Wound Care
Contents:
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Wound Care Introduction
Wound Care Signs and Symptoms
Home Care
When to Call the Doctor
When to Go to the Hospital
Physician Diagnosis
Wound Care Treatment
Prognosis
Prevention
Glossary
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:
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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.
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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.
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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.
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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
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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.
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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.
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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.
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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.
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Stop the bleeding: If bleeding will not stop, apply a clean bandage to the
area and press down on it for 10 minutes.
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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.
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Check when you last had a tetanus shot.
When to Call the Doctor
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All bites and any cut or laceration greater than 1/2-inch long in which you
can see fat or deeper tissues (muscle or bone) will require medical
attention.
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If bleeding is brisk or blood spurts with your heartbeat or does not stop
after 10 minutes, your doctor should be called.
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If there is still dirt and debris in an abrasion after your best attempt at
cleaning the area, you should notify your doctor.
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Any redness extending from the wound after 2 days or yellow drainage
from the area should warrant medical attention.
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You should find out from your doctor when you last had a tetanus shot. If
the wound was dirty, you should have one if it has been more than 5 years
since your last tetanus immunization. You should have this done within 48
hours of the injury.
When to Go to the Hospital
Most doctors will not stitch a cut or laceration that is more than 8-12 hours old. This is
because there is a greater chance of infection after that time. In fact, after 3 hours, the
incidence of infection begins to increase. Therefore, do not wait to have the injury
repaired. If you are in doubt, call your doctor or go to the nearest hospital's emergency
department. An open wound takes longer to heal and leaves a bigger scar.
Reasons to go to the hospital if you have a wound:
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Obvious life-threatening wounds (Call 911 for emergency services.)
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Any laceration greater than 1/2-inch long that is through all layers of the
skin exposing the underlying fat.
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If you cannot stop the bleeding
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If the blood continues to "spurt" from the wound (Apply pressure and go to
the hospital’s emergency department.)
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If you think that there may be something in the wound such as glass, wood,
or rust, for example
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If you cannot move your finger or toe in the area of the laceration, or you
have lost sensation in the area beyond the laceration
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For any bite wound (human or animal)
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If your physician cannot see you that day
Physician Diagnosis
The doctor will want to know how the injury occurred, what home care you did for the
injury yourself before coming in, if you feel as if there is anything in the wound, and
when your last tetanus shot may have been.
You will be asked about your general health, present medications, and any allergies to
medications. Conditions such as diabetes, cancer, AIDS, immunosuppression, sickle
cell disease, and clotting abnormalities affect wound healing. Steroids and
chemotherapy drugs also interfere with wound healing.
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If a hand or finger is involved, the doctor will want to see that you are able
to move the extremity or finger through its full range of motion. There is a
difference between not being able to bend or extend a finger or not being
able to do so simply because it is uncomfortable. Sensation and circulation
to the area will be tested carefully as well.
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If there is some suspicion of a foreign body in the wound or an underlying
bone break, an x-ray may be ordered.
Wound Care Treatment
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After careful examination and evaluation, the wound will once again be
cleaned.
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The area will then be numbed with a local anesthetic. This will allow a deeper
examination of the wound as well as repair without any further discomfort. You
may feel pressure, but no pain.
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If the wound requires stitches, it will be cleansed with an antiseptic solution,
and sterile towels or drapes placed over the area.
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The doctor will wear sterile gloves and put in the stitches to bring the
wound edges together.
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Once this has been accomplished, the area will be washed off once
again and a sterile bandage applied.
You will be given further instructions regarding care of the wound.
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Generally the bandage is kept on for 2 days. You should keep it clean
and dry, elevating it whenever possible to minimize swelling and pain.
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Over-the-counter pain relievers such as acetaminophen (Tylenol) or
ibuprofen (Motrin) are usually sufficient for any pain.
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You will be told when the stitches need to be removed. Once they are
removed, small tapes may be applied over the wound to lessen the
stress on the healing wound and to lower the amount of scarring,
especially if on the face.
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Use a sunblock (not a sunscreen) on the area for 6 months to avoid
discoloration from sun exposure.
Bites may not be sutured unless a large area is involved or the bite involves the
face. Many of these become infected, so most doctors prefer to leave them
open for daily wound care. You usually will be given antibiotics for bite
wounds.
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Abrasions will be washed and scrubbed, if needed. It is important that all the
dirt and debris be removed because tattooing (permanent skin discoloration)
may result if this debris is left in the wound.
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Puncture wounds will require careful examination. If there is any dirt or debris
in the wound, the doctor may remove this small area so that an infection does
not occur.
Prognosis
Most wounds heal just fine if given proper care.
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Overall, the infection rate is 6.5%. Redness around the wound, a red line
extending toward the body from the wound, or yellowish drainage from the
wound are signs of infection and require immediate re-evaluation by a
doctor.
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Keeping the sutures clean and avoiding the formation of a scab over them
aid in a good cosmetic result. A dilute peroxide solution or plain water may
be used. It is all right to wash a sutured wound after 48 hours, but it should
not be soaked.
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Antibiotics are not necessary in most cases.
Prevention
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Take care when using sharp objects such as knives, scissors, saws, and
trimmers.
Wear shoes or boots on your feet.
Use helmets when riding a bicycle.
Use helmets, kneepads, wrist protectors, and elbow pads when using inline skates.
Avoid picking up broken pieces of glass and handling razor blades.
Glossary
Abrasion: An abrasion or "excoriation" is a wearing away of the upper layer of skin as
a result of applied friction force. In dentistry an "abrasion" is the wearing away of the
tooth substance.
Acetaminophen: A pain reliever and fever reducer. Brand name: Tylenol. The exact
mechanism of action of acetaminophen is not known. Acetaminophen relieves pain by
elevating the pain threshold (that is, by requiring a greater amount of pain to develop
before it is felt by a person). Acetaminophen reduces fever through its action on the
heat-regulating center (the "thermostat") of the brain. Generic is available.
Anesthetic: A substance that causes lack of feeling or awareness. A local anesthetic
causes loss of feeling in a part of the body. A general anesthetic puts the person to
sleep .
Antiseptic: Something that discourages the growth microorganisms. By contrast,
aseptic refers to the absence of microorganisms.
Bacteria: Single-celled microorganisms which can exist either as independent (freeliving) organisms or as parasites (dependent upon another organism for life).
Blood: The familiar red fluid in the body that contains white and red blood cells ,
platelets , proteins , and other elements. The blood is transported throughout the body
by the circulatory system . Blood functions in two directions: arterial and venous.
Arterial blood is the means by which oxygen and nutrients are transported to tissues
while venous blood is the means by which carbon dioxide and metabolic by-products
are transported to the lungs and kidneys, respectively, for removal from the body.
Bone: Bone is the substance that forms the skeleton of the body. It is composed
chiefly of calcium phosphate and calcium carbonate . It also serves as a storage area
for calcium, playing a large role in calcium balance in the blood.
Cancer: An abnormal growth of cells which tend to proliferate in an uncontrolled way
and, in some cases, to metastasize (spread).
Capillaries: Capillaries are the smallest of blood vessels. They serve to distribute
oxygenated blood from arteries to the tissues of the body and to feed deoxygenated
blood from the tissues back into the veins. The capillaries are thus a central
component in the circulatory system, essentially between the arteries and the veins.
When pink areas of skin are compressed, this causes blanching because blood is
pressed out of the capillaries. The blood is the fluid in the body that contains, among
other elements, the red blood cells (erythrocytes) that carry the oxygen and give the
blood its red color.
Cell: The basic structural and functional unit in people and all living things. Each cell is
a small container of chemicals and water wrapped in a membrane .
Chemotherapy : 1. In the original sense, a chemical that binds to and specifically kills
microbes or tumor cells. The term chemotherapy was coined in this regard by Paul
Ehrlich (1854-1915).
2. In oncology, drug therapy for cancer. Also called "chemo" for short.
Circulation: The movement of fluid in a regular or circuitous course. Although the noun
"circulation" does not necessarily refer to the circulation of the blood, for all practical
purposes today it does. Heart failure is an example of a problem with the circulation.
Collagen: Collagen is the principal protein of the skin, tendons, cartilage, bone and
connective tissue.
Cuts: Severed skin. Washing a cut or scrape with soap and water and keeping it clean
and dry is all that is required to care for most wounds. Putting alcohol hydrogen
peroxide, and iodine into a wound can delay healing and should be avoided. Seek
medical care early if you think that you might need stitches. Any delay can increase the
rate of wound infection. Any puncture wound through tennis shoes has a high risk of
infection and should be seen by your healthcare professional. Any redness, swelling,
increased pain, or pus draining from the wound may indicate an infection that requires
professional care.
Dermis: The lower or inner layer of the two main layers of cells that make up the
skin.The dermis contains blood vessels, lymph vessels, hair follicles, and glands that
produce sweat , which helps regulate body temperature, and sebum , an oily substance
that helps keep the skin from drying out. Sweat and sebum reach the skin's surface
through tiny openings in the skin that act as pores.
Diabetes: Refers to diabetes mellitus or, less often, to diabetes insipidus . Diabetes
mellitus and diabetes insipidus share the name "diabetes" because they are both
conditions characterized by excessive urination (polyuria).
Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or
decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any
problem. The diagnosis was a plugged IV.
Dominant: A genetic trait is considered dominant if it is expressed in a person who has
only one copy of that gene. (In genetic terms, a dominant trait is one that is
phenotypically expressed in heterozygotes).
Elbow: The juncture of the long bones in the middle portion of the arm. The bone of the
upper arm (humerus) meets both the ulna (the inner bone of the forearm) and radius
(the outer bone of the forearm) to form a hinge joint at the elbow. The radius and ulna
also meet one another in the elbow to permit a small amount of rotation of the forearm.
The elbow therefore functions to move the arm like a hinge (forward and backward)
and in rotation (outward and inward). The biceps muscle is the major muscle that
flexes the elbow hinge, and the triceps muscle is the major muscle that extends it. The
primary stability of the elbow is provided by the ulnar collateral ligament, located on
the medial (inner) side of the elbow. The outer bony prominence of the elbow is the
lateral epicondyle, a part of the humerus bone. Tendons attached to this area can be
injured, causing inflammation or tendonitis (lateral epicondylitis, or tennis elbow). The
inner portion of the elbow is a bony prominence called the medial epicondyle of the
humerus. Additional tendons from muscles attach here and can be injured, likewise
causing inflammation or tendonitis (medial epicondylitis, or golfer's elbow). See also:
Elbow bursitis ; Elbow pain ; Nursemaid's elbow.
Emergency department: The department of a hospital responsible for the provision of
medical and surgical care to patients arriving at the hospital in need of immediate care.
Emergency department personnel may also respond to certain situations within the
hospital such cardiac arrests.
Environment: The sum of the total of the elements, factors and conditions in the
surroundings which may have an impact on the development , action or survival of an
organism or group of organisms.
The epidermis is mostly made up of flat, scale-like cells called squamous cells . Under
the squamous cells are round cells called basal cells. The deepest part of the
epidermis also contains melanocytes. These cells produce melanin , which gives the
skin its color.
Epithelial: Relating to the epithelium, the outside layer of cells that covers all the free,
open surfaces of the body including the skin, and mucous membranes that
communicate with the outside of the body.
Extremity: The extremities in medical language are not freezing cold or scorching heat
but rather the uttermost parts of the body. The extremities are simply the hands and
feet.
Fat: 1 Along with proteins and carbohydrates, one of the three nutrients used as
energy sources by the body. The energy produced by fats is 9 calories per gram.
Proteins and carbohydrates each provide 4 calories per gram. 2 Total fat; the sum of
saturated, monounsaturated and polyunsaturated fats. Intake of monounsaturated and
polyunsaturated fats can help reduce blood cholesterol when substituted for saturated
fats in the diet. 3 A slang term for obese or adipose. 4 In chemistry, a compound
formed from chemicals called fatty acids. These fats are greasy, solid materials found
in animal tissues and in some plants. Fats are the major component of the flabby
material of a body, commonly known as blubber.
Feet: The plural of foot, both an anatomic structure and a unit of measure.
Hospital: It may seem unnecessary to define a "hospital" since everyone knows the
nature of a hospital. A hospital began as a charitable institution for the needy, aged,
infirm, or young.
Ibuprofen: A non-steroidal anti-inflammatory drug (NSAID) commonly used to treat
pain, swelling, and fever . Common brand names for Ibuprofen include Advil, Motrin,
and Nuprin.
Immunization: Vaccination. Immunizations work by stimulating the immune system,
the natural disease-fighting system of the body. The healthy immune system is able to
recognize invading bacteria and viruses and produce substances (antibodies) to
destroy or disable them. Immunizations prepare the immune system to ward off a
disease. To immunize against viral diseases, the virus used in the vaccine has been
weakened or killed. To immunize against bacterial diseases, it is generally possible to
use only a small portion of the dead bacteria to stimulate the formation of antibodies
against the whole bacteria. In addition to the initial immunization process, it has been
found that the effectiveness of immunizations can be improved by periodic repeat
injections or "boosters." Also see Immunizations (in the plural) and Immunization of a
specific type (such Immunization, Polio).
Immunosuppression: Suppression of the immune system . Immunosuppression may
result from certain diseases such as AIDS or lymphoma or from certain drugs such as
some of those used to treat cancer . Immunosuppression may also be deliberately
induced with drugs, as in preparation for bone marrow or other organ transplantation
to prevent the rejection of the transplant .
Incidence: The frequency with which something, such as a disease, appears in a
particular population or area. In disease epidemiology, the incidence is the number of
newly diagnosed cases during a specific time period. The incidence is distinct from the
prevalence which refers to the number of cases alive on a certain date.
Infection: The growth of a parasitic organism within the body. (A parasitic organism is
one that lives on or in another organism and draws its nourishment therefrom.) A
person with an infection has another organism (a "germ") growing within him, drawing
its nourishment from the person.
Injury: Harm or hurt. The term "injury" may be applied in medicine to damage inflicted
upon oneself as in a hamstring injury or by an external agent on as in a cold injury .
The injury may be accidental or deliberate, as with a needlestick injury . The term
"injury" may be synonymous (depending on the context) with a wound or with trauma .
Laceration: A cut.
Muscle: Muscle is the tissue of the body which primarily functions as a source of
power. There are three types of muscle in the body. Muscle which is responsible for
moving extremities and external areas of the body is called "skeletal muscle." Heart
muscle is called "cardiac muscle." Muscle that is in the walls of arteries and bowel is
called "smooth muscle."
Nail: In medicine, there are two types of nails. One is just a plain old metal nail used to
hold 2 or more pieces of bone together, for example, after a fracture. The other type of
nail is the horny plate on the end of the finger or toe. Each nail anatomically has a
body, lateral nail folds (on the sides), a lunula (the little moon-shaped feature at the
base), and a proximal skin fold (at the base).
Open wound: An injury that is exposed due to broken skin. An open wound is at high
risk for infection.
Oxygen: A colorless, odorless and tasteless gas that makes up about 20% of the air we
breathe (and at least half the weight of the entire solid crust of the earth) and which
combines with most of the other elements to form oxides. Oxygen is essential to
human, animal and plant life.
Pain: An unpleasant sensation that can range from mild, localized discomfort to agony.
Pain has both physical and emotional components. The physical part of pain results
from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it
can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific
nerve fibers that carry the pain impulses to the brain where their conscious
appreciation may be modified by many factors.
Pharmacy: A location where prescription drugs are sold. A pharmacy is, by law,
constantly supervised by a licensed pharmacist.
Primary: First or foremost in time or development. The primary teeth (the baby teeth)
are those that come first. Primary may also refer to symptoms or a disease to which
others are secondary.
Prognosis: 1. The expected course of a disease .
2. The patient's chance of recovery.
The prognosis predicts the outcome of a disease and therefore the future for the
patient . His prognosis is grim, for example, while hers is good.
Proliferative: Growing and increasing in number rapidly.
Proteins: Large molecules composed of one or more chains of amino acids in a
specific order determined by the base sequence of nucleotides in the DNA coding for
the protein.
Range of motion: The range through which a joint can be moved, usually its range of
flexion and extension. Due to an injury, the knee may for example lack 10 degrees of
full extension.
Scrub: 1. As a verb, to wash the hands and forearms very thoroughly, as before
engaging in surgery. To scrub implies the use of a brush (and often an implement to
clean under the nails). To scrub, to scrub in (on a surgical procedure), and to scrub up
are synonymous.
2. As a noun, a person who scrubs, as for surgery.
3. As an adjective, pertaining to scrubbing in for surgery, as a scrub nurse or a scrub
tech.
Sensation: In medicine and physiology , sensation refers to the registration of an
incoming ( afferent ) nerve impulse in that part of the brain called the sensorium ,
which is capable of such perception. Therefore, the awareness of a stimulus as a result
of its perception by sensory receptors. (Sensory is here synonymous with sensation.)
Sickle cell disease: A genetic blood disease due to the presence of an abnormal form
of hemoglobin, namely hemoglobin S . Hemoglobin is the molecule in red blood cells
that transports oxygen from the lungs to the farthest reaches of the body.
Skin: The skin is the body's outer covering. It protects us against heat and light, injury,
and infection. It regulates body temperature and stores water, fat, and vitamin D.
Weighing about 6 pounds, the skin is the body's largest organ. It is made up of two
main layers; the outer epidermis and the inner dermis.
Stress: Forces from the outside world impinging on the individual. Stress is a normal
part of life that can help us learn and grow. Conversely, stress can cause us significant
problems.
Substance:
1- Material with particular features, as a pressor substance .
2- The material that makes up an organ or structure. Also known in medicine as
the substantia.
3- A psychoactive drug as, for example, in substance abuse .
Sunscreen: A substance that blocks the effect of the sun's harmful rays. Using lotions
that contain sunscreens can reduce the risk of skin cancer , including melanoma .
Superficial: In anatomy, on the surface or shallow. As opposed to deep. The skin is
superficial to the muscles. The cornea is on the superficial surface of the eye.
Tetanus : An often fatal infectious disease caused by the bacteria Clostridium tetani (C.
tetani) which usually enters the body through a puncture, cut, or open wound. Tetanus
is characterized by profoundly painful spasms of muscles, including "locking" of the
jaw so that the mouth cannot open (lockjaw). C. tetani releases a toxin that affects the
motor nerves, (the nerves which stimulate the muscles).
Tissue: A tissue in medicine is not like a piece of tissue paper. It is a broad term that is
applied to any group of cells that perform specific functions. A tissue in medicine need
not form a layer. Thus,
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The bone marrow is a tissue;
Connective tissue consists of cells that make up fibers in the framework
supporting other body tissues; and
Lymphoid tissue is the part of the body's immune system that helps protect
it from bacteria and other foreign entities.
Tylenol: See: Acetaminophen .
Vessel: A tube in the body that carries fluids: blood vessels or lymph vessels.
Wrist: The proximal segment (the near part) of the hand consisting of the carpal bones
and the associated soft parts.
X-ray: 1. High-energy radiation with waves shorter than those of visible light. X-rays
possess the properties of penetrating most substances (to varying extents), of acting
on a photographic film or plate (permitting radiography), and of causing a fluorescent
screen to give off light (permitting fluoroscopy). In low doses X-rays are used for
making images that help to diagnose disease, and in high doses to treat cancer .
Formerly called a Roentgen ray. 2. An image obtained by means of X-rays.
‫مع تحيات‬
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:‫صباح نوري شلاكه الكناني‬
‫الممرض الجامعي‬
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