Pathophysiology of the skin and wound care

• What are the functions of the skin

  1. protection - barrier against foreign matter, dehydration, UV light
  2. Sensation - sense organ
  3. Movement without injury
  4. Excretion - regulating the volume and chemical content of sweat
  5. Vitamin D production - exposure to UV light
  6. Immunity - specialized cells that attack and destroy pathogenic microorganisms
  7. Temperature regulation - heat production and heat loss
• Wound definition

  A break in the skin or mucous membrane : an altercation I the skin integrity and underlying issues
• Causes of wounds

  Surgical incision

  Trauma

  Pressure

  Shearing force

  Friction

  Poor circulation
• what makes developing a would more likely

  broken skin

  age (young or old)

  nutritional status

  stress

  hereditary

  disease process

  medical therapies
• Types of wound

  Intentional - surgical

  Unintentional - trauma

  Open wound - skin or mucous is broken

  Closed wound - tissues are injured but the skin is not broken

  Clean wound - not infected

  Contaminated wound -high risk of infection

  Infected wound - contains bacteria

  Chronic wound - does not heal easily

  Partial thickness wound - epidermis and dermis of skin is broken

  Full thickness wound - epidermis, dermis and subcutaneous tissue are involved and may involve muscle or bone
• abrasion 


  scraping or running away of the skin
• contusion

  closed wound caused by a blow to the body
• incision

  open wound with clean straight edges
• laceration

  open wound with torn and jagged edges
• penetration wound

  skin and underlying tissues are pierced
• puncture wound

  open wound from a sharp object
• factors that influence the healing of a wound

  age

  nutrition

  obesity

  extent of wound

  wound stress

  circulating oxygen

  smoking

  drugs

  chronic diseases

  infection (local / systematic)
• types for wound drainage

  serous

  sanguineous

  serosanguineous

  purulent
• serous drainage appearance

  clear water fluid
• sanguineous drainage appearance

  bloody
• serosanguineous drainage appearance

  thing watery drainage - blood tinged
• Purulent drainage appearance

  Thick green, yellow or brown drainage
• types of drains

  Penrose drain

  hemovac

  Jackson-pratt

  t-tube
• penrose drain

  an open drain that drain exudate onto the dressing; no structure, safety pin prevents slippage into the wound, drains by gravity
• hemovac

  closed suction drainage, structured in place
• Jackson-pratt

  closed suction drainage, structured
• t-tube

  closed drainage, structured, drains by gravity
• best practice for drainage

  keep drainage tubes free of kinks

  drainage collection resivoir is emptied every eight hours and when 1/2 to 1/3 full

  drainage volume decreases 2-3 days after insertion

  report any purulence, foul odor, redness around the insertion site, bleeding
• measuring drains

  note the number and size of dressings with drainage (describe the. amount of drainage)

  weighing dressing before and after removal

  measuring the amount of drainage in the collection receptacle
• wound complications

  drains and drainage - colour, consistency, odor and amount

  odor of the wound

  surrounding skin

  pain assessment of the patient

  physiological indicators - temp, pulse
• Wound complications pt2

  Hemorrhage

  Shock

  Infection

  Dehiscence

  Evisceration

  Fistula
• Signs and symptoms of skin infection

  Erythema and edema

  Painful and tender

  Drainage and odor

  Fever

  Fatigue

  Rash

  Change in WBC

  Loss of appetite

  Mucous membrane sores

  In elderly - confused, agitated, incontinent