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Surgical Wound care

Surgical Wound care. Tarja Bergfors RN for surgical nursing M.Ed.Sc Turku University of Applied Science. Postoperative wound management. Classification of wounds. Wound's age acute wound = vulnus , chronic wound = ulcus - fresh wound vulnus recens < 6 h

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Surgical Wound care

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  1. Surgical Wound care Tarja Bergfors RN for surgical nursing M.Ed.Sc Turku University of Applied Science

  2. Postoperativewound management

  3. Classification of wounds Wound's age acute wound =vulnus, chronic wound =ulcus - fresh wound vulnus recens < 6 h - outdated woundvulnus inveteratum > 6 h - chronic wound2-3kk Wound's depth - a simple wound =vulnus simplex - Complicated wound =vulnus complicatum - the body cavity extending wound =vulnus penetrans - penetrating wound =vulnus perforans

  4. Stages of wound healing 1. phase ofinflammatory= Phase von entzündlichen 2. phase of proliferative = Phase der proliferativen 3. phase of remodeling= Phase der Umgestaltung

  5. InflammatoryPhase A) Immediate to 2-5 days B) Hemostasis Vasoconstriction Plateletaggregation Thromboplastinmakesclot C) Inflammation Vasodilation Phagocytosis

  6. ProliferativePhase A) 2 days to 3 weeks B) Granulation Fibroblastslaybed of collagen Fillsdefect and produces new capillaries C) Contraction Woundedgespulltogether to reducedefect D) Epithelialization Crossesmoistsurface Cell travelabout 3 cm frompoint of origin in alldirections

  7. RemodelingPhase A) 3 weeks to 2 years B) New collagenformswhichincreasestensilestrength to wounds C) Scartissue is only 80% as strong as originaltissue

  8. Factorsaffectingwoundhealing… The principles of correct wound care1. The patient (age, health status, lifestyle) 2. Aseptic 3. Instruments Tissue oxygenation Wound location (crook=Falte) Type and amount ofmissing tissue (mucous=Schleimhaut)

  9. Factorsaffectingwoundhealing Temperature Classification of purity (howclean the wound is)= Klassifizierung der Reinheit Technical issues(hematoma, surgicaltechnique, stitches) Decreasedimmuneresponse (=Verminderte Immunabwehr?) Nutritionalfactors = Ernährungsfehler

  10. Postoperative wound management

  11. Traumatic wound

  12. Postoperative wound management • 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

  13. Wound management after surgery Aseptic principles Fresh wound < 24 hours: if it’s needed to open because of bleeding, use sterile equipments and materials Possible to remove dressings > 24 hours: use factory clean gloves or an instrument Insert dressing or tape or can be without any dressing

  14. Infected surgical wound

  15. Complications Hematoma - sometimes develops into wound, usually heals by itself - where appropriate, puncture Rupture of wound - either before or after removal of the sutures - cause deterioration of tissue resistance, Infections

  16. Infected surgical wound Surgicalsiteinfectionsare general (4 – 10% ) Superficialwoundinfections Deep woundinfections Bodyinfections Woundinfectionsdepends on the presence of surgery and purity(clean) classes Antibioticsbymouth

  17. Infected surgical wound

  18. Identification of an infected wound Redness,flushes,swelling,pain Bad secretion Leak sensitivity is increasing The wound surface is broadened and deepenedimprovement/healing process slows

  19. a drain removes blood and other fluids from a surgical wound Monitor that: the drain is on it’s place it’s open the vacum is working Surgical drain

  20. Monitor that: skin area is clean (disinfection solution if it’s not clean) cover with dressing measure the bleeding document! Surgical drain

  21. Removing a drain 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

  22. Thank you! • Děkuji vám! • Kiitos!

  23. References • 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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