PNUR124 WEEK 5 STUDY GUIDE Page
Week 5: Wound Care
Types of Wound Healing
Primary intention
o Primary intention healing happens when the wound edges are
approximated e.g. by sutures, staples or glue.
Secondary intention
o Healing by second intention or Secondary intention healing takes place
when the wound edges cannot be approximated and the wound needs to
heal from the bottom.
Phases of Healing
1. Inflammatory phase – This phase begins at the time of injury and lasts up to
four days. ...
2. Proliferative phase – This phase begins about three days after injury and
overlaps with the inflammatory phase. ...
3. Remodeling phase – This phase can continue for six months to one year after
injury.
Types of Drainage
Serous
Sanguineous
Serosanguinous
Purulent
Wound Complications
Infection/sepsis
Gangrene
Nerve or organ damage
Amputation
Skin Ulcers
Skin ulcers are a common issue in geriatric and nursing home care.
The impact of skin ulcers can be significant with increased length of hospital
stays, higher rates of nursing home placement, and decreased quality of life. The
management of a large ulcer can be daunting but a sound basic approach can
have a significant impact on the majority of ulcers.
The purpose of this presentation is to provide an approach to ulcer
management, with emphasis on assessment, optimization of the healing
environment and choice of dressings
Prevention of ulcers is important in frail older patients.
Clarifying the cause and contributing factors is the first step in management.
Pressure and venous ulcers are the most common cause in the elderly. Poor
nutrition, edema, arterial insufficiency, and anemia commonly impair wound
, PNUR124 WEEK 5 STUDY GUIDE Page
healing. Adequate debridement is important to decrease infection risk and to
promote healing. Guidelines exist for the cleaning of ulcers.
The choice of dressings depends on the needs of the individual wound but
should emphasize the provision of a moist wound environment.
When you assess a wound, you need to know if the intention is to heal the
wound, prevent further injury (maintain) or treat as palliative
Need to know “heal-ability” of wound and this is dependent on the following:
o Oxygenation
o Infection
o Foreign body
o Venous sufficiency
Risk Factors for Pressure Ulcer Development
Poor mobility/immobility: Patients who are unable to independently change
position are at increased risk of developing a pressure ulcer, due to pressure
exerted over bony prominences which results in reduced blood flow to the
tissues and subsequent hypoxia.
Poor nutritional status: Although there are few studies to support this idea, it is
widely accepted (based on anecdotal evidence) that patients who are
compromised nutritionally are at higher risk for the development of pressure
ulcers; for this reason, patients with poor nutritional status may benefit from a
dietary consult.
Compromised blood flow: Whenever there is compromised blood flow to the
tissues, there is increased risk of pressure ulcer development. What are some
common reasons that blood flow might be compromised? Peripheral arterial
disease (PAD), venous insufficiency and shock are common culprits.
Neuropathy/compromised sensation: Obviously, if you cannot feel pain or
pressure, you are at higher risk of developing a pressure ulcer. Patients who fit
into this category include patients with spinal cord damage, stroke,
MS, neuropathy and other conditions that compromise one’s ability to perceive
pain and/or pressure.
Skin color/changes: Patients with darker skin pigmentation may be at risk for
pressure ulcers simply because health care professionals fail to recognize the
early signs of pressure damage (i.e. blanching erythema). In addition, patients
with conditions that change the normal appearance of the skin are at high risk
(e.g. patients with bruising, dermatitis, eczema and other skin diseases).
Support surfaces: The surface upon with the patient lies or sits can profoundly
influence pressure over bony prominences, as can lying or sitting in the same
position for long periods of time. Support surfaces should be assessed frequently
and adjusted accordingly.
Pain: Pain may prevent patients from moving, even when they are feeling the
unpleasant effects of pressure. Too much pain medication may sedate patients
to the point where they don’t change position as often as they should. Patients
Week 5: Wound Care
Types of Wound Healing
Primary intention
o Primary intention healing happens when the wound edges are
approximated e.g. by sutures, staples or glue.
Secondary intention
o Healing by second intention or Secondary intention healing takes place
when the wound edges cannot be approximated and the wound needs to
heal from the bottom.
Phases of Healing
1. Inflammatory phase – This phase begins at the time of injury and lasts up to
four days. ...
2. Proliferative phase – This phase begins about three days after injury and
overlaps with the inflammatory phase. ...
3. Remodeling phase – This phase can continue for six months to one year after
injury.
Types of Drainage
Serous
Sanguineous
Serosanguinous
Purulent
Wound Complications
Infection/sepsis
Gangrene
Nerve or organ damage
Amputation
Skin Ulcers
Skin ulcers are a common issue in geriatric and nursing home care.
The impact of skin ulcers can be significant with increased length of hospital
stays, higher rates of nursing home placement, and decreased quality of life. The
management of a large ulcer can be daunting but a sound basic approach can
have a significant impact on the majority of ulcers.
The purpose of this presentation is to provide an approach to ulcer
management, with emphasis on assessment, optimization of the healing
environment and choice of dressings
Prevention of ulcers is important in frail older patients.
Clarifying the cause and contributing factors is the first step in management.
Pressure and venous ulcers are the most common cause in the elderly. Poor
nutrition, edema, arterial insufficiency, and anemia commonly impair wound
, PNUR124 WEEK 5 STUDY GUIDE Page
healing. Adequate debridement is important to decrease infection risk and to
promote healing. Guidelines exist for the cleaning of ulcers.
The choice of dressings depends on the needs of the individual wound but
should emphasize the provision of a moist wound environment.
When you assess a wound, you need to know if the intention is to heal the
wound, prevent further injury (maintain) or treat as palliative
Need to know “heal-ability” of wound and this is dependent on the following:
o Oxygenation
o Infection
o Foreign body
o Venous sufficiency
Risk Factors for Pressure Ulcer Development
Poor mobility/immobility: Patients who are unable to independently change
position are at increased risk of developing a pressure ulcer, due to pressure
exerted over bony prominences which results in reduced blood flow to the
tissues and subsequent hypoxia.
Poor nutritional status: Although there are few studies to support this idea, it is
widely accepted (based on anecdotal evidence) that patients who are
compromised nutritionally are at higher risk for the development of pressure
ulcers; for this reason, patients with poor nutritional status may benefit from a
dietary consult.
Compromised blood flow: Whenever there is compromised blood flow to the
tissues, there is increased risk of pressure ulcer development. What are some
common reasons that blood flow might be compromised? Peripheral arterial
disease (PAD), venous insufficiency and shock are common culprits.
Neuropathy/compromised sensation: Obviously, if you cannot feel pain or
pressure, you are at higher risk of developing a pressure ulcer. Patients who fit
into this category include patients with spinal cord damage, stroke,
MS, neuropathy and other conditions that compromise one’s ability to perceive
pain and/or pressure.
Skin color/changes: Patients with darker skin pigmentation may be at risk for
pressure ulcers simply because health care professionals fail to recognize the
early signs of pressure damage (i.e. blanching erythema). In addition, patients
with conditions that change the normal appearance of the skin are at high risk
(e.g. patients with bruising, dermatitis, eczema and other skin diseases).
Support surfaces: The surface upon with the patient lies or sits can profoundly
influence pressure over bony prominences, as can lying or sitting in the same
position for long periods of time. Support surfaces should be assessed frequently
and adjusted accordingly.
Pain: Pain may prevent patients from moving, even when they are feeling the
unpleasant effects of pressure. Too much pain medication may sedate patients
to the point where they don’t change position as often as they should. Patients
