Wound Healing

foreign engineers in this video today we're going to be talking about wound healing so if you like this video make sure to give it a thumbs up comment down below and don't forget to subscribe here at an engineered nursing and then check out nature.org that's where we have all the notes and illustrations for all the lectures here and from an ninja nerd that we put up for you guys to use and study from and we hope it really helps so let's get started with wound healing here what we're talking about here is the skin and how when we have a wound that is within our body that is caused within our skin right and how does it heal naturally through itself and also from us helping it as well so this is the nurses we're going to be at bedside we may have patients that have gone through surgery have gone through traumas have had something else go on within their life and they have wounds that we have to help facilitate healing so I think it's really important for us to understand how the wound can repair itself and also how we can intervene and also help so with different wounds right we want to remember that there is an opening from or a an opening that is causing our barrier our natural barrier to the outside world our skin that exposes you know our insides out right or allows outside to come in and when we do that we are exposing things like if it's really um at the top superficial it's our epidermis our dermis our hypodermis and then we can go into our subcutaneous and then our bone and our muscle right so when we have wound repair meaning when our wounds are able to heal there's a couple different ways that we can help and there's three different intentions that we can do we can do primary secondary or tertiary intention right and what does that mean that means we can have the first intention which is where we have some type of approximation of the Skin So this skin here was either cut very very cleanly and we are able to approximate or bring these edges together really nicely right so this is edge to edge healing so this will typically leave a minimal a minimal scar as we can see right here over time it'll heal and it'll look really really nice because you want to think about how these are edges of the skin are able to be brought together really nicely and when they do that all that healing process here all those sutures and those stitches or their Staples holding them together is going to allow the healing process to occur in a very very small area right so let's move in here to our second intention and our second intention is now we have edges that maybe aren't able to be approximated as nicely or we have something that is not going to be able to be closed as we would like to so because of that we're going to have this healing that is going to occur from inside out which is important because you want to make sure that we aren't trapping anything inside our body right because we don't want to create a pocket of bacteria that on the surface we have this nice closed wound but on the underneath we have a pocket of bacteria that's just festering and growing and growing and then we have an abscess or something else serious along the lines of the healing process so we are healing here from inside out with our secondary intention right and what we're looking at is it's an after typically a large injury so maybe this is a giant pressure ulcer that is trying to heal or something else that's going on it's taking out a big get out of the skin and we are able to just let this heal this is also going to be just abrasions or secondary degree wounds that are just trying to heal but there's nothing that we can put so we might start thinking about other types of interventions like little graphs or the type of wound care we can give it to keep it moist but overall this is not edge to edge this is inside out healing and then tertiary intention is Our intention meaning we're going to leave this open on purpose right and that has to do again with what I was talking about is we don't want to create a pocket of bacteria underneath the skin so what we're going to do is we're going to leave this open and allow that to heal from the out or the inside out so we're going to push all that bacteria this is going to be something like a dog bite or a cat bite or any type of puncture wound that's going to be deep if in the skin but we're also going to have this patient get lots of possibly a wound VAC they may be getting cleaning daily debridements or every other day debridements in order to make sure that that is really cleaned out so these are also going to be some type of deep injury okay and we want to make sure that we are getting it to a point that maybe we can help close later so what we're talking about here is primary secondary and tertiary intention and then we can talk about the result so as these heal if we have primary intention it's usually a nice really thin scar right a surgical scar maybe it has a couple little marks a little small Marks here from sutures or Staples secondary intention is going to look a little more pulled you're going to see that striation maybe a little bit in the scar maybe a keloid or two that is formed and then the third could be very very big and open or when we are able to close and approximate it it could start to look like secondary as well because now we're going to have some healing that we're going to able to at least get a little closer together and then we'll have this mishmash of first degree in tertiary or primary and tertiary intention mixing together so now that we understand how we can have the wound be repaired let's talk about all of the complications and the process that we go through when we do have an injury and how we get to the point of healing and then keeping this patient stable all right Engineers now we're going to be talking about the phases of wound healing and what we're looking at here is how our body goes through from injury to heal itself right so we first have the injury right the injury occurs the patient gets stabbed the patient gets burned by something and all of a sudden we have our first phase immediately starting so immediately we jump into this first phase what is that first phase that is hemostasis so what does that mean we have a cut right the cut goes into our body and it starts to disrupt and damage all those blood vessels those blood vessels then we'll start to what we start to bleed right so as we start bleeding our body doesn't want this to happen right we want to keep all the blood that we have in in so we start to get a response of vasoconstriction that constricting then of our blood vessels as that constriction occurs of the blood vessels we then get some platelets starting to aggregate right and they start to form our blood clot here right so as the platelet plug forms and we eventually get our clock right and the whole point of this is for what the whole goal is to go from bleeding to not bleeding so now that bleeding has stopped we can then move into our next phase all right Engineers now we're into phase two here of wound helium we're going into inflammatory so hemostasis has stopped it's it's phases over right bleeding has stopped we have a clot and now we're going to immediately move into the inflammatory stays and stage in the inflammatory stage can last for a couple days right so it's going to be a couple days after the injury and we're going to have lots of things going on here but I'm going to try to break it down to something very simple so we first want to think about what was going on previously we had the constriction of the blood vessels we had the clot form now our vessels are going to start to dilate back a little bit right when they dilate right or vasodilate we are going to have some leakage right and that leaky vessel because it becomes more permeable is going to increase that swelling right so the first thing in the inflammatory stage is inflammation right that makes sense along with the inflammation that we get is pain right with that inflammation the patient is going to experience pain as shown by these lightning bolts here and then we also are going to have a scab that starts to form as well so with the inflammation with the pain with the scab you can also note some heat from the area or some redness right and all that has to do with the underlying work that's going on with our skin so if we look over here we have two things that I wanted to identify the first here is our macrophage so what happens is we have this injury occur and the macrophage comes along and it starts to see all this debris in here so it's going to go and it's going to take out the trash as it takes out the trash it's going to drop off growth factor here so we have this growth factor that it drops off which is great because what the growth factor does is it puts up its flag and it says hey fibroblasts why don't you come on over and fibroblasts are important to come to the area because they are going to help us with the next phase so let's think about this again we have an injury all of these inflammatory responses start we have inflammation we get pain we get a scab that can form we get healing or heat we get redness all that within the area of the skin right it should be with localized to that injury because of that macrophages come and the white blood cells come right they're going to help fight this infection the macrophage is going to come it's going to take out all the trash get all the debris out and it's going to drop off that growth factor that growth factor is going to signal to the fibroblasts and say hey why don't you come on over here we're going to need your help too so we go to the proliferation stage in the proliferation stage is now where we have this scab that's really nice right this one can take anywhere from weeks to months depends again on the injury and the depths and everything else that's going on with the patient are they able to heal etc etc but the fibroblasts come and you can see them here as these little green stars the fibroblasts are coming and they are going to drop off collagen and collagen is really nice and important for us because it's going to allow us to start to generate some tissue in here right it is going to also help close up this wound so really important for fibroblasts is they bring us let's do it in purple because it was purple there they're going to bring us collagen right and that's going to help not only proliferate meaning create some new skin in there granulized skin but it's also going to help close up that wound so it's really important for oxygen to play a role in here because we want some oxygenation to come to this area in order for us to get new cell growth then as the the wound is healing we go into the maturation so as that collagen has been deposited we have that granular tissue that is formed right and this can be years because now the wound is fully closed right months to years the wound is fully closed but we have that new scar that's there well the collagen that's within is able to help close and pull that together right so as it it's pulling and tightening it's able to cause a nice hopefully smaller Scar and help that skin be a little tougher because this is new skin it's a little weaker it's not going to be able to um be a hold up to any type of area that's around it like the skin around it's a lot stronger than that scar so this collagen is going to help you know create a little more tension and create a little more strength within that new skin that's developed so that is how wound healing occurs in a the very simplest form now let's go over to what would cause some barriers for a patient to heal and also complications that they couldn't get from some type of wound our conditioners now let's talk about the barriers for a patient to be healing their wounds so we're going to go through and talk about a bunch of these really quickly one of them is when we use the Braden scale for right the brain scale is for detection of someone developing a pressure injury and one of the key components of pressure injuries is the unrelieved pressure right so a patient that has unrelieved pressure and what is the root cause of that I want you to think even further it's not just the pressure what is the component because of the pressure that is causing that barrier and that's the decreased oxygen right or the decreased blood flow to that area moving on here we have somebody who we're going to check their skin trigger right where you're going to pinch on that knuckle so a barrier for this patient is either dehydration or over hydration you're going to say wait why is it both think about it if you're dehydrated you're not getting the circulatory volume right of the blood going through the body so very similar if we have decreased blood flow to the area we're going to have decreased transmission of the nutrients and the debris and the oxygen and over hydration is the same thing if it's if the patient's over hydrated they're fluid filled we're going to have a decrease in blood flow to that area as well moving on to here this one's nice I'm sure everyone's experienced this before this is a nice open uh stage to blister right here on the back of your heel around your Achilles tendon I probably got it from a new pair of cleats or shoes right and that's not going to heal if you're playing in a tournament over the weekend so repeat trauma to the area right so when you have repeat trauma to an area you have a little area maybe a blister you played at a soccer tournament not that I'm speaking from experience but you play in a soccer tournament over the weekend and then you have this blister and then you add a day or two off then you go and you put those cleats back on you run out in the field and you're like Duck this blister it's opening again it's because you have repeat trauma right that area wasn't able to heal now we're gonna introduce some more trauma and again we're going to have an opening that's not going to heal so there's another barrier here's somebody who is already obviously over over hydrated or fluid filled right and they have an ulcer so it's not healing they're already over hydrated or they got edema in that area but there's some other things going on in that wound as well one of those is infection right if a patient has an infection going on or we can even say bacteria in the area right that is going to decrease the healing the patient could also have necrosis right they have that decreased oxygen supply to the wound so now they're going to have necrotic material that's going to be hard to heal and there can also be a biofilm that develops right and then we talked about that in other videos where the biofilm prevents the wound from healing correctly because it's cutting off again oxygen supply and the ability for that skin to heal then we have patients that might also have systemic factors and what I mean by that is it's these are things that are maybe a little bit harder to control but we're going to talk about them as well one of them is just age so right here we have a baby bottle age those are that are really young or really old they will have compromised healing a patient who has some type of respiratory or cardiac disease right and that comes back again to the blood flow right to the issue of transferring oxygen to the area so they have any type of underlying condition that can also decrease their wound healing as well also nutrition right now some people have the ability to control it and they just don't but nutrition can also play an issue again we talked about this before where a patient might be NPO so they're going to have a decrease in the ability to eat or get the nutrients that they need maybe they had some type of intense jaw injury so now they're only going to be able to have liquids clear liquids through the draw right because that draws will soon shut so again these are factors that we can maybe help a little bit but not much we can't really help modify this too much and then we also have here any type of medication that they might be on that might cause some barrier right so if they are on some type of immunosuppression medication as well or they are immunocompromised immunocompromised all right so we talked about some barriers right let's talk about some complications and you're going to be like well that is kind of a barrier yeah we they kind of coincide so some complications again would be infection and when we talk about infection you also want to think about other things that be going on within that wound so think about all the different types of Staff the patient can get right or we can also talk about the bacteria or the antibiotics that they were on those antibiotics that they were on maybe didn't correctly help that patient right so now the bacteria that was not it failed to treat is now coming back so it's getting even worse right so infection is one we can think staff or failed to treat if you've never heard that before failed to treat means we give the patient some type of antibiotic that we believe is going to fix whatever's going on with them because most of the time that is the proven choice to use and then what happens is that doesn't treat exactly what's going on with them happens commonly in like UTIs when we think we know exactly what type of bacteria they have moving on another complication we talked about it a little bit is that decrease in blood so if a patient is actively hemorrhaging right and that doesn't have to be outward they could be having some type of GI bleed well that is also going to cause some issues with healing right and then we have the two down here that the NCLEX always likes to hit on they they ask this question all the time right the first one is we have a wound here here that is healing and then it starts to open right and the word that we use for that is dehiscence so this wound is starting to open up it is not exposing anything but maybe some under underlying materials but we're going to hopefully be able to get that cleaned up get that sutured back up and then we'll be okay this is our medical emergency here and this is our evisceration right and what we're looking at here is we have a patient who had a wound that hissed and then eventually organs came out and when these organs come out we've talked about this before in videos where it's a medical emergency we need to make sure that we can get that back in and do it properly in order so that the patient doesn't have an ischemic bowel along with any other issues so I hope this video made sense I hope you understand now how our body heals and how we also can help heal our patient as well and as always until next time [Music] thank you [Music]

Channel: Ninja Nerd Nursing

Views: 63,495

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Id: xV348kZWNQ4

Length: 19min 55sec (1195 seconds)

Published: Wed Feb 15 2023