Wound Healing - Fundamentals of Nursing - Principles & Skills

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 to 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. It's important for the healing process. These new skin cells help to cover the wound and promote its closure. In addition to new skin cells, blood vessels also begin to form in the area, providing oxygen and nutrients to support the healing process. The final phase of wound healing is the remodeling phase. During this phase, the newly formed skin cells and blood vessels continue to mature and strengthen, and the wound gradually becomes less noticeable. It's important to note that the wound healing process can be influenced by various factors, such as age, overall health, and the size and severity of the wound. Additionally, certain medical conditions, such as diabetes, can impair the body's ability to heal wounds. So, when it comes to wound healing, a certain amount of inflammation is necessary, but excessive or prolonged inflammation can impede the healing process. Therefore, it's important to strike a balance and support the body's natural healing mechanisms. Next, we're going to talk about the different ways wounds can heal. There are three main ways: primary intention, secondary intention, and tertiary intention. Primary intention occurs when the edges of the wound are brought together and closed with sutures, staples, or adhesive strips. This is typically done with clean, straight surgical incisions. Healing by primary intention results in minimal scarring and faster healing time. It is the ideal way to heal a wound if possible. Next, we have healing by secondary intention. This occurs when the wound is left open and allowed to heal naturally from the bottom up. It is usually used for larger, deeper wounds or if there is a risk of infection. Healing by secondary intention results in more tissue regeneration and a larger, more noticeable scar. Lastly, we have healing by tertiary intention, also known as delayed primary closure. This occurs when a wound is left open for a period of time and then closed with sutures. It is typically done when there is a risk of infection or if the wound was too contaminated to close initially. Healing by tertiary intention combines aspects of both primary and secondary intention. So those are the three ways wounds can heal: primary, secondary, and tertiary intention. Now let's talk about wound approximation. Well approximated means that the edges of the wound 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, are 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 are eroded so far out from one another that they can't be brought together, so it's going to heal from the inside out. It's going to take longer and have a 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 we 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 I 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. It is very important that we maintain tight glycemic control in diabetics. This means keeping their blood glucose levels closely monitored and within a good range when they are healing from an injury, wound, or surgery. Another factor to consider is immunosuppression. Corticosteroids can cause immune suppression, so it is important to be aware of this. Finally, let's discuss drainage and wound appearance. When performing a dressing change or assessing a wound, it is important to determine if what we are seeing is normal. Different types of drainage may occur. Serous drainage is watery and clear, with perhaps a hint of a tan color. It is not thick but rather slightly off-white. This type of drainage is normal and does not indicate any issues. 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. I invite you to subscribe to our channel and share a link with your classmates and friends in nursing school. If you found value in this video, be sure to hit the like button and leave a comment letting us know what you found particularly helpful.