Skin Integrity - Wound Healing - PPT
Skin Integrity - Wound Healing - PPT
Skin Integrity - Wound Healing - PPT
Objectives
Skin integrity
Wound
Suturing
Stich removal
summary
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Objectives
Demonstrate suturing
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Brain storming
Skin
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•Skin enables us to assume our own identity and to
recognize among ourselves.
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Anatomy of Skin
The skin or integumentary system is the
largest system of the body.
Hair, nails, and skin glands are a part of this
organ system.
The skin is a thin, relatively, flat organ that
is classified as a cutaneous membrane.
It forms a protective boundary between the
internal environment of the body and the
external environment.
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Skin Layers
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Diagram of the Skin
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Epidermis
The outer skin layer that is in direct
contact with the environment
The epidermis has five layers
Contains skin pigment (melanin) that
gives color to the skin
Contains a water repellant protein
called keratin
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Epidermis …
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Dermis
Composed of collagen (a tough
fibrous protein layer), blood vessels,
and nerve cells
70% of the dermis layer is collagen which
is very important in wound healing
Dermis restores the physical properties of
the skin and its structural integrity
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Dermis…
Provides mechanical strength of the skin
Provides a reservoir storage area for water
and important electrolytes
Contains a specialized network of nerves
and nerve endings for sensation of pain,
pressure, touch, and temperature
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Dermis…
Hair follicles
Collagen makes the skin stretchable &
elastic
Point of attachment for smooth and
voluntary muscles
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Subcutaneous Layer
Is not part of the skin itself, but supplies
the major blood vessels and nerves to the
skin above
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Breakout
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Functions of the Skin
Functions of the skin are crucial for
maintenance of homeostasis.
1.Protection
Barrier against bacteria, foreign matter,
dehydration, ultraviolet (UV) light
2. Sensation
Sense organ
3. Movement without injury
4. Excretion
Regulating the volume and chemical content of
sweat
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Functions of the Skin
5. Vitamin D production
Exposure of skin to UV light
6. Immunity
Specialized cells that attack and destroy
pathogenic microorganisms
7. Temperature regulation
Heat production and heat loss (shivering,
vasoconstriction, etc)
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Functions of the Skin cont’d
8.Psychosocial
9.Absorption
10.Elimination
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Wound
A break in the skin or mucous membrane;
An alteration in the integrity of the skin and
underlying tissues.
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Causes
Accidental falls
Handling of sharp objects
Gunshot
Burn
Vehicle accident
Animal bite -etc.
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Classification
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Types of Open Wounds
1. Abrasion
• The surface and sometimes deeper layers of the
skin is scraped off.
• Bleeding is usually limited, but infection must be
prevented because dirt and contaminants often
enter the wound.
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Incision
• This cut is caused by a sharp object such as a knife,
scissors, or razor
• The edges are smooth and regular
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Puncture cont’d
Are compound wounds which involve deeper
structures.
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Avulsion
• Occurs when tissue is torn or ripped away from the victim’s
body
• It can result in a piece being torn and hanging from the ear,
nose, hand, or any other body part
• Wrap the body part in sterile gauze, wet it, bag it, and ice it
make sure it goes w/pt
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Amputation
Occurs when a body part is cut off or torn off
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Missile injuries
& complicated.
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Bites
A. CLEAN-CONTAMINATED:
Cholecystectomy procedures.
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Septic wound-----
B. CONTAMINATED WOUND :
Leave open these wounds initially for 5days when the resistance
to infection is increased.
traumatic wounds
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SEPTIC WOUND-----
C. DIRTY WOUND :
Gunshot wound
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What are the stages of wound healing?
Hemostasis
Inflammation
Epithelialization
Angiogenesis
Fibroplasia
Wound contracture
Scar remolding
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Phases of wound healing ------
Secondary—healing by granulation.
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Phases of healing---
Coagulation phase:
The first phase of healing which is induced immediately
following injury.
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Phases of healing-----
INFLAMMATORY PHASE:
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PHASES OF HEALING-----
PROLIFERATIVE PHASE:
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Answer to Question
Answer: C. Proliferation phase
Rationale:
In the proliferation phase, granulation tissue is formed to fill the
wound. In hemostasis, involved blood vessels constrict and blood
clotting begins.
In the inflammatory phase, white blood cells move to the wound.
In the maturation phase, collagen is remodeled, forming a scar.
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PHASES OF HEALING-----
MATURATION PHASE:
up to one year.
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Types of Wound Healing
SECOND INTENTION :
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Types of Wound Healing cont’d
THIRD INTENTION
Healing occurs when there is a delay in the time.
For example, a wound may be left open temporarily to allow for drainage
or removal of infectious materials.
surgical wounds are left open 3 - 5 days & then sutured closed.
When the wound closes later, in the mean time, wound surfaces start to
granulate.
Scaring is common.
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Wound Healing Influencing Factors
Age
Nutrition
Obesity
Extent of wound
Wound stress
Circulating oxygen
Smoking
Drugs
Chronic diseases
Infection (local/systemic)
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Wound Complications
Hemorrhage
May be internal or external
Shock
Infection
Dehiscence
Separation of wound layers, usually abdominal, caused by
wound stress (coughing, vomiting, abdominal distention)
Evisceration
Separation of wound with protrusion of abdominal organs.
osurgical emergency
o cover with normal saline sterile dressings.
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Wound Observations
Wound location
May have multiple wounds from surgery or trauma
Wound size and depth
Measure in centimeters
Size - measure from top to bottom, side to side
Depth - use a sterile swab into the depth of the open wound
Wound appearance
Red, swollen, area around wound warm to touch, sutures, staples -
intact or broken
4 Cs in determining muscle viability
Color
Consistency
Contraction and
Circulation
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Types of wound dressing
Clean wound dressing
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Dressing of a clean wound
Purpose:
To keep wound clean.
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Equipment
Sterile gallipots.
Sterile gauze.
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Equipment
Antiseptic solution as ordered.
Scissors.
Benzene or ether.
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Technique
Place rubber sheet and its cover under the affected side.
Remove the outer layer of the dressing e.g. adhesive tape bandage.
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Procedure:-----
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Method of Application
Leave patient comfortable and tidy
N.B.
The above-mentioned equipment can be prepared in a
separate pack if central sterilization department is available.
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DRESSING OF SEPTIC WOUND
The purpose is to:
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Equipment
Pick up forceps in a container.
Sterile forceps -3
Sterile gallipot
Sterile gauze.
Sterile test tube or slide
Sterile cotton ball and - tipped application
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Equipment
Spatula.
Probe and director if required
Scissors.
Benzene or ether
Bandages or adhesive tape.
Bucket to put in soiled dressing.
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Procedure
Explain procedure.
Place rubber sheet & its cover under the affected part
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Procedure-------
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Procedure
unintentional wound
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Contraindication
1. Edema of the wound margins
2. Infection
3. Puncture(deep) wounds
4. Animal bites
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Precautions
1. Check that the patient gets TAT before he leaves the hospital.
2. Do not suture puncture (deep) wound.
3. Before you suture any wounds make sure it is free of any
foreign body.
4. The completed knot must be tight, firm, and tied
5. To avoid wicking of bacteria, knot should not be placed in
incision lines
6. Knots should be small and the ends cut short (2-3mm)
7. Avoid using a jerking motion, which may break the suture
8. Do not tie suture too tightly as tissue ischemia may occur.
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Primary closure
Primary closure is effective in wounds presenting
within 6-8 hours & should accurately be debrided.
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Uses of different sizes of sutures
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Technique for interrupted sutures
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Technique for simple continuos sutures
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Suture sizes and suggested indications for their use
Wound suturing Equipment
Sterile field set
1. Tray or trolley covered with a sterile towel
2. Sterile needle holder
3. Sterile suture scissors
4. Sterile round needle (2)
5. Sterile cutting needle (2)
6. Sterile hole towel (fenestrated towel)
7. Sterile kidney dish(2)
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Wound suturing Equipment cont’d
8. Sterile needle and syringe
9. Sterile gloves
10. Sterile tissue forceps(2)
11. Sterile cotton swabs in gallipots
12. Sterile gauze
13. Sterile artery forceps(3)
14. Sterile needle holder (2)
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Clean tray
3. Adhesive plaster
4. Local anesthesia
5. Light bulb
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Procedure
Check the order for suturing
Great the patient, introduce yourself and explain the
purpose of the procedure to the patient.
Adjust light
Wash your hands
Clean trolley or tray, assemble sterile equipment on one
side & clean items on the other side and make sure that the
sterile equipments are properly covered.
Clean the wound thoroughly
Wash your hands again
Put on sterile gloves , skin test with TAT & administer TAT
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Procedure-----
Drape the Wound with the hole- sheet
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Procedure-----
Using the cutting needle and silk: suture the skin.
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The Stitch Removal
Technique: Use aseptic technique
Principles:
Do not cut stitches in more than one place as a part of it maybe
left behind and may cause infection.
Pull-up gently the knot resting against the skin with the
forceps, pass the point of the scissors under the knot then
cut the stitch on one side and remove.
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Stitch removal-----
Receive pieces of stitches on a sterile gauze.
Apply dressing.
days
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