Wound Care

Art and Science

Treat the

Cause,Patient/Family

and

the Wound

A combination that can prove difficult

 Long-term Goal
Increase knowledge base of wound care providers
Provide a training tool for wound care including
Palliative wounds
Wound assessment, cause and treatment will be
enhanced
Wound care knowledge will be demonstrated by
increased Quality of Care, use of assessment
tools and Best Practice Recommendations,post
learning test, on unit demonstration
evaluations, patient questionnaire
SWAT team development
 Customer Wishes
Knowledge on wound care advancements
Knowledge of wound care products and
their uses
Knowledge on wound assessment and
evidence based treatments and
management
Pain control in wound care
Adjunctive therapies in Wound care
 Fulfilling
Customer Needs
Presentation based on regionally accepted
wound care program (Winnipeg Regional
Health Authority wound Care Program)
Slide presentation, interactive product
demonstration, evidence based reading
material, interactive care planning based
on actual case histories
Interdisciplinary participation
Pre and Post learning questionnaires
Presentation evaluation
 Strengths and Advantages
Knowledge will increase wound healing and
decrease admissions and length of care in
acute care facility, while maintaining
wound care across continuum
Wound care will remain consistent across
the care continuum, transitions will be
smooth
Client teaching will provide client centred
care and improve prevention of wound
development
 Next Steps of Action
A letter to the Regional Home Care
Director and the Regional Vice President
requesting approval to conduct a needs
assessment for education on wound care
Designed and provided the needs
assessment questionnaire
Receive approval from the designer of the
original teaching tool for wound
care,Beth Kondratuk, to use her files and
information in my design of a modular
education tool to include malignancies,
and non healing
 Next Steps of Action
Review previous training tools
Complete new educational tool with additions to
the original tool
Prepare wound dressings and hand on practical
portion of presentation, dolls with wounds and
design of wound care plan, different wound
dressing types, VAC, ABI Assessments,Braden
scale, Time Scale, DIM and Dime
Presentation team development – Pain control,
Physiotherapy, Occupational Therapist,product
educator
 Next Step of Action

Therapy, Directors of Health services

(acute, long-term care, home care),
Physicians, Pharmacy and Wound Nurse
Prepare for presentation – posters,
registration pamphlets, proposed dates
for educational sessions, printed
handouts, pre and post educational tests
 Training- Wounds only the
Beginning
Acknowledgement of Winnipeg Regional
Health authority Wound Care Team and
Wound Care Manual
Beth Kondratuk BN,CNS – Wound Care
Educator slide designs
− International Interdisciplinary wound Care
Course, University of Toronto, Toronto,
Ontario, Canada – information and guidance
 Wound Care
Where Art And
Science Combine
to Produce Success
 Agenda
A&P of skin and Principles of wound healing
Treat the cause
Prevention and management of:
Pressure ulcers
Arterial and venous ulcers
Diabetic foot ulcers
Malignant Wounds
Treat the wound
Care of the wound bed and dressing selection
The Skin

Largest body organ

10-15% of body's weight

1/3 of total blood supply

> 20 feet square feet

 Epidermis
Varies in thickness depending on it's
function 0.04mm eyelids – 1.6 mm
palms of hands
Protection for the Dermis
Physical barrier to micro organisms
& environmental insults
Made up of 5 layers – cells in different
stages of maturation
 Epidermal Layers
Basal Layer -bottom consists of melanocytes
& Keritinocytes
Melanocytes – produce melanin – protects
from UV light
Keritinocytes (epidermal cells) split in two
as they move up towards the stratum
corneum, outer most layer of epidermis
Stratum corneum regenerates every 4-6
weeks, avascular
Epidermal Junction -fibres, blood vessels,
and nerves – separates epidermis from the
dermis
 Dermis
Thicker then epidermis
Supports the epidermis
Thick like jelly – moulds to irregular shape
Function:
Strength
Support
Blood

Oxygen
 Subcutaneous Layer

Loose Adipose & Connective tissue, anchors skin

to deep tissue

Padding, insulation
Each square cm of skin contains:
15 sebaceous glands
1 yard of blood vessels
100 sweat glands
3000 sensory nerves
4 yards of nerves
300,000 epidermal cells
and 10 hairs
Function of the Skin
Barrier between body and
external environment

Regulates body temperature

Produces Vitamin D by
absorption of ultra violet
light and protects from
ultra violet light

Eliminates waste products

through perspiration

Immunologic -immune
cells in epidermis and
dermis
 Age Related Changes
Dermis thinning
Decreased strength of
collagen & elastin
Weakening of
epidermal/dermal
junction &
dermal/subcutaneous
junction Cell replacement slower
Easily damaged Slow repair process
Dry less efficient sweat Nerves less efficient
& oil glands Thickening of nails
Less fat, cushioning Presence of age spots
Diminished blood -brown
circulation Less melanin produced –
easily damaged
Increase in skin growth
tags,moles
Principles of Wound Healing

Complex,
dynamic
and
delicate
process
 Factors that Influence Healing
Systemic (internal) – manage
medical conditions- Diabetes,
peripheral vascular disease,
incontinence
Local (external) – pressure, friction
Iatrogenic (adverse effects of
medications or treatments) things
we do as care providers
(inappropriate technique)
 Systemic
Depressed immune system: cancer,
chemo/radiation, HIV

Nutritional deficiencies: low protein,

vitamins, minerals, iron, zinc

Impaired coagulation

vascular compromise
(arterial/venous/mixed)

connective tissue disorder; rheumatoid

arthritis,Lupus
 Systemic
Metabolic disease – Diabetes

Tissue hypoxia: impaired cardiac

or pulmonary status, anaemia,
hypertension, smoking

Body build – emaciated or obese

 Local Factors
Wound infection

Topical agents or treatments

re-injury: allergic reactions, radiation,

pressure, friction, shear

environment to dry or wet

Edema

Incontinence -4X more likely for pressure

sacral ulcers
 Phases of Normal Wound Healing
Haemostasis

Inflammation

Proliferation

Maturation

four distinct phases overlap – factors

affecting one phase can stimulate or
inhibit the overall healing process
 Haemostasis
(Immediate Response)
Platelets aggregate – adhere to exposed
collagen, create substances to cause
vasoconstriction,production of
Thrombin and Fibrin to promote
clotting to plug the injured blood
vessels

Release Growth Factors – platelet

derived growth (PDGF) which begins
to initiate the next phase
 Inflammatory Phase (4-6 Days)
Presents clinically as erythema, swelling,
warmth, and pain – loss of function
The body's code “99” to trauma
Control microbial invasion/infection
Neutrophils: clean up debris
prepare the wound for healing by
phagotizing dead tissue & micro
organisms
Macrophages (contractors):
phagocytose bacteria & secrete growth
factors – direct the next stage of healing,
angiogenesis factor (form new blood
vessels)
Exudate: nourish cells 7 flush out
necrotic tissue and foreign debris
 Type of Inflammatory Response

Acute : dramatic response

Chronic: damaging to the host

Stunned wound: dormant

elevated levels of pro-inflammatory

cytokines because of presence of
bacteria,fungi, & viruses
 Proliferation Phase
the Goal is to Fill and Cover
the Defect
(Days 4-21)

Granulation -pebbled red tissue in wound base

replacement of dermal tissue
A. Collagen formation (fibroblasts -framer
cells)
Framework for connective tissue
Causes wound bed to fill and contract
Vit. C, Zinc, Oxygen, & iron needed
restoration of vascular integrity – builds
small blood vessels
 Proliferation Phase
the Goal is to Fill and Cover
the Defect
(Days 4-21)

Granulation -pebbled red tissue in wound base

replacement of dermal tissue
A. Collagen formation (fibroblasts -framer
cells)
Framework for connective tissue
Causes wound bed to fill and contract
Vit. C, Zinc, Oxygen, & iron needed
restoration of vascular integrity – builds
small blood vessels
Maturation or Re-Modelling Phase
(Up to 2 years)
Greater textile strength

80% of strength – maximum

Previously wounded tissue may remain

vulnerable to re-injury

Collagen re-organizes, remodels,

strengthens,
scar reduction

Healed Wound
 Treat the Patient/Family
Concerns
Manage Pain

Provide psychological,
emotional, & financial support

Provide patient/family education

 Treat the Cause
Pressure

Venous stasis disease

Arterial disease
Treat the Cause

Diabetic foot disease

Malignant

Other systemic illnesses Surgical