Wound Care Wound Care Introduction A wound is a break in the skin (the outer layer of skin is called the

epidermis). Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some scarring. The object of proper care is to minimize the possibility of infection and scarring. There are basically 4 phases to the healing process: Inflammatory phase: The inflammatory phase begins with the injury itself. Here you have bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells clear the wound of debris over the course of several days. Proliferative phase: Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar. Remodeling phase: This begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of 6 months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin. Epithelialization: This is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis). Wound Care Signs and Symptoms Scrapes and abrasions are superficial (on the surface). The deeper skin layers are intact, and bleeding is more of a slow ooze. They are usually caused by friction or rubbing against an abrasive surface. Lacerations (cuts) go through all layers of the skin and into the fat or deeper tissues. Bleeding may be more brisk or severe. Severe blows by a blunt object, falls against a hard surface, or contact with a sharp object are the most common causes of lacerations. Puncture wounds are generally caused by a sharp pointed object entering the skin. Most common examples are stepping on a nail, getting stuck with a needle or a tack, or being stabbed with a knife. Bleeding is usually minimal, and the wound may be barely noticeable. Human bites and animal bites can be puncture wounds, lacerations, or a combination of both. These wounds are always contaminated by saliva and require extra care. Home Care Scrapes and abrasions often do not require any more care than washing the area 4 times daily for the first 48 hours and keeping the area covered with a sterile bandage. Deeper wounds and bites will require medical attention. Stop the bleeding: If bleeding will not stop, apply a clean bandage to the area and press down on it for 10 minutes. Clean the wound: Water under pressure is the best way to clean a wound. Either a briskly running faucet or a hand-held shower nozzle is the best way to wash a wound. The wound should be washed for 10-15 minutes. Make sure you remove all dirt and debris. Do not scrub deep wounds or bites, just wash them out. Check when you last had a tetanus shot. Signs and Symptoms of Wound Infection Serious complications may result from neglected wounds and, at times, even the best cared for wounds. If you notice any of these signs when examining your wounds, see a health care provider immediately:

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Redness or excessive swelling in the wound area Throbbing pain or tenderness in the wound area Red streaks in the skin around the wound or progressing away from the wound Pus or watery discharge collected beneath the skin or draining from the wound Tender lumps or swelling in your armpit, groin or neck Foul odor from the wound Generalized chills or fever CARDI NAL SIG NS AND SYM PT OM S OF W O UND INFECT ION A p ati ent who h a s an inf ec ted w o u n d may s h o w s ympt oms at t h e wound site a n d als o h a v e g en er al s ympt oms . S ym pt oms at t h e w o u n d site ar e c aus ed by t h e inf lam m ati on pr oc es s . The g en er ali z ed s igns a n d s ympt oms of inf ec ti on ar e t h e b od y's res p ons e to inf ec tion. The d egr ee to whic h a p ers on s h ows s om e or al l of th es e s ympt oms d ep ends gr eatl y on how s ever e t h e inf ec ti on is a n d how much r es is tanc e to inf ec tion a p ers on h as . H er e ar e s igns a n d s ympt oms of w o u n d inf ec ti on. a. At t h e w o u n d s ite: (1) Pai n a n d t end ern es s . (2) Red n es s a n d s welling. (3) Inc reas ed l oc al t emp er atur e. (4) For m ati on of pus . (5) Cellulitis . In this c onditi on, inf ec ti on s preads thr ough t h e s ubc ut an eous layer of s kin. Si gns a n d s ym pt oms inc lud e ed em a, (f luid r et ent i on), er yt h em a (r edn es s ), warmt h, a n d l oc al p ain. (6) L ym ph an gitis /l ymp h ad enitis . T his is inf lamm ati on of t h e l y m p h c h ann els a n d n od es in dic at ed by r ed s tr eaks l eading a w a y f rom t h e wou nd. (7) L oc al inf ec ti on h a s a d ef in ed ar ea whi l e inf ec tion th at is s pread ing is illdef in ed wit h ob vi ous in vol vem ent to t h e s urr oundi ng ar ea. b. In vol vem ent of t h e entir e b od y is evi d enc ed by f ever a n d possible c hills .

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PROPER WOUND CLEANSING

Proper wound cleansing, treatment, and protection from contamination can prevent infections. The following three simple steps are recommended for infection prevention. CLEAN the Wound Clean the wound and surrounding area gently with mild soap and rinse with water. Blot dry with gauze pads. These sterile gauze pads prepare the wound for the next step without introducing contaminants. TREAT the Wound Treat the wound with antibiotic ointment to protect against infection. PROTECT the Wound Protect the wound by covering it with a gauze pad to absorb fluids and prevent further contamination. Handle only the edges of the gauze pad. Secure with first aid tape to help keep out dirt and germs. For people with diabetes, poor circulation can result in a slower healing process, so preventing infections while aiding the bodys natural healing process is important. Covering any wounds with first aid tape and gauze can help prevent infection and speed healing by keeping infection and germs out. For years, people have believed that keeping wounds uncovered to let them air out helps them heal faster. Extensive research has proven this is untrue. A covered wound

Heals more efficiently Sterile wound covers help absorb a wound s fluids and maintain a natural moisture balance that is ideal for healing. Skin cells are able to migrate seamlessly without drying out and developing into a scab to form new, smooth tissue.

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Decreases the chance of scarring Keeping a wound covered until it heals can prevent a scab from forming, thereby minimizing chances of scarring. Has less chance of infection Sterile wound covers help prevent exposure to water, dirt, and germs. Enjoys superior protection The extra cushioning provided by first aid covers protects a wound from re-injury until it is completely healed.

An uncovered wound

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Dries out and forms a scab Scabs impede the healing process by creating a barrier between healthy skin cells. The cells have to work their way under the scab in order to form new tissue and heal. Has a greater chance of scarring Scabs formed from leaving a wound uncovered often result in unwanted scars. Has a greater chance of re-injury When the body forms a scab, it s nature s way of protecting against germs. However, scabs can be scratched or torn, causing re-injury that prolongs healing.

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