Fundamentals - Practice & Skills, part 13: Wound Healing
August 02, 2021 Updated: August 03, 2021 6 min read
Hi, I'm Meris, and in this video, we're going to be talking about wound healing. I'm going to be following along using our Fundamentals of Nursing flashcards. These are available for purchase on our website, leveluprn.com, along with a lot of other amazing flashcards. If you're following along with me using your own set, I am starting on card number 81. Let's get started.
Okay. So first off, we're going to start talking about the phases of wound healing. Keep in mind, this applies for small wounds and big ones, but they all have the same phases in common. It just may take more or less time, depending on the type of wound. So first we have hemostasis. The goal of hemostasis is to stop bleeding. Hemo means blood. Stasis means stop. So that's going to be through the process of vasoconstriction and using our clotting cascade and activating platelets so that we can actively stop that bleeding. We're going to move on to the inflammatory stage after that. I want you to pay careful attention to this because inflammation is a normal part of wound healing, to an extent. So inflammation is important because this is what allows for the neutrophils, the first responders, to get to the injured area so that they can start gobbling up the pathogens and trying to prevent infection. If you remember way back to A&P, they do this through a process called diapedesis. Diapedesis is done by vasodilating those capillaries to make them leaky. Leaky capillaries allow neutrophils out, but they can also cause swelling, and this is why we see swelling and edema and pain with inflammation. After that point in time, we are at the proliferation phase of wound healing. Proliferate means to make more of. So in this phase, we are generating new skin cells that are going to actually fill and cover the wound to help to regenerate the tissue that was lost because of that injury. And then we are at the maturation phase. And the phase here is going to be remodeling that scar tissue, which can take a long time. It can take a year or more to rebuild that collagen and get that nice strong scar tissue in there. So those are the phases of wound healing.
Next up, we're going to be talking about healing by intention, and you will hear this referred to, healing by primary, secondary, or tertiary intention, literally means, first, second, and third way of doing something. So if you'll see here on our card, we have some bold red text to really let you know that something's important, so pay careful attention to that. When we heal something by primary intention, this means that the edges of the wound are well approximated. Well approximated means that they are brought together well. So they are touching. I think of this surgery that I just had right here. This is healing by primary intention. I had a surgical incision made. The edges were approximated, brought together with surgical sutures, and then that's how the wound is healing. That is going to be very common with surgery. Things like paper cuts, that sort of thing, is going to heal by primary intention.
Now, when we heal by secondary intention, a wound is intentionally left open to heal through granulation. So this is going to be granulation, contraction, and epithelialization. This is going to happen when we heal basically from the inside out is how you can think about it. This is going to have a higher risk of infection but longer healing times. A good example of this would be a pressure injury. It's not something where we can really approximate the edges. They're eroded so far out from one another they can't be brought together, so it's going to heal from the inside out. It's going to take longer and higher risk of infection. And then tertiary intention is when the closure of a wound is intentionally delayed. So this might mean that it has become open or it is left open, and we delay the closure so that can irrigate the wound, debride the wound, and observe it usually for about a week, and then we're going to close it surgically when the risk for infection is lower.
Okay. Now moving onto complications and barriers of healing. This is a big one because you need to know who is most at risk for poor wound healing. If you see here, there's a ton of bold, red information on these cards here, so I would say definitely make sure you feel comfortable with all of it. Let's talk about it. So one of the complications of wound healing is going to be dehiscence. Dehiscence is when a previously closed wound opens back up. This could be for a lot of reasons, but the point here being, dehiscence refers to a closed wound separating and opening. Now evisceration is dehiscence with organs protruding. So for instance, if this wound here on my elbow were to dehisce, these layers would pop open and separate but nothing is going to eviscerate, right? It's not in a location where it can. But when I had abdominal surgery, if I had dehiscence in that area, it's possible that it could go deep enough. It could open all the way potentially and cause evisceration where my bowels, my organs are actively exposed and on the outside of my body, right? When that happens, it's a true medical emergency, and this is going to be one of the times where you need to know what to do. So we need to put saline moistened gauze. Not water, right? We do not want bacteria, and we need the right isotonicity. We need it to be the same tonicity as our body fluids. So saline moistened gauze over the open area. I'm going to lower the head of the bed, maybe even put them in Trendelenburg. And then I'm going to notify the provider immediately. After I put saline-moistened gauze on and lower the head of the bed, there's nothing else that me can do-- that I can do as the nurse, right? The only thing I can do after that point is call the provider. They need surgical intervention immediately.
Now, barriers to healing, there are a lot. In general, chronic illnesses are going to complicate wound healing almost all the time, right? A big one we think of would be diabetes mellitus. That's going to be a problem with circulation. We're going to have poor circulation, and that can cause impaired healing, as well as any time we have fluctuating blood glucose levels, we can impact our healing as well. So very important that we keep tight glycemic control on diabetics, meaning that we keep their blood glucose level in a good range very closely when we're trying to have them heal from some kind of an injury or wound or surgery. Other things would be immunosuppression. Corticosteroid can cause immune suppression, so things like that to be aware of.
Lastly, we're going to talk about drainage and wound appearance. You need to know, when you're doing a dressing change or assessing a wound, "Is what I'm seeing normal?" So we can have different types of drainage. Serous is going to be that watery, kind of clear, maybe has a little hint of a tan color-- not tan. It's not thick, but it's just kind of maybe a little off-white, I would say. Serous draining, that's normal. It's nothing crazy going on there. Serosanguineous, so serous fluid mixed with blood, sanguineous, is going to be kind of pink tinged. So it's going to be maybe a light pink. Then we have sanguineous. Sanguineous means bloody, so this is going to be bright red discharge here, drainage, and then purulent. When we have something that is purulent, it means it is looking like pus. This is going to be thick, cloudy. It might be white, yellow, or beige. It's going to smell bad. Any time discharge smells foul, we need to be concerned about that. Malodorous, mal meaning bad, odor meaning smell, right? A bad smell. It's not good. That indicates infection. And then when we talk about what the wound itself looks like, know that a red wound that has a beefy appearance, that's a healthy looking wound. We like that. That means that there is good circulation happening. If we have a yellow wound, that probably means that it needs to be cleaned. And if it is black, it means we need debridement. We need to actually remove the dead necrotic skin or tissue from that area so that it can heal in a good way.
Okay. I hope that review was helpful. If it is, please go ahead and like this video. That would mean so much to us. If you have a great way to remember something, I definitely want to hear it in the comments below. And be sure to subscribe to the channel, because you want to be the first to know when our next video posts, which is going to be talking about diabetic foot care and wound care. Thanks so much, and happy studying.
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