WOUND AND WOUND DRESSING.ppt x

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1. WOUND AND WOUND DRESSING BY MERCIA KANAI AHN

2. DEFINITION A wound is a break or cut in the continuity of any body structure , internal or external caused by physical means. or A break in the skin or other body tissues caused by injury or surgical incision that leaves the body vulnerable to pain or infection.

3. Classification of wound According to status of skin integrity OPEN WOUND -: A type of injury that involve in break of the skin and leave the internal tissue exposed. CLOSED WOUND -: A type of injury when the skin remain intact and the tissue that lies underneath is not exposed. example-: contusion , blister. According to the cause of the wound INTENTIONAL/ SURGICAL WOUND-: Injuries resulting from purposeful human action, whether directed at self or others. UNINTENTIONAL WOUND -: Injury due to accidental events

4. According to severity of injury SUPERFICIAL WOUND -: Injury that occur on the skin mainly limited to the epidermis and usually does not cause any bleeding, mostly referred as ‘simple’ or ‘soft tissue’ wound . Example-: abrasions, scratch. PENETRATING WOUND-: Injury that occurs when a foreign objects pierces the skin and enter the body creating the wound Example – stab wound, bite marks PERFORATED WOUND-: Injury in which an object enters the body and passes through , it is associated with an entrance wound and an exit wound. Example -; bullet wound. PUNCTURE WOUND -: Wound made by a pointed objects, it is usually narrow and deeper than a cut. Example – nail , animal teeth

5. According to cleanliness/contamination CLEAN WOUND-: Wound that aren’t contaminated with bacteria or have the lowest risk for infection Example-: surgical wound CONTAMINATED WOUND-: The presence of bacteria within a wound most cases there is no multiplication so wound healing is not impaired. Example – break in sterile technique. INFECTED OR SEPTIC WOUND-: Presence of bacteria or other micro-organism in the wound and its multiplication leading to infection, tissue damages and affect wound healing.

6. WOUND HEALING PROCESS STAGE 1 INFLAMMATORY PHASE STAGE 2 DESTRUCTIVE PHASE STAGE 3 PROLIFERATIVE PHASE STAGE 4 MATURATION PHASE

7. INFLAMMATORY PHASE This stage starts within few seconds after injury, inflammation begin and last for about 3 days. Injured tissues and mast cells secrete histamine, resulting in vasodilation of surrounding capillaries and exudation of serum and white blood cell into damaged tissues. Leukocytes reach the wound within few hours, The neutrophil begins to ingest bacteria and small debris. The neutrophil dies within a few days. Doing this period the monocytes which transforms into macrophages cells clean the wound bacteria, dead cells and debris. This process continuous for about 48 hours. Finally a thin layer of epithelial tissue forms over the wound, which is later absorbed

8. DESTRUCTIVE PHASE This begins before the inflammatory phase ends. Macrophages continues its cleaning process and stimulate the formation of fibroblast. This stage last for 2 to 5 days.

9. PROLIFERATIVE PHASE This phase begins with the appearance of a new blood vessels and last from 3-24 days. Fibroblast appear alongside the capillaries . These two together constitute the granulation tissues. Subsequently there is epithelization. All the cells forming the surface epithelium undergoes rapid division and migrates as a thin film covering the wound. The wound appear pink owing to the new capillaries in the granulation tissues and the area is soft and tender.

10. MATURATION PHASE This final phase may take more than one year There is formation of scar by the fibroblast. The capillaries and lymphatic endothelial bud in the new tissues disappear and the scar then shrinks. The collagen scar continues to regain strength over several months.

11. WOUND DRESSING DEFINITION It is a sterile protective covering applied to a wound/incision with aseptic technique with or without medications. or It is cleansing of a wound or incision and apply sterile protective covering using aseptic technique.

12. TYPES OF WOUND DRESSINGS Dressing are vary by the types of material and mode of application. Gauze dressings Non-antiseptic dressings Antiseptic dressings Wet dressings Pressure dressings Self-adhesive transparent film (Tegaderm).

13. PURPOSES OF WOUND DRESSINGS To prevent infection. To prevent further tissues damages. To promote healing To prevent haemorrhage. To apply medication in place. To restore the function of the parts. To provide physical and mental comfort to the patient. To promote thermal insulation to the wound surface area.

14. PRINCIPLES / INSTRUCTIONS INVOLVES IN WOUND DRESSING Clean the area where there is less number of organism, before cleaning the area where there is more organism. To minimize the spread of organism to the clean area. Any break in the skin and mucus membrane acts as the portal of entry for the pathogenic organism. Practice strict aseptic technique to prevent cross infection in the wound and from the wound. All material touching the wound should be sterile.

15. Wash hands thoroughly before and after the procedure. Instruments used for one dressing cannot be used for another until they have been re-sterilized. Use mask. Sterile gloves and gown for large dressings to minimize the wound contamination. Dressings should not be changed for at-least 15 minutes after the rooms has been swept or cleaned. Create sterile field around the wound by spreading sterile towel. Avoid talking , coughing and sneezing when the wound is open