Overview
This lecture covers the types of wounds, pressure ulcer staging, wound healing, wound prevention, and essential principles and techniques in wound care and dressing.
Types of Wounds
- Wounds are breaks or discontinuities of skin or tissue.
- Types include abrasions, lacerations, incisions, punctures, avulsions, amputations, gunshot wounds, blast injuries, surgical wounds, gangrene wounds, burns, and fungating wounds.
- Acute wounds heal at a predictable rate; chronic wounds do not heal within three months.
Pressure Ulcers
- Pressure ulcers (bed sores) are localized injuries from prolonged pressure, often over bony areas.
- Aggravated by moisture and shearing forces, especially in bedbound patients.
- Pressure ulcers are indicators of care quality.
Staging of Pressure Ulcers
- Stage 1: Intact skin with non-blanchable redness, usually over bony prominence.
- Stage 2: Partial-thickness dermis loss with red/pink wound bed, shallow open ulcer.
- Stage 3: Full-thickness tissue loss, visible fat, no exposed bone/muscle, may have slough.
- Stage 4: Full-thickness tissue loss with exposed bone or muscle, slough/eschar may be present, includes undermining/tunneling.
- Unstageable: Full-thickness loss with depth unknown due to slough or eschar covering.
- Suspected deep tissue injury: Discolored intact skin or blood-filled blister, depth unknown.
Pressure Ulcer Prevention
- Perform routine, systematic skin assessments.
- Encourage mobility and repositioning.
- Reduce friction and shear.
- Use pressure-prevention devices.
- Provide incontinence and skin care, early treatment, and optimize nutrition.
Principles of Wound Dressing
- Purpose: Remove debris/exudate, protect granulation, promote healing.
- Use standard precautions, aseptic technique, and accurate documentation.
- Assess patient history, allergies, condition, needs, and past experience.
- Assess wound etiology, duration, location, size, exudate, wound bed, edge, tunneling, and surrounding skin.
Wound Dressing Process & Equipment
- Prepare safe environment and dry, intact, unexpired equipment.
- Set up sterile field and use sterile materials, cleansing solutions, gloves, and appropriate dressings.
- Clean wound with aseptic technique: one stroke per swab, clean-to-dirty, swab wound bed, margin, and skin.
- Dispose waste properly: red bag (blood/body fluids), yellow bag (tissue).
Documentation & Technology
- Document wound condition, care provided, patient response, education, date, time, and signature.
- Use digital tools like wound apps for tracking progress and resource planning.
Advanced Wound Care
- Negative pressure wound therapy and maggot debridement therapy are specialized treatments.
- Multidisciplinary care includes surgeons, specialty doctors, nurses, dietitians, physiotherapists, social workers, and family caregivers.
Key Terms & Definitions
- Aseptic Technique — Method to prevent contamination during wound care.
- Slough — Yellow/white tissue, a sign of tissue death in wounds.
- Eschar — Dead, necrotic tissue, appears dry and black.
- Undermining — Tissue loss under intact skin at wound edges.
- Tunneling — Channeling that can occur in a wound, creating passageways.
- Granulation Tissue — New tissue formed during healing.
Action Items / Next Steps
- Watch linked videos on aseptic wound dressing and advanced wound care.
- Explore extra learning resources provided in the lecture.
- Review wound care documentation methods and digital tools.
- Prepare for practical OSCE demonstration using aseptic non-touch technique.