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CHAPTER 32 Skin Integrity & Wound Healing
Muscle (separated)
Protruding bowel
Adipose tissue
FIGURE 32-8 Evisceration is a total separation of the layers of a wound, with internal viscera protruding through the incision.
Fistula between rectum and vagina (enterovaginal)
the organs from drying out and becoming contami- nated with environmental bacteria. ■ Have the patient stay in bed with the knees bent to minimize strain on the incision. ■ Do not put a binder on the patient. ■ Notify the surgeon and ready the patient for surgery (see Chapter 36 for care of the surgical patient). Fistulas A fistula is an abnormal passage connecting two body cavities or a cavity and the skin. Fistulas often result from infection or debris left in the wound. Fistulas can occur after bowel surgery, especially in compromised patients. It can also occur spontaneously and is associ- ated with certain diseases, such as inflammatory bowel disease (IBD) and cancer (McNichol et al., 2021). An abscess forms, which breaks down surrounding tissue and creates the abnormal passageway. Chronic drain- age from the fistula may lead to skin breakdown and delayed wound healing. The most common sites of fis- tula formation are the gastrointestinal and genitouri- nary tracts. Figure 32-9 illustrates a fistula between the rectum and vagina.
FIGURE 32-9 A fistula is an abnormal passage connecting two body cavities or a cavity and the skin. Fistulas are most common in the gastrointestinal and genitourinary tracts.
2 to 4 weeks may be considered chronic. A pressure injury is a type of chronic wound. To learn about pres- sure injuries, see the Example Client Condition: Pres- sure Injury and Figures 32-10 and 32-11. Practical Knowledge knowing how As a nurse, you will care for many patients who have wounds or who are at risk for skin break- down. The remainder of the chapter explains how to
Mobility and activity
Time and pressure
Sensation
Knowledge Check 32-5 ■ Describe four types of wound closures. ■ Identify five types of wound complications. ■ Describe three signs of internal hemorrhage. ■ Compare dehiscence and evisceration.
Pressure injury
Intrinsic factors
• Nutrition • Age
Tissue tolerance
Think Like a Nurse 32-2: Clinical Judgment in Action
• Circulation • Underlying
health status
Recall the case of Mr. Harmon (Meet Your Patient).What form of wound healing (primary, secondary, or tertiary) is he undergoing? How long would you expect it to take before his wounds heal?
Extrinsic factors
• Friction • Shearing •Moisture
CHRONIC WOUNDS A chronic wound is one that has not healed within the expected time frame. Wounds that do not heal within
FIGURE 32-10 Several factors contribute to the development of a pressure injury.
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