The disruption of the integrity of the skin at different diameters and depths as a result of an acute injury is an acute wound, and the healing process begins rapidly unless there is a dirty, necrotic wound. Wounds that do not heal in seven to fourteen days are chronic wounds. Pressure sores, diabetic wounds and venous wounds are in this group. Healing of these wounds requires a long medical and surgical treatment process. Chronic wound causes:
In bedridden patients, metabolism slows down, muscles atrophy, blood flow slows down, respiratory problems, hypoxia begin, contractures develop in the joints, osteoporosis, constipation occurs and skin integrity is impaired.
It is more common in patients who are bedridden and generally in areas where there is little subcutaneous tissue and a bone protrusion. It consists of ulceration and necrosis that occurs as a result of long-term or frequently repeated pressure.
Among the causes of pressure sores: old age, malnutrition, obesity, cachexia, smoking, stress, hypertension, hyperthermia, hypothermia, diabetic neuropathy, long-term shock, coma, orthopedic surgeries, sepsis, fractures, fecal and urinary incontinence, diarrhea, long-term stay in the intensive care unit, urinary tract infections. infection, cancer, edema and acid accumulation.
The wound must be described and staged in detail. Thus, the success of wound care increases.
Wound healing occurs in four stages.
Hemostasis Phase
After injury, hemostasis and inflammation processes begin. Clots and vasoconstriction occur at the ends of small vessels. Platelets release factors that initiate tissue repair. At this stage, wound care can prevent bleeding and clot formation and prevent bacterial contamination.
Inflammation Phase
It is the basic phase of wound healing. High vascular permeability enables blood cells to migrate to the injury site. Vasoconstriction caused by platelet factors disappears and bradykinin and histamine are secreted from mast cells thirty minutes after the injury. Leukocytes protect the body against microorganisms and clean the wound. In immunocompromised patients, the normal inflammation phase does not occur and recovery is delayed.
Proliferation Phase
At this stage, the wound has the appearance of a bright red cauliflower and is rich in blood vessels. Resistance to tearing in the wound is provided by collagen synthesis. New blood vessels are formed and this vascularization continues until the end of wound healing. During the wound healing process, the wound edges begin to recede and epithelial cells close the wound bed.
Maturation Stage
Tension increases, the vascular bed disappears, and the scar tissue turns dark red. After a while, as nutrition increases, it turns into a silvery color.
of the wound; It is achieved by cutting off contact with infectious agents, trauma, chemical and toxic agents that are likely to cause harm, and not creating conditions in the wound that would require re-surgical intervention.
Aim; It is to clean dirty and infected wounds to prepare them for healing and to ensure that the wound remains clean until normal healing occurs. Wound care and the type of dressing vary depending on the type, width, depth and characteristics of the wound.
In primary healing wounds, it is sufficient to cover the incision with a dry sterile dressing. Surgical incisions may be left open in some circumstances. Transparent dressings (spray) can be used on clean wounds/injuries.
The care of the wound left for secondary healing varies as red, yellow and black wound.
Nutrition is very important in improving general health and maintaining well-being. Nutritional sources containing protein, carbohydrates, vitamins (vitamin C), fluid and minerals are required for wound healing. If necessary nutrients are not taken sufficiently, wound healing will be negatively affected.
Since smoking reduces prostaglandin and fibrinogen production and causes vasoconstriction, the patient should be informed that it should not be used until the wound heals.
Individual cleaning and dressing practices should be done very carefully to avoid damaging the wound dressing or drain. There are approaches to leave the wound area open 1-2 days after surgery. If the wound area is covered with a special dressing, care should be taken to prevent these dressings from coming off while moving. Wet dressings should be changed within the first 24 hours after surgery. Bathing should be done as a shower, with a transparent film applied to the wound. Clothing should not tighten the wound area and should be loose and comfortable. Clothes and bedding should be changed immediately when they become dirty with blood and similar waste leaking from the wound. Bad odor may occur in infected wounds, necessary precautions should be taken.
Continuous observation (control of bleeding, observation of signs of inflammation, color and odor of the drainage and signs of infection),
Recording and photographing wound healing forms the basis of wound healing.
The most important point in fever management is to determine the cause of fever. Although fever is often associated with a damaging event, an increase in body temperature can be beneficial to an individual's defense mechanism. To reduce the patient's fever; Antipyretic drugs are given (at intervals of 2-4 hours) and cold application is applied. Thus, heat loss is achieved through evaporation.
Resting the inflamed area and keeping it still shortens the inflammatory process, helps the repair process, and reduces metabolic demand. Immobilization with a cast, fixation material, and bandage reduces the possibility of wound debris and bleeding. Rest ensures the effective use of oxygen and nutrients. The patient's sleep pattern may be disrupted due to pain in the wound or discomfort caused by the discharge. The patient's feeling of discomfort can be reduced with appropriate interventions.
It reduces edema in the inflammation area and therefore pain. It facilitates venous return. By accelerating circulation, it helps the effective use of nutrients and oxygen necessary for recovery.
It is necessary for the differentiation of fibroblasts, acceleration of collagen synthesis, cell division and development.
Cold application; It is applied immediately after trauma. It reduces edema, pain and congestion. Hot application; It is applied after 24-48 hours. It accelerates circulation in the inflamed area.
Patients; They may experience stress due to scarring or deformity caused by the incision or wound, immobility, and excessive wound drainage. Using inappropriate facial expressions (grimace, etc.) while changing the dressing may create anxiety and fear in the patient by giving the impression that there is a problem with the wound.
The nurse's knowledge and skills in wound care are also important factors that affect the patient's psychology.
Providing the patient with the necessary explanations about the wound healing process and the changes that occur during healing will be an effective approach in reducing fear and anxiety. An important point that should not be ignored in wound care is that "care is not limited to the wound alone, but the patient must be considered as a whole (bio-psycho-social)."
Patient and Family