Introduction
Wounds are breaks in the outer layer of the skin, epidermis, or any injury caused by physical means that result in disruption of normal continuity of tissues and structures. Wounds are surgical, distressing, vascular, associated with disease, or result from the forces of cut, rubbing, strain, and/or wetness. Wounds are usually caused by cuts or scratches and, are treated differently depending on the cause or on their level of seriousness. Wounds are classified as acute or chronic. An acute wound is a clean-cut wound usually closed by sutures or clips. On the other hand, a chronic wound is an open wound usually expanding into the second layer of the skin called the dermis that needs to be filled by new tissues. These types of wounds may take a lot of time to heal and may require difficult wound care. Nursing is defined as the care of people of all tribes, groups, and the well or sick in various settings. It entails the promotion of health, avoiding illnesses, and taking care of the disabled, sick, and dying people (NSCCHealth, 2009, par. 2-5).
Definition
Wound care nursing is the management of wounds to encourage healing. The main priorities are reducing or abolishing the cause factors, demonstrating regular support for healing and, applying the appropriate topical therapy. In addition, remove necrotic tissue, remove the infection, wipe out dead space, take up exudates, retain moist environment, protect from trauma and offer thermal insulation. A wound care nurse is a person whose area of specialty is the management of wounds. Wound care nurses together with the medical team manage various wounds and this encourages fast and, healthy healing of the wounds. Wound care nurses first check on the wounds so that they can determine the extent, and they take note of any upcoming issues to come up with a plan on how to administer the treatment. The nurse checks the size of the wound, how far the tissue is involved and its color, whether there are any tracts, and if there are any foreign bodies that are present. The wound is first cleaned to remove dead tissues or any foreign material by debridement. In the long term, the nurse regularly examines and cleans the wound, if necessary rebandages it, and continues to check its healing progress. In the case of a serious wound, consultations are necessary between doctors and wound care nurses so that they can determine if surgical drains or antibiotics are necessary. They also educate patients and the community on how to handle and care for wounds; this is done with the help of other caregivers (Ignatavicius & Workman, 2005, p. 3).
Phases of wounds healing
Healing is a reaction to injury by the body that places into action a series of actions. The purpose of care is to reduce the chances of contagion or scarring during the healing process. The entire wound healing process is a complex series of events that starts from the time of injury and may take months or years to end. There are four stages of the wound healing process; these are epithelialization, proliferative, inflammatory, and remodeling. Each stage occurs at its own time and it should not be a hindrance to the process of healing.
From injury to three days, it is the inflammatory phase. It is characterized by homeostasis and inflammation. It is characterized by narrowing of the blood vessels, bleeding initiation of clotting, and mobilization of the white blood cells to protect the area from any possibility of invasion by bacteria. Vasodilation and serious exudates facilitate the removal of debris and supply of nutrients to the tissues and the healing process begins.
Proliferation is the next phase and begins from day two until the area is healed. It is characterized by the formation of a matrix or latticework of cells where new blood cells and skin cells form. The new blood vessels called capillaries give the wound its pink or purple-red appearance. The growth of new cells is sustained and the production of collagen is supported, by the oxygen and nutrients supplied to the rebuilding cells by the capillaries (Durkin, 2009, par. 2-4).
Remodeling begins after two to three weeks. The collagen becomes more organized making the tissue stronger and has more tensile strength. The blood vessels become less density and the wound begins to lose its pink color over time. The strength increases to 80% of the uninjured area’s strength.
The procedure of laying down epithelial cells or the new skin is epithelialization. A protective layer between the body and the outer environment is formed, which offers protection against bacteria and excess loss of water. After the injury, reconstruction of this area begins and may last for two to three days if the stitched wounds are kept clean. However, if the wounds are kept open, they might take seven to ten days to heal and a long inflammatory period leads to scars.
Factors affecting the healing of wounds
The healing progress may be affected by infections, movements, age factors, sensations, medications, nutrients provided, oxygenation, and tissue perfusion. Wound healing requires the proper circulation of oxygen in the body because; the inflammatory stage is extended if the tissues and bacteria compete for nutrients. This leads to a delay in epithelialization and the synthesis of collagen. The risks of infection are widened when the underlying chronic diseases compete for nutrients and this might result in the extension of the process of healing. The healing process is suppressed when the inflammatory process is affected by drugs. Wound formation is caused by limited sensation and mobility and, this causes more complications in the process of healing (Ignatavicius & Workman, 2005, p. 5).
One important thing in the healing process is to ensure that the right process is carried out for the right wounds. The variety of the dressing products makes it hard when decide which dressing method to use. Dry wounds should be moistened, while those with drainage should be absorbed and, necrotic wounds should be debrided. The categories of dressing are foam, transparent film, alginate, hydrocolloid, gauze, and accessory products like biological dressings, growth factors, compression tools, and enzymes (Wound Care Strategies Inc., 2007, par 1-4).
Techniques of wound healing
In wound dressing and cleansing, one uses either clean or sterile techniques. The choice of the technique to use depends on the host’s defense system and the type of wound. An ideal dressing should maintain a moist environment, promote wound dressing, provide mechanical protection, and allow for removal without pain or trauma. It should also be able to absorb excess exudates, allow gaseous exchange, impermeable to microorganisms, acceptable to the patient, easy to use, and be cost-effective (Thanh & Hau, 2002, p. 2).
Conclusion
In conclusion, wounds may be categorized as acute, complex, simple, or chronic. Each wound has its features and their extents are different hence, requiring different methods of treatment and care. They pose a clinical challenge and, the main aim of the wound care nurses is to prevent complications and promote healing through a natural and nurtured healing process.
Reference List
Durkin, W. (2009). The Six steps to proper wound care: What to do if you are ever cut, scraped, stung and more.
Ignatavicius. D., & Workman, L. (2005). Medical surgical nursing: Critical thinking for collaborative care, U.K: W. B. Saunders.
NSCCHealth (2009). General wound care. Web.
Thanh, D. & Hau, P. (2002). Feature: Emerging treatments in diabetic wound care. Wounds, 14(1), 2-10.
Wound Care Strategies Inc. (2007). Wound care strategies. Web.