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CHAPTER 32 Skin Integrity & Wound Healing
Table 32-1 ➤ Types of Wounds TYPE DESCRIPTION Abrasion
A scrape of the superficial layers of the skin; usually unintentional but may be performed intentionally for cosmetic purposes to smooth skin surfaces (also see excoriation ) A localized collection of pus resulting from invasion from a pyogenic bacterium or other pathogen; must be opened and drained to heal
Abscess
Contusion
A closed wound caused by blunt trauma; may be referred to as a bruise or an ecchymosis
Crushing
A wound caused by force leading to compression or disruption of tissues, often associated with fracture. Usually there is minimal or no break in the skin.
Excoriation
Superficial wound, usually self-inflicted as a result of excessive scratching or mechanical force
Incision
An open, intentional wound caused by a sharp instrument
Laceration
The skin or mucous membranes are torn open, resulting in a wound with jagged margins.
Penetrating
An open wound in which the agent causing the wound lodges in body tissue
Puncture
An open wound caused by a sharp object; often, there is collapse of tissue around the entry point, making this wound prone to infection.
Tunnel
A wound with an entrance and exit site
■ Chronic wounds are wounds that exceed the expected length of recovery, usually because the natural healing progression has been interrupted or stalled because of infection, continued trauma, ischemia, or edema. Chronic wounds include pressure injuries, or arterial, venous, and diabetic ulcers (Fig. 32-3). These wounds are frequently colonized with several types of bacteria, and healing is slow because of the underlying disease process. Unless the type of wound is properly diag- nosed and the underlying disease process is treated, a chronic wound may linger for months or years (Table 32-2). Level of Contamination ■ Clean wounds are uninfected wounds with minimal inflammation. They may be open or closed and do not involve the gastrointestinal, respiratory, or genitouri- nary tracts (these systems frequently harbor micro- organisms). There is little risk of infection in a clean wound. ■ Clean-contaminated wounds are surgical incisions that enter the gastrointestinal, respiratory, or genito- urinary tracts. There is an increased risk of infection for these wounds, but there is no obvious infection. ■ Contaminated wounds include open, traumatic wounds or surgical incisions in which a major break in asepsis occurred. The risk of infection is high for these wounds. ■ Infected wounds are those in which the bacteria count in the wound is above 100,000 organisms per gram of tissue. Key Point: Keep in mind that the presence of beta-hemolytic streptococci, in any number, is con- sidered an infection. Signs of wound infection include
FIGURE 32-3 Diabetic foot ulcer.
erythema and swelling around the wound, fever, foul odor, severe or increasing pain, large amount of drain- age, or warmth of the surrounding soft tissue. Depth and Location of the Wound Major deter- minants of healing time are the depth of the wound and its location. Key Point: The deeper the wound, the longer the healing time. Wounds located at points of pressure or movement are also slower to heal. Wounds in areas
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