WOUND

WOUND
A wound is is a break in the continuity of a tissue of the body, either internal or external. external. It is a type of injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it wound). specifically refers to a sharp injury which damages the dermis of the skin. skin.

CLASSIFICATION OF WOUND

Open wounds is a break in the skin or in a mucous membrane. It can be classified according to the object that caused the wound. The types of open wound are:
 Incisions Incised wounds, or cuts in-body tissues are commonly caused by knives, metal edges, broken glass, or other sharp objects commonly cause incised wounds, or cuts, in-body tissues. The degree of bleeding depends on the depth and extent of a cut. Deep cuts may involve blood vessels and may cause extensive bleeding. They may also damage muscle, tendons, and nerves.

 Lacerations - are jagged, irregular, or blunt breaks or tears in the soft tissues. Bleeding may be rapid and extensive. The destruction of tissue is greater in lacerations than in cuts. The deep contamination of wounds that result from accidents involving moving parts of machinery increases the chances of later infection.

MANAGEMENT:
Minor lacerations 1. Clean the laceration site well with warm water and an antibacterial soap. 2. Most bleeding can be stopped with direct pressure and time (rest and elevation are also helpful). 3. Apply an antibiotic ointment such as Bacitracin or Neosporin as prescribed 4. Cover the laceration with a Band-Aid or sterile gauze. Change the Band-Aid daily or when soiled. When the dressing is changed, clean the site and reapply the ointment. 5. If red streaks or drainage appear around the laceration, please contact your primary care physician immediately. If the laceration involves the full thickness of the skin, stitches may be required to close the laceration site. If stitches are placed, the wound care is as follows: 1. Keep the site clean. 2. Apply antibiotic ointment if instructed to by your doctor. 3. Elevate the site to prevent or decrease pain, swelling and throbbing. 4. Take Tylenol or Ibuprofen for pain per the directions on the bottle. 5. Return to your doctor to have the stitches removed within 7-10 days or when asked. 6. Monitor the site for drainage or redness. If this occurs, contact your primary care physician immediately, 7. Once the stitches are removed you can apply Vitamin E to the site and massage the scar to minimize scarring.

 Abrasions - results from scraping (abrading) the skin and thereby damaging it. Bleeding in an abrasion is usually limited to oozing of blood from ruptured small veins and capillaries. However, there is a danger of contamination and infection, because of dirt and bacteria may have been ground into the broken tissues. Abrasions commonly result from falls or the handing of rough objects. Example are skinned knees, rope burns (which are actually abrasions, not burns), and shallow multiple scratches.

 Punctures - are produced by bullets and pointed objects, such as pins, nails, and splinters. External bleeding is usually minor, but the puncturing object may penetrate deeply into the body and this damage organs and soft tissues and sever internal bleeding. Because puncture wounds generally are not flushed out by external bleeding, they are more likely than some other wounds to become infected. Tetanus organisms and other harmful bacteria that grows rapidly deep within body tissues by a penetrating object.

MANAGEMENT:
1. Remove the object if you can. 2. Stop the bleeding - apply firm, direct pressure with sterile gauze or clean cloth until bleeding stops. 3. Clean and protect the wound Rinse the wound under clean water for several minutes. Then wash the area with mild soap and water and rinse again. Apply an antibiotic cream. Use a sterile bandage to protect the puncture wound from dirt or further injury. 4. Follow-up See a healthcare provider for any signs of infection: redness, increasing pain, swelling, or pus at the site. Ask the health care provider if a tetanus shot is needed. Some wounds may need antibiotics. Ask the health care provider.

 Avulsions - Avulsion wounds involve the forcible separation or tearing of tissue from the victim s body. Avulsions are commonly caused by animal bites and accidents involving motor vehicle, heavy machinery, guns and explosives. They are usually followed immediately by a heavy bleeding, a detached finger, toe, nose tip, ear, or, in rare cases, whole limb may be successfully attached to a victim s body by a surgeon if the severed part is sent with the victim to the hospital.

MANAGEMENT:
1. Stay Safe. If you are not the victim, practice universal precautions and wear personal protective equipment if available. 2. Control bleeding with direct pressure and elevation, avoiding tourniquets unless bleeding cannot be controlled and and medical care will not be available for several hours. 3. Rinse the wound with water or saline solution, the cleaner the better. Sterile irrigation is the best. 4. If the tissue (skin, fat, and muscle) is not completely removed, replace the flap and dress the wound. If the tissue is completely separated from the victim's body, collect it if available and bring it with the victim to the emergency department. 5. Avulsion injuries will often need medical care, especially if the injury was from an animal bite. Bites have a high incidence of infection. 6. If bleeding cannot be controlled, or if the area of the avulsion cannot be covered by both of the victim's open hands, go to the near hospital.

 Amputations - A traumatic amputation is the nonsurgical removal of the limb from the body. Bleeding is heavy and requires a tourniquet, which will be discussed later, to stop the flow. Shock is certain to develop in these cases. As with avulsed tissue, wrap the limb in sterile dressings , place it in a cool container, and transport it to the hospital with the victim. Do not allow the limb to be in direct contact with ice, and do not immerse it in water or saline. The limb can often be successfully reattached. Penetration wounds - caused by an object such as a knife entering and coming out from the skin.

Gunshot wounds - caused by a bullet or similar projectile driving into or through the body. There may be two wounds, one at the site of entry and one at the site of exit, generally referred to as a "through-and-through."

Closed wounds involve underlying tissues without a break in the skin or a mucous membrane. It is just as dangerous as open wounds. The types of closed wounds are:
 Contusions - injuries resulting from a forceful blow to the skin and soft tissue, however leaving the outer layer of skin intact. These injuries generally require minimal care as there is no open wound. However, contusions should be evaluated for possible hematoma deep to the surface or other tissue Injuries that may indicate more severe morbidity. An expanding hematoma can damage overlying skin and demands evacuation.  Hematomas - also called a blood tumor, caused by damage to a blood vessel that in turn causes blood to collect under the skin.  Crush injury, caused by a great or extreme amount of force applied over a long period of time.

Complications of Wound

Hemorrhage Hemorrhage (massive bleeding) is abnormal. A dislodged clot, a slipped stitch, or erosion of a blood vessel may cause severe bleeding. The risk of hemorrhage is greatest during the first 48 hours after surgery. Hemorrhage is an emergency; the nurse should apply pressure dressings to the area and monitor the client s vital signs. Infection Contamination of a wound surface with microorganisms (colonization) is an inevitable result. Because the colonizing organisms compete with new cells for oxygen and nutrition, and because their by-products can interfere with a healthy surface condition, the presence of contamination can impair wound healing and lead to infection. Infection suggested by the presence of a change in wound color, pain, or drainage is confirmed by performing a culture of the wound.

Dehiscence Dehiscence is the partial or total rupturing of a sutured wound. Dehiscence usually involves an abdominal wound in which the layers below the skin also separate. Evisceration Evisceration is the protrusion of the internal viscera through an incision.

MANAGEMENT FOR DEHISCENCE AND EVISCERATION:

1. Stay with the patient to ease the patient's anxiety. Tell him to stay in bed. If possible, stay with him while someone else notifies the physician and collects the necessary equipment. 2. Place a linen-saver pad under the patient to keep the sheets dry when you moisten the exposed viscera. 3. Place the moistened dressings over the exposed viscera. Then place a sterile, waterproof drape over the dressings to prevent the sheets from getting wet. 4. Moisten the dressings every hour by withdrawing saline solution from the container through the syringe and then gently squirting the solution on the dressings. 5. When you moisten the dressings, inspect the color of the viscera. If it appears dusky or black, notify the physician immediately. With its blood supply interrupted, a protruding organ may become ischemic and necrotic.

6. Keep the patient on absolute bed rest in low Fowler's position (no more than 20 degrees' elevation) with his knees flexed. This prevents injury and reduces stress on an abdominal incision. 7. Don't allow the patient to have anything by mouth to decrease the risk of aspiration during surgery. 8. Monitor the patient's pulse, respirations, blood pressure, and temperature every 15 minutes to detect shock. 9. If necessary, prepare the patient to return to the operating room. After gathering the appropriate equipment, start an I.V. infusion, as ordered. 10.Insert an NG tube and connect it to continuous or intermittent low suction, as ordered. 11.Continue to reassure the patient while you prepare him for surgery. Make sure he has signed a consent form and that the operating room staff has been informed about the procedure. 12.Administer preoperative medications to the patient, as ordered.

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Serlyn D. Rodulfo BSN - IIIA