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

Inflammationand Wound Healing

Inflammationand Wound Healing

Chapter 13 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2

Inflammatory ResponseInflammatory Response


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

3


•Vascular Response•Cellular Response

Neutrophils Monocytes Lymphocytes Eosinophils and basophils


4


•Chemical Mediators Complement system Prostaglandins and

leukotrienes


5


•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.

6


•Exudate Formation•Clinical Manifestation

Fever


7


•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.

8


•Types of Inflammation


9

Nursing and Collaborative Management: Inflammation


•Nursing Diagnoses•Nursing Implementation

Health promotion


10



•Nursing Implementation, continued Acute intervention

• Observation and vital signs• Fever• Drug therapy


11



•Nursing Implementation Acute intervention,

continued• RICE

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


12

Healing ProcessHealing Process

•Regeneration•Repair


13



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

14


•Repair, continued Primary intention

• Initial phase• Granulation phase


15



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).

16


•Repair Primary intention, continued

• Maturation phase and scar contraction


17



Table 13-6. Phases in Primary Intention Healing.

18


•Repair, continued Secondary intention Tertiary intention


19



Fig. 13-6. Dehiscence folloawing a cholecystectomy.

20


•Wound Classification•Delay of Healing•Complications of Healing

Collaborative care Drug therapy Nutritional therapy


21



Fig. 13-7. Hypertrophic scarring.

22



Fig. 13-8. Keloid scarring.

23

Nursing and Collaborative Management: Wound

Healing


Healing

•Nursing Assessment


24


Healing


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.

25


Healing


Healing

•Nursing Diagnoses•Nursing Implementation


26


Healing


Healing


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

27


Healing


Healing

•Nursing Implementation, continued Red, yellow, and black

wounds• Red wounds• Yellow wounds• Black wounds


28


Healing


Healing

•Nursing Implementation, continued Negative-pressure wound

therapy Hyperbaric oxygen therapy Drug therapy Nutritional therapy


29


Healing


Healing

•Nursing Implementation, continued Infection prevention and

control Psychologic implications Patient teaching


30

Pressure UlcersPressure Ulcers

•Etiology and Pathophysiology


31



Table 13-12. Risk Factors for Pressure Ulcers.

32


•Clinical Manifestations


33

Nursing and Collaborative Management: Pressure

Ulcers


Ulcers

•Nursing Assessment


34


Ulcers


Ulcers


Table 13-14. Assessing Patients With Dark Skin.

35


Ulcers


Ulcers

•Nursing Diagnoses•Planning


36


Ulcers


Ulcers

•Nursing Implementation Health promotion Acute intervention Ambulatory and home care

•Evaluation


Documents

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