
become smaller as it heals.
 Phase 3 - MATURATION PHASE (24-365 Days) the final
phase of healing, when scar tissue is formed. The wound at
this stage is still at risk and should be protected where
possible.
 This process forms the underlying knowledge base for the
care and management of Wounds

10.  healing by first intention that in which
union or restoration of continuity occurs
directly without intervention of
granulations.
 healing by second intention union by
closure of a wound with granulations.
 healing by third intention treatment of
a grossly contaminated wound by delaying
closure until after contamination has been
markedly reduced and inflammation has
subsided.

11.  Is not just the few minutes or hours spend in the treatment
room or theater, for dressing, cleaning, and bandaging of
the wound
 It includes all activities before, during and after the wound
dressing that has direct or indirect, local or systemic
bearing on the healing of the wound
 Wound dressing is a vital part of the process
 Example include eg nutritional status, pain management,
psychological management, management of underlying
conditions, etc
 We are aware of it but we may lack the sense of
coordinating all nursing on activities too often.

12. Detail Assessment of Wound
History taken
Estimation of the Wound size or TBSA
Tetanus prophylaxis
Psychological preparation
Pain management
Antibiotic therapy
Support
choose appropriate lotion
set up trolley

13.  Reassure patient
 Position the patient in comfortable situation eg chair or bath
 Assessment of wound site
 Removal of old dressing layer one at a time
Communicate with the patient
Work in unison with your assistance or team members
Maintain accept techniques throughout
 Primary dressing should not be forced
 Observe the patient , throughout the process for any changes eg pain, bleeding
,color
 Clean with antiseptic agents eg savlon, saline, acetic
 Irrigation with saline is very ideal
 Cleaning or dubbing is dependent on the wound
 Apply appropriate lotion
 Apply dressing and bandage, and secure well with plaster
 Decontaminate the instruments and bath accordingly

14. lotion indication Remarks
Normal saline Irrigation, Irrigation &
Dressing
………………………………….
Savlon Antiseptic Cleansing
agent for wound
Skin reactions may occur
Acetic Acid
1:19
Pseudomonas infections
…wound is greenish/Pink
Can cause allergic reacrion
Dermazine Cream
Hilder
For debridement of burns
wound..penetrate deep
into the burnt tissues
Less toxicity, but contraindicated
with patient who react to silver
Nadoxine cream Anbiotic topical cream Sensititivity
Povidine/Betadine
(Aqeous base)
For debridement and
granulation formation
Toxicity if used on wide area
Ionsil Antimicrobial gell hypersensitify
Chloranphenicol cream Antibiotic mostly for
perenial and face
Hydrgen peroxide Outmoded and not in use

15. Documentation
 It is an expectation that all aspects of care,
including assessment, treatment and management
plans, implementation and evaluation are
documented clearly and comprehensively.
 All wounds should be assessed regularly and
outcomes of the assessment documented. A Wound
care Chart can be used to monitor and record the
progress of the wound through its stages of healing.
Simple wound documentation can be captured in
progress notes and treatment plan

16. Date
Color Red/Pinkish moist
tissue shows
healthy
granulation
tissues
pink, almost
white, on
healthy
granulation
tissue is
epithilium
Slough the
presence of
devitalized
yellowish
tissue
Necrotic:
wound
containing
dead tissue.
It may appear
hard dry and
black
Odor
exud
ates
Serous
Clear, straw
coloured Thin,
watery
Normal.
An increase may
be indicative of
infection
Haemoserous
Clear, pink
Thin, watery
Normal
Sanguinous
Red Thin,
watery
Trauma
to blood
vessels
Purulent
Yellow, grey,
green Thick
Infection.
Contains
pyogenic
organisms
and other
inflammatory
cell

17. size
% take
Lotion of
dressing
Frequency
Remarks
Signature

18.  Wound cleansing should not be undertaken to remove
'normal' exudate
 Cleansing should be performed in a way that minimises
trauma to the wound
 Wounds are best cleansed with sterile isotonic saline or
water
 The less we disturb a wound during dressing changes the
lower the interference to healing
 Fluids should be warmed to 37°C to support cellular
activity
 Skin and wound cleansers should have a neutral pH and be
non-toxic
 Avoid alkaline soap on intact skin as the skin pH is
altered, resistance to bacteria decreases

19.  Maintain a moist environment at the wound/dressing interface
 Be able to control (remove) excess exudates. A moist wound
environment is good, a wet environment is not beneficial
 Not stick to the wound, shed fibres or cause trauma to the wound or
surrounding tissue on removal
 Protect the wound from the outside environment - bacterial barrier
 Good adhesion to skin
 Sterile
 Aid debridement if there is necrotic or sloughy tissue in the wound
(caution with ischaemic lesions)
 Keep the wound close to normal body temperature
 Conformable to body parts and doesn't interfere with body function
 Be cost-effective
 Diabetes - choose dressings which allow frequent inspection
Non-flammable and non-toxic

20. Local indicators
 Redness (erythema or
cellulitis) around the wound
 Increased amounts of
exudate
 Change in exudates
colour
 Localised pain
 Localised heat
 Delayed or abnormal
healing
 Wound breakdown
Systemic
indicators
 Increased systemic
temperature
 General malaise
 Increased leucocyte count
 Lymphangitis

21.  Malnutrition- inadequate
supply of protein, carbohydrates,
fatty acids, and trace elements
essential for all phases of wound
healing
 Reduced Blood supply -
Cardiovascular disorders and
Ischaemia
 Medication - Non-steroidal
anti inflammatory drugs and
Corticosteroids.
 Chemotherapy - suppresses
the immune system and
inflammatory response
 Radiotherapy - increases
production of free radical which
damage cells
 Psychological stress
and lack of sleep- increase risk
of infection and delayed healing
 Obesity - decreases tissue
perfusion
 Infection -prolong inflammatory
phase, use vital nutrients, impair
epithelialisation and release toxins
 Reduced wound
temperature - prolonged
dressing changes or use of cold
cleansing products.
 Underlying Disease -
Diabetes Mellitus and Autoimmune
disorders
 Inappropriate wound management
 Patient compliance
 Unrelieved pressure
 Immobility
 Substance abuse including alcohol
and cigarette smoke

22.  Antibiotic Therapy –
Medications used to address
bacterial contamination of the
wound
 Compression Therapy – The
application of pressure dressings
and wraps may reduce swelling of
tissues and may promote proper
venous blood drainage and arterial
blood supply
 Debridement – this is the
process of removing dead tissue
from the wound bed in order to
stimulate the wound bed and
promote healing
 * Education – The Wound Care
Staff will provide information
regarding ambulation and
exercise, diet and nutrition, and
self care
 Offloading – Reduction of
pressure from bony area of the body
and other areas creating pressure is
important to address the underlying
disorder of the wound itself
 Skin Grafts – The physician staff
can take a patient into the operating
room for an autologous (graft is from
the patient’s own skin) or in the
Wound Care Center using a skin
substitute product
 Wound Vaccum – “Wound Vac”
– This treatment has proven to be
very effective to reduce the and
remove unnecessary fluid and
bacteria from around your wound
 * Hyperbaric Oxygen Therapy –
"HBOT” – This is a therapy that is
available in the Wound Care Center.
It is designed to deliver increased
concentrations of oxygen directly to
the wound site – oxygen rich blood
is a necessary component to
effective healing.

23. CHALLENGES
Nursing staff
Logistical challenges
Documentation
RECCOMENDATION
Remember always wound care is not
just wound dressing
Conclusion
The most important practical lesson that
can be given to nurses is to teach the
what to observe, how to observe, what
symptoms indicate improvement, what is
the reverse, which kind of importance,
which are none, which are the evidences
of neglect and what kind of neglect”
Florence nightingale ,1992.p59
References
Australian Wound Management Association Inc. (August
2011). Bacterial impact on wound healing: From
contamination to infection. Position Paper, Version 2.
# Ashton J, Morton N, Beswick S, Barker V, Blackburn F,
Wright C, Turner L, Morton K, Jennings A. BoltonNHS -
Primary Care Trust. (March 2008) "Wound care
Guidelines"

24. THANK YOU
I PUT IT
TO YOU THAT
THIS PRESENTATION
IS
FAAAANTASTIC