Inflammation and Wound Healing Chapter 13 Overview Copyright © 2011, 2007 by Mosby, Inc., an...

Inflammationand Wound Healing

Chapter 13 Overview

Inflammatory ResponseInflammatory Response

Fig. 13-1. Vascular and cellular responses to tissue injury.

•Vascular Response•Cellular Response

Neutrophils Monocytes Lymphocytes Eosinophils and basophils

•Chemical Mediators Complement system Prostaglandins and

leukotrienes

•Chemical Mediators, continued

Fig. 13-2. Pathway of generation of prostaglandins, thromboxanes, and leukotrienes. Corticosteroids, nonsteroidal antiinflammatory drugs (NSAIDs), and acetylsalicylic acid (ASA) act to inhibit various steps in this pathway.

•Exudate Formation•Clinical Manifestation

•Clinical Manifestation, continued

Fig. 13-3. Production of fever. When monocytes-macrophages are activated, they secrete cytokines such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF), which reach the hypothalamic temperature-regulating center. These cytokines promote the synthesis and secretion of prostaglandin E2 (PGE2) in the anterior hypothalamus. PGE2 ncreases the thermostatic set point, and the autonomic nervous system is stimulated, resulting in shivering, muscle contraction, and peripheral vasoconstriction.

•Types of Inflammation

Nursing and Collaborative Management: Inflammation

•Nursing Diagnoses•Nursing Implementation

Health promotion

•Nursing Implementation, continued Acute intervention

• Observation and vital signs• Fever• Drug therapy

•Nursing Implementation Acute intervention,

continued• RICE

•Rest• Ice and heat•Compression and immobilization•Elevation

Healing ProcessHealing Process

•Regeneration•Repair

Fig. 13-4. Types of wound healing. A, Primary intention. B, Secondary intention. C, Tertiary intention.

•Repair, continued Primary intention

• Initial phase• Granulation phase

Fig. 13-5. A, Wound clean but not granulating (note lack of red cobblestone appearance), suggesting heavy bacterial contamination or other impediments to wound healing. B, Same wound granulating after 1 week of topical antibiotic use (note healthy red cobblestone appearance).

•Repair Primary intention, continued

• Maturation phase and scar contraction

Table 13-6. Phases in Primary Intention Healing.

•Repair, continued Secondary intention Tertiary intention

Fig. 13-6. Dehiscence folloawing a cholecystectomy.

•Wound Classification•Delay of Healing•Complications of Healing

Collaborative care Drug therapy Nutritional therapy

Fig. 13-7. Hypertrophic scarring.

Fig. 13-8. Keloid scarring.

Nursing and Collaborative Management: Wound

Healing

•Nursing Assessment

Healing

Fig. 13-9. Wound measurements are made in centimeters. The first measurement is oriented from head to toe, the second is from side to side, and the third is the depth (if any). If there is any tunneling (when cotton-tipped applicator is placed in wound, there is movement) or undermining (when cotton-tipped applicator is placed in wound, there is a “lip” around the wound) this is charted in respect to a clock with 12 o’clock being toward the patient’s head. This wound would be charted as a full-thickness, red wound, 7 cm × 5 cm × 3-cm, with a 3-cm tunnel at 7 o’clock and 2 cm undermining from 3 o’clock to 5 o’clock.

Healing

•Nursing Diagnoses•Nursing Implementation

Healing

Fig. 13-10. Jackson-Pratt drainage device.

Healing

•Nursing Implementation, continued Red, yellow, and black

wounds• Red wounds• Yellow wounds• Black wounds

Healing

•Nursing Implementation, continued Negative-pressure wound

therapy Hyperbaric oxygen therapy Drug therapy Nutritional therapy

Healing

•Nursing Implementation, continued Infection prevention and

control Psychologic implications Patient teaching

Pressure UlcersPressure Ulcers

•Etiology and Pathophysiology

Table 13-12. Risk Factors for Pressure Ulcers.

•Clinical Manifestations

Nursing and Collaborative Management: Pressure

Ulcers

•Nursing Assessment

Ulcers

Table 13-14. Assessing Patients With Dark Skin.

Ulcers

•Nursing Diagnoses•Planning

Ulcers

•Nursing Implementation Health promotion Acute intervention Ambulatory and home care

•Evaluation

Inflammation and Wound Healing Chapter 13 Overview Copyright © 2011, 2007 by Mosby, Inc., an...

Documents

CHAPTER 2 Pharmacologic Principles Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc

Mosby items and derived items © 2005 by Mosby, Inc. Chapter 23 Communication

Cellular Biology Chapter 1 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc

Infection Chapter 9 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc

1 Innate Immunity: Inflammation Chapter 6. Mosby items and derived items © 2006 by Mosby, Inc. 2 Immunity First line of defense Innate resistance

Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 10 Analgesic Agents

Innate Immunity: Inflammation Chapter 6 Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc

Mosby items and derived items © 2005, 2002 by Mosby, Inc. CHAPTER 13 Antiepileptic Agents

Mosby items and derived items © 2005 by Mosby, Inc. Chapter 43 Nutrition

1 Mosby items and derived items © 2010 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 4 Vital Signs

Mosby items and derived items © 2006 by Mosby, Inc. Slide 1 Chapter 3 Fats

Chapter 18 Fluid and Electrolyte Balance. Copyright © 2005 Mosby, Inc. All rights reserved. 2 Mosby items and derived items © 2008 by Mosby, Inc., an

Mosby items and derived items © 2005 by Mosby, Inc. Chapter 38 Hygiene

Mosby items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. Chapter 6 Medical Terminology Review

Mosby items and derived items © 2005, 2001 by Mosby, Inc

Hospice Care Chapter 40 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc

Mosby items and derived items © 2006 by Mosby, Inc. Slide 1 Chapter 5 Vitamins

Mosby items and derived items © 2005 by Mosby, Inc. Chapter 31 Vital Signs

Enteral Administration Chapter 9 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc

Focus on Pressure Ulcers (Relates to Chapter 13, “Inflammation and Wound Healing,” in the textbook) Copyright © 2011, 2007 by Mosby, Inc., an affiliate