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Skin & wound
Learning Outcomes:
• Label a diagram of the skin (epidermis and dermis)
• Describe the structure and function of the skin
• Explain process of wound healing
SKIN STRUCTURE IMAGE
Epidermis:
• Protects other layers from outside environment
• Contains cells that make Keratin which waterproofs and
strengthens the skin
• It has cells with Melanin which give the skin its colour
• Other cells in the epidermis allow us to feel and provide immunity
against invaders such as bacteria
Dermis:
•
•
Contains cells that provide strength, support and flexibility
Has sensory receptors to allow the body to receive stimulation from
the outside
...
Wounds that fail to heal may cause:
• Depression
• Negative self-image
• Lessen their self-worth
• Difficulty in doing normal day to day activities
For a nurse to heal a wound, they will have to make a diagnosis which involves:
• Dressing choice
• Use of compression
•
•
Review of medication
Any lifestyle or psychosocial factors
A holistic assessment is a discussion with your doctor, nurse, or other health
professional involved in your care to talk about your physical, psychological,
spiritual and social needs
...
Wound assessments require all of the nurse’s senses including listening as well
as touching, smell and how it looks
...
In the assessment, clinicians can discuss option with patients and ask questions
encouraging them to make choices and decisions
...
However there are some factors that may hinder this assessment by nurses:
• Lack of knowledge
• Insufficient time
The size of the wound is important to assess and can help determine the
wound’s progression, deterioration and its upcoming management
...
Exudate is a fluid produced by the circulatory system that contains and
transports cellular elements across the wound bed
...
• Normal or healthy exudate is straw/amber in colour
When describing exudate, we must look at the dressings' appearance:
• Dry - indicates no visible moisture, not an ideal environment for
healing
• Moist - more ideal with surrounding skin and looks healthy
• Wet - not ideal environment, indicates the dressing is having
difficulty dealing with exudate
• Saturated - very concerning, likelihood of deteriorating surrounding
skin
Aetiology = causes of a wound/disease
Acute Wounds
These are wounds that may not need any nursing attention as it heals itself
within a period of 4 weeks
...
g
...
Such wounds require staples, clips or sutures to bring the wound edges
together and hold in place but in most cases will also heal within 4 weeks
...
To heal a wound successfully a nurse must know how, when and where the
wound occurred
...
Any debris
such as gunpowder, glass or virulent pathogens left in the wound may prolong
the inflammatory phase of healing
...
Chronic Wounds
These are wounds that may worsen a number of times before they heal, and
some not ever heal
...
Almost all wounds are colonised by bacteria and is the main reason to cause
infections, however chronic wounds can tolerate a lot of bacteria and continue
to heal
...
Things that may hinder the inflammation process are:
• Medication - e
...
steroids or anti-inflammatories slow down the
process of healing
• Old age - tissue regeneration in elders is slow
• Smoking - obstruct blood flow
Most chronic wounds are often categorised as 'ulcers' which have different
aetiologies
...
Arterial Aetiology
Arterial ulcers are much harder to manage and arterial diseases must be
confirmed before the wound can be managed
...
Other features include:
• Absence of hair
• Limb feels cold
• Appear dusky in colour
• Reduced blood pumping into the area
•
Sharp pains when elevating the limb
Diabetic Aetiology
These wounds are also complicated and are characterised by degeneration of,
or damage to, the peripheral nerves, resulting in a loss of sensation and
autonomic dysfunction
...
•
•
•
Motor neuropathy results in muscle weakness, atrophy, and
paresis
...
Autonomic dysfunction causes vasodilation and decreased
sweating, impairing skin integrity and leaves the patient at risk of
infection
Sinus tract wounds
This is a narrow opening or passageway extending from a wound underneath
the skin in any direction through soft tissue and results in dead space with
potential for swelling
...
Pressure Ulcers
Pressure ulcers arise from a combination of sustained pressure and shearing
forces and potentially further complicated by friction
...
In darker
skin, the skin tone may appear red, blue or purple
...
This has a yellow, brown or grey/black substance that sticks to the wound bed,
which is made of dead white cells and bacteria, rehydrated necrotic tissue and
fibrous tissue
...
it is classified as non-viable tissue, and may prolong the inflammatory process
so that new cellular growth and granulation is slowed
...
• This can bleed easily
• But indicates any infection
Wound Infections:
This can usually be shown through signs of:
• Delayed healing
• New/increasing pain
• Warmth
• Tenderness
• Swelling
• Pus discharging from wound
• Odour
• Pyrexia
• Hypergranulation
Wound Healing
There are three methods of wound healing
...
Primary - the wounds are closed by maintaining the edges stick
together through mechanical aids e
...
sutures, staples and tissue
adhesives
...
2
...
3
...
g
...
This approach is only used because:
• There's a risk of contamination/infection
• Risk of swelling
• Poor vascular blood supply
The process of wound healing goes like this:
Haemostasis -> phase of early inflammation -> destructive phase/late
inflammation -> proliferative phase -> maturation phase
Step 1: Haemostasis
• Vasoconstriction - blood vessels tighten to minimalise bleeding
...
9%
• Tap water
• Antiseptics