inflammation and wound healing

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

By: sureshbommaji (119 month(s) ago)

its worthy

Presentation Transcript

INFLAMMATION:

INFLAMMATION PRESENTED BY: KIRAN RANDHAWA

INTRODUCTION:

INTRODUCTION Inflammatory response is sequential reaction to cell injury. It neutralizes and dilutes the inflammatory agent, removes necrotic material, and establishes environment suitable for healing and repair.

DEFINITION:

DEFINITION Inflammation is a defensive reaction intended to neutralize, control or eliminate the offending agent and to prepare the site for repair.

CAUSES :

CAUSES PHYSICAL AGENTS Heat ,Cold Radiation Electro thermal injury Mechanical traumas CHEMICAL INJURY Strong acids and alkalies MICROBIAL INJURIES Viruses Bacteria

CONTD….:

CONTD…. ISCHEMIC INJURY NEOPLASTIC GROWTH NORMAL SUBSTANCES Digestive enzymes Uric acid

STEPS OF INFLAMMATORY RESPONSE:

STEPS OF INFLAMMATORY RESPONSE VASCULAR RESPONSE CELLULAR RESPONSE EXUDATE FORMATION

VASCULAR RESPONSE :

VASCULAR RESPONSE First response to cellular injury is transient vasoconstriction. It is followed by vasodialation as a result of release of histamine and other chemicals by injured cells. These responses increases capillary permeability.

CONTD….:

CONTD…. Fluid shifts from capillaries into tissue spaces. Plasma proteins [albumin] moves into tissue spaces. It further draws fluid from blood vessels Tissues become edematous. Fibrinogen is converted into fibrin. It strengthens the clot.

CELLULAR RESPONSE:

CELLULAR RESPONSE CELL INJURY MARGINATION CHEMOTAXIS DIAPEDESIS OF BLOOD LEUKOCYTES MIGRATION OF LEUKOCYTES AT INJURY SITE

CONTD…:

CONTD… NEUTROPHILS It arrive within 6 to 12 hours They phagocytize bacteria, foreign material and damaged cells.

CONTD….:

CONTD…. MONOCYTES MACROPHAGES PHAGOCYTOSIS CELLULAR EXUDATE

CONTD…:

CONTD … LYMPHOCYTES IMMUNE RESPONSE

CONTD…:

CONTD… CHEMICAL MEDIATORS Complement system : major functions are : Enhances phagocytosis Increase vascular permeability Chemotaxis Cellular lysis

CONTD..:

CONTD.. EXUDATE FORMATION Consists of fluid and leukocytes that move from circulation to site of injury.

CARDINAL SIGNS OF INFLAMMATION:

CARDINAL SIGNS OF INFLAMMATION REDNESS (rubor) HEAT(colour) PAIN(dolor) SWELLING(tumor) LOSS OF FUNCTION(functio laesa)

CONTD..:

CONTD.. SYSTEMIC MANIFESTATIONS Malaise Fever Increased pulse and respiratory rate Leukocytosis

TYPES OF INFLAMMATION :

TYPES OF INFLAMMATION ACUTE CHRONIC SUBACUTE

CONTD….:

CONTD…. ACUTE INFLAMMATION Healing occurs in 2 to 3 weeks Local vascular changes

CONTD..:

CONTD.. CHRONIC INFLAMMATION It takes months to years. Scarring may occur. The injured agents persists or repeatedly injures tissue.It has no protective function.

CONTD..:

CONTD.. SUBACUTE INFLAMMATION It has features of acute process but lasts longer. It persists for weeks or months.

MEDICAL MANAGEMENT:

MEDICAL MANAGEMENT THREE GOALS Reducing inflammation Minimize complications of edema Monitor systemic responses

CONTD..:

CONTD.. Reducing inflammation Antiinflammatory agents NSAIDS Corticosteroids Removal of foreign body

CONTD…:

CONTD… Controlling edema RICE R:rest I:ice C:compression E:elevation

CONTD..:

CONTD.. Monitor systemic responses Fever: antipyretics Diet: calories ,proteins,fluids,vitamin-c rich diet should be given.

NURSING MANAGEMENT :

NURSING MANAGEMENT Observe for manifestations of inflammation. Observe inflammatory exudate. Check for edema . Assess bleeding in area,adequate blood flow,nerve conduction distal to affected site every 2 hourly.

CONTD..:

CONTD.. Assess pulses skin temperature,capillary refill,sensation and movements in areas distal to inflammation. Compare involved side with other side. Dressing and cast cause constriction,check for compartment syndrome. Elevate inflammed area,remove rings. Apply cold applications. Keep edematous skin lubricated and protected from injury.

CONTD…:

CONTD… Factors that impede venous flow should be controlled eg rolled stocking. Monitor WBCs level,differential counts. Check for fever,infections.

CONTD…:

CONTD… Teach self care at home about : Use of heat and cold applications Medication regimen follows How to change dressings,maintain hygiene. Extremity elevation. Early reporting if there is change in colour, odor,appearance,pain in wound.

INTRODUCTION:

INTRODUCTION WOUND HEALING It is more apparent on the skin but occurs in all areas of body. Bones, tendons, organs and tissues all heal by regenerating cells to restore function.

DEFINITION:

DEFINITION It is defined as a complex and dynamic process that results in restoration of anatomic continuity and function.

PHASES OF WOUND HEALING:

PHASES OF WOUND HEALING VASCULAR RESPONSE INFLAMMATION PROLIFERATION OR RESOLUTION MATURATION OR RECONSTRUCTION

CONTD… :

CONTD… VASCULAR RESPONSE -Within seconds after injury, vasoconstriction takes place. -Platelets form clot and stop bleeding. -Plasma protein system forms a fibrous meshwork -Plug formation occurs.

CONTD…:

CONTD… Capillaries dilation occurs.(10-30 minutes after injury) Phagocytosis occurs and inflammation takes place.

CONTD…:

CONTD… INFLAMMATION PHASE - It is second phase of wound healing. - It extend for 4-6days.

CONTD…:

CONTD… Walling off effect WBCs activity Neutrophils

CONTD…:

CONTD… Macrophages : also helps in phagocytosis. Eosinophils : secrete antihistamine to control inflammatory response. Basophils : secretes histamines Lymphocytes : helps macrophages to become more effective at site of local injury through number of processes.

CONTD…:

CONTD… Mediators of inflammation phase Mast cells Kinins Cytokines Complement system

CONTD…:

CONTD… PROLIFERATION PHASE This phase ends about 2 weeks after injury. Fibroblasts: synthesize collagen and granulation tissue.Macrophages secrete angiogenesis factor , which stimulates the formation of new blood vessels at end of injured vessels.

CONTD…:

CONTD… Wound contraction :it is a scar that can produce profound deformities. Epithelization : Mediators of this phase : growth factor matrix metalloproteases

CONTD…:

CONTD… MATURATION PHASE It occurs for years or longer. Collagen remodeling of scar takes place It provides tensile strength to the wound. Scar tissue appears thin and white and becomes mature.

WOUND HEALING INTENTION:

WOUND HEALING INTENTION It refers to probable process of healing of any wound. Primary Secondary Tertiary

FACTORS AFFECTING WOUND HEALING:

FACTORS AFFECTING WOUND HEALING INTRINSIC FACTORS : Local factors in the wound itself , that can alter healing. Infection Foreign body Inadequate blood supply Smoking Neuropathy

CONTD…:

CONTD… EXTRINSIC FACTORS Protein malnutrition Carbohydrate malnutrition Lack of vitamin c intake Diabetes Glucocorticoid steroids

COMPLICATIONS OF HEALING:

COMPLICATIONS OF HEALING Hypertrophic scars or keloid formation Contractures Dehiscence Excess granulation tissue Adhesions

DISORDERS OF WOUND HEALING:

DISORDERS OF WOUND HEALING Delayed wound healing Wound infection

TOPICAL AGENTS USED IN TREATMENT OF WOUNDS:

TOPICAL AGENTS USED IN TREATMENT OF WOUNDS ANTISEPTIC SOLUTIONS Normal saline Hydrogen peroxide Povidone iodine ANTIBIOTIC SOLUTIONS Gentamycin Neosporin

WOUND ASSESMENT:

WOUND ASSESMENT Patients history Causative intrinsic and extrinsic factors Duration of wound Wound painful or not Method of treatment used Physical assessment Level of acivity

CONTD…:

CONTD… Drainage from wound Signs of inflammation Muscle wasting Examine laboratory values Hb, hematocrit,albumin, lymphocytes, WBCs.

CONTD….:

CONTD…. Psychosocial assessment Clients age Occupation Health status Patient with diabetes, collagen diseases

MEDICAL MANAGEMENT:

MEDICAL MANAGEMENT Control cause of wound protein calorie malnutrition lack of arterial blood flow DM, collagen diseases Remove devitalized tissue from the wound wound debridement

CONTD….:

CONTD…. After surgery Reliving pain : opoid analgesics Patient controlled analgesia antihistamine drugs antibiotic resistant organisms MRSA, PRSP.

CONTD…:

CONTD… Nutritional therapy protein , carbohydrates , vitamin rich diet fluid rich diet

NURSING DIAGNOSIS:

NURSING DIAGNOSIS NSG diagnose : acute pain related to surgical incision. Goal : to reduce or alleviate the pain. Interventions check for intensity, location, type, and duration of pain. Immobilize the affected site.

CONTD…:

CONTD… Heat and cold applications if prescribed. Non pharmacological pain relief measures such as relaxation techniques, distraction can be used. Perform tolerate activities. Opoid analgesics , patient control analgesia can be used.

CONTD…:

CONTD… NSG diagnose : Hyperthermia related to infection as manifested by increased body temperature and respiratory rate Goal : to reduce fever.

CONTD…:

CONTD… Interventions: Asses patients temperature every 2-4 hourly. Keep environment temperature at 70 0 F Avoid heavy layers of clothing or bed covers. Change linens of patient frequently if is profusely sweating.

CONTD…:

CONTD… Encourage more fluid intake by patient. Administer prescribed analgesic to the patient.

CONTD…:

CONTD… NSG diagnose: Impaired peripheral tissue perfusion related to edema. Goal: client will have adequate tissue perfusion, normal skin color, presence of pulses in area distal to edema.

CONTD…:

CONTD… Interventions frequent assessment of edematous area is needed. assess circumference ,pulses,skin temperature ,capillary refill , sensation & movement in areas distal to inflammation

CONTD..:

CONTD.. Apply cold compresses over affected site. For 24-72 hours, if prescribed. Elevate edematous extremity. Keep edematous skin lubricated and protected from injury.

CONTD….:

CONTD…. Compression bandage can be used. Prescribed anti-inflammatory agents can be given as NSAIDS.

CONTD…:

CONTD… NSG diagnose : impaired skin integrity related to delayed wound healing secondary to impaired circulation, infection or malnutrition. Goal: client will have improved skin integrity, less drainage from wound or manifestations of infection.

CONTD…:

CONTD… Interventions Use aseptic techniques while cleaning wound at home or hospital. Change position of patient every 2 hourly , if bed ridden patient. Clean wound properly as with normal saline or hydrogen peroxide.

CONTD…:

CONTD… Keep surrounding skin dry and wound bed moist. Wound debridement should be done. Diet rich in protein, fat, carbohydrate, vitamins, minerals should be provided.

PATIENT EDUCATION:

PATIENT EDUCATION Keep wound dry and clean. Do not wet dressing during bath.If it is wet change it if taught by nurse or physician Clean area with normal saline , apply antimicrobial lotion as butadiene on the wound and apply sterile gauze and secure it with bandaging.

CONTD..:

CONTD.. To report immediately signs of infection as redness, red streaks in skin near wound, swelling, warmth, pus, odor or any discharge from wound. If pain occurs apply dry cool packs or take prescribed medicine as PCM, 2 tablets every 4-6 hourly (avoid aspirin)

CONTD……:

CONTD…… Elevate affected part to heart level to reduce swelling. After sutures are removed : follow directions of nurse or physician regarding extent of activity. Keep sutured site clean , do not rub vigorously, pat dry.

CONTD…:

CONTD… If site continues to be red, thick, and painful to pressure after 8 weeks , consult physician Take diet rich in proteins, carbohydrates, vitamins.

SUMMARIZATION:

SUMMARIZATION INFLAMMATION INTRODUCTION DEFINITION CAUSES OF CELL INJURY STEPS OF INFLAMMATORY RESPONSE LOCAL AND SYSTEMIC MANIFESTATIONS

CONTD…:

CONTD… TYPES OF INFLAMMATIONS MEDICAL MANAGEMENT NURSING MANAGEMENT WOUND HEALING INTRODUCTION DEFINITION

CONTD…:

CONTD… PHASES OF WOUND HEALING VASCULAR RESPONSE INFLAMMATION PROLIFERATION OR RESOLUTION MATURATION OR RECONSTRUCTION FACTORS AFFECTING WOUND HEALING

CONTD….:

CONTD…. DISORDERS OF HEALING TOPICAL AGENTS USED FOR TREATMENT OF WOUNDS WOUND ASSESSMENT MEDICAL MANAGEMENT NURSING MANAGEMENT

BIBLIOGRAPHY:

BIBLIOGRAPHY Black m Joyce & hawks H.J “Medical Surgical nursing ’’7ed, vol-1, Elsevier publishers,pg 398-410. Suddharths & Brunner, “Textbook of Medical surgical nursing’’, 10ed, Williams &Wilkins publishers, pg 93-94

CONTD…:

CONTD… Dirksen Heitkemper Lewis ‘medical surgical nursing”, 6ed, Mosby publishers, pg 207-216.

Slide 77:

THANKS

authorStream Live Help