Surgical Wound care Tarja Bergfors RN for surgical
Surgical Wound care Tarja Bergfors RN for surgical nursing M. Ed. Sc Turku University of Applied Science
Postoperative wound management
Classification of wounds n Wound's age acute wound =vulnus, chronic wound =ulcus - fresh wound vulnus recens < 6 h - outdated wound vulnus inveteratum > 6 h - chronic wound 2 -3 kk - n Wound's depth - a simple wound =vulnus simplex - Complicated wound = vulnus complicatum - the body cavity extending wound =vulnus penetrans - penetrating wound =vulnus perforans
Stages of wound healing 1. 2. 3. phase of inflammatory= Phase von entzündlichen phase of proliferative = Phase der proliferativen phase of remodeling= Phase der Umgestaltung
Inflammatory Phase A) Immediate to 2 -5 days B) Hemostasis Vasoconstriction Platelet aggregation Thromboplastin makes clot C) Inflammation Vasodilation Phagocytosis
Proliferative Phase A) 2 days to 3 weeks B) Granulation Fibroblasts lay bed of collagen Fills defect and produces new capillaries C) Contraction Wound edges pull together to reduce defect D) Epithelialization Crosses moist surface Cell travel about 3 cm from point of origin in all directions
Remodeling Phase A) 3 weeks to 2 years B) New collagen forms which increases tensile strength to wounds C) Scar tissue is only 80% as strong as original tissue
Factors affecting wound healing… n n n The principles of correct wound care 1. The patient (age, health status, lifestyle ) 2. Aseptic 3. Instruments Tissue oxygenation Wound location (crook=Falte) Type and amount of missing tissue (mucous=Schleimhaut) mucous=
n n n Factors affecting wound healing Temperature Classification of purity (how clean the wound is)= Klassifizierung der Reinheit Technical issues (hematoma, surgical technique, stitches ) Decreased immune response (=Verminderte Immunabwehr? ) Nutritional factors = Ernährungsfehler
Postoperative wound management
Traumatic wound
Postoperative wound management n n n n Circulation = Blutzirkulation Bleeding and haematoma Tight suturing = Enge Naht Swelling of the wound=Schwellung der Wunde Monitoring the drain The signs of wound infections=die Anzeichen von Wundinfektionen Pain= Schmerz
Wound management after surgery Aseptic principles n Fresh wound < 24 hours: if it’s needed to open because of bleeding, use sterile equipments and materials n Possible to remove dressings > 24 hours: use factory clean gloves or an instrument n Insert dressing or tape or can be without any dressing
Infected surgical wound
Complications n Hematoma - sometimes develops into wound, usually heals n n by itself - where appropriate, puncture Rupture of wound - either before or after removal of the sutures - cause deterioration of tissue resistance, Infections
Infected surgical wound n Surgical site infections are general (4 – 10% ) n Superficial wound infections n Deep wound infections n Body infections n Wound infections depends on the presence of surgery and purity(clean) classes n Antibiotics by mouth
Infected surgical wound
Identification of an infected wound n Redness, flushes, swelling, pain Bad secretion n Leak sensitivity is increasing n n The wound surface is broadened and deepened improvement/healing process slows
Surgical drain a drain removes blood and other fluids from a surgical wound Monitor that: n the drain is on it’s place n it’s open n the vacum is working n
Surgical drain Monitor that: n skin area is clean (disinfection solution if it’s not clean) n cover with dressing n measure the bleeding n document!
Removing a drain n n Inform the patient Pain medication Remove the suture or tape Close the drain and draw it out in line with the drain tube New dressing
n Thank you! n Děkuji vám! n Kiitos!
References n n n Lewis, Collier and Heitkemper. 1996. Medical –Surgical Nursing. Assessment and management of clinical problems. Worley C. 2005. So, what do I put on this wound? Dermatology Nursing 17(4), 299 -300. Kozier, Erb; Berman & Snyder. 2009. Fundalmentals of Nursing. Wound care. Prentice Hall. Hietanen H, Iivanainen A, Seppänen S & Juutilainen V. 2009. Haava. WS Bookwell, Porvoo. Iivanainen A, Jauhiainen M & Pikkarainen P. 2011. Sairauksien hoitaminen terveyttä edistäen. Helsinki, Tammi.
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