Wound Care

Wound Care

Wound care, asepsis & sepsis

I Asepsis: Limiting the spread of microorganisms as much as possible.
Clean technique (asepsis):
- changing bed linens
- sanitizing bed pans
- individual medication cups for each patient
- Anti-bacterial Gels should not be used more than 5 times
Before hand washing occurs

II Sepsis: a systemic inflammatory response to a documented or suspected
- occurs when there is a BREAK IN STERILE TECHNIQUE
- S/S fever , chills, pain, headache, nausea, vomiting &
Extreme fatigue

III Surgical asepsis: a condition free from germs, infection & any forms of life

IV Wound Care: A wound occurs when the integrity of any tissue is compromised
(Skin breakdown, muscle tears, burns or bone fractures)

A. Types of Wounds:
1. Closed: without a break in the skin
- contusion (bruise)
- Hematoma (deep bleeding under the skin)
- Sprain ( pulled ligaments)
2. Opened: occurring through the skin
- Incision
- Laceration (cut)
- Abrasion ( scrape)
- Puncture (hole)
- Penetrating ( goes through tissue)
- Avulsion (almost severed)
- Ulceration (skin/ tissue that has been eaten away)

B. Wound Terms:
- Full thickness : dermal layer no longer present, only at wound margins
- Partial thickness : wound heal more quickly by producing new skin
- Clean: containing microorganisms
- Dirty: contains microorganisms
- Necrosis : dead tissue
- Regeneration : growth of new cells
- Replacement: fibrous cells replace with no functional characteristics
- Red – rich beefy , healthy, ready to heal
- Yellow – fibrous debris, will slough off , Risk for infection
- Black - unhealthy, Eschar ( dead tissue) will need to be debrided
Surgically, by whirlpools &/or wound care

V Phases of wound healing: wound healing is the bodies’ natural process of
Regenerating dermal & epidermal tissue....

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