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

2 Inflammatory Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Vascular and cellular responses to tissue injury.

3 Inflammatory Response Vascular Response Cellular Response  Neutrophils  Monocytes  Lymphocytes  Eosinophils and basophils Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

4 Inflammatory Response Chemical Mediators  Complement system  Prostaglandins and leukotrienes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

5 Inflammatory Response Chemical Mediators, continued Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig 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 Inflammatory Response Exudate Formation Clinical Manifestation  Fever Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

7 Inflammatory Response Clinical Manifestation, continued Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig 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 (PGE 2 ) in the anterior hypothalamus. PGE 2 ncreases the thermostatic set point, and the autonomic nervous system is stimulated, resulting in shivering, muscle contraction, and peripheral vasoconstriction.

8 Inflammatory Response Types of Inflammation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

9 Nursing and Collaborative Management: Inflammation Nursing Diagnoses Nursing Implementation  Health promotion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10 Nursing and Collaborative Management: Inflammation Nursing Implementation, continued  Acute intervention Observation and vital signs Fever Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Nursing and Collaborative Management: Inflammation Nursing Implementation  Acute intervention, continued RICE Rest Ice and heat Compression and immobilization Elevation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

12 Healing Process Regeneration Repair Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

13 Healing Process Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Types of wound healing. A, Primary intention. B, Secondary intention. C, Tertiary intention.

14 Healing Process Repair, continued  Primary intention Initial phase Granulation phase Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

15 Healing Process Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig 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 Healing Process Repair  Primary intention, continued Maturation phase and scar contraction Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

17 Healing Process Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Phases in Primary Intention Healing.

18 Healing Process Repair, continued  Secondary intention  Tertiary intention Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

19 Healing Process Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Dehiscence folloawing a cholecystectomy.

20 Healing Process Wound Classification Delay of Healing Complications of Healing  Collaborative care  Drug therapy  Nutritional therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

21 Healing Process Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Hypertrophic scarring.

22 Healing Process Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Keloid scarring.

23 Nursing and Collaborative Management: Wound Healing Nursing Assessment Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

24 Nursing and Collaborative Management: Wound Healing Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig 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 Nursing and Collaborative Management: Wound Healing Nursing Diagnoses Nursing Implementation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

26 Nursing and Collaborative Management: Wound Healing Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Jackson-Pratt drainage device.

27 Nursing and Collaborative Management: Wound Healing Nursing Implementation, continued  Red, yellow, and black wounds Red wounds Yellow wounds Black wounds Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

28 Nursing and Collaborative Management: Wound Healing Nursing Implementation, continued  Negative-pressure wound therapy  Hyperbaric oxygen therapy  Drug therapy  Nutritional therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

29 Nursing and Collaborative Management: Wound Healing Nursing Implementation, continued  Infection prevention and control  Psychologic implications  Patient teaching Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

30 Pressure Ulcers Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

31 Pressure Ulcers Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Risk Factors for Pressure Ulcers.

32 Pressure Ulcers Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

33 Nursing and Collaborative Management: Pressure Ulcers Nursing Assessment Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

34 Nursing and Collaborative Management: Pressure Ulcers Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Assessing Patients With Dark Skin.

35 Nursing and Collaborative Management: Pressure Ulcers Nursing Diagnoses Planning Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

36 Nursing and Collaborative Management: Pressure Ulcers Nursing Implementation  Health promotion  Acute intervention  Ambulatory and home care Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.