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  • Nursing CS Wound-Types 01

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    Jazzmine Gura
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    There are three main types of wounds: open wounds which break the skin and expose internal tissue, closed wounds where the skin remains intact but internal tissue may be damaged, and pressure wounds which can be open or closed depending on their stage. Wound closure can occur through primary intention where edges are approximated, secondary intention allowing granulation tissue to form, or tertiary intention leaving the wound open initially. Factors that can delay healing include medications, infections, poor circulation, and underlying health conditions. Nursing priorities for wound care include assessment, monitoring for healing and infection, pain management, cleaning, dressing changes, and patient education.

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    Wound types

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    Nursing_CS_Wound-Types_01

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    There are three main types of wounds: open wounds which break the skin and expose internal tissue, closed wounds where the skin remains intact but internal tissue may be damaged, and pressure wounds which can be open or closed depending on their stage. Wound closure can occur through primary intention where edges are approximated, secondary intention allowing granulation tissue to form, or tertiary intention leaving the wound open initially. Factors that can delay healing include medications, infections, poor circulation, and underlying health conditions. Nursing priorities for wound care include assessment, monitoring for healing and infection, pain management, cleaning, dressing changes, and patient education.

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    © All Rights Reserved
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    8 views1 page

    Nursing CS Wound-Types 01

    Uploaded by

    Jazzmine Gura
    There are three main types of wounds: open wounds which break the skin and expose internal tissue, closed wounds where the skin remains intact but internal tissue may be damaged, and pressure wounds which can be open or closed depending on their stage. Wound closure can occur through primary intention where edges are approximated, secondary intention allowing granulation tissue to form, or tertiary intention leaving the wound open initially. Factors that can delay healing include medications, infections, poor circulation, and underlying health conditions. Nursing priorities for wound care include assessment, monitoring for healing and infection, pain management, cleaning, dressing changes, and patient education.

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    © All Rights Reserved
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    of 1

    WOUND TYPES

    Classifying Wounds
    Open wounds: Pressure wounds may be Closed wounds:
    involve a break in the skin, open or closed depending skin remains intact,
    internal tissue exposed on their stage. internal tissue not exposed

    Incision Laceration Abrasion Puncture Pressure Contusion Hematoma

    Types of Wound Closures


    Primary intention Secondary intention Tertiary intention
    Wound edges are approximated, Wound edges cannot be Wound is left open and later closed
    either on their own or by approximated due to significant due to risk of infection or risk for poor
    intervention. Fastest type of wound tissue loss. Granulation tissue and healing. Wound is cleansed, monitored, and
    closure, low risk of infection/ wound contraction occur to close surgically closed when appropriate.
    scarring. the defect. Higher risk of infection/
    scarring.
    E.g.: surgical incisions, paper cuts E.g.: lacerations, burns, ulcers E.g.: animal bite, avulsion

    Gaping irregular Increased Late suturing


    Clean incision Early suture Granulation Wound
    wound granulation with wide scar

    Nursing Care Priorities Risk Factors for Delayed Healing


    • Assess and document wound. • Medications: • Infections
    • Monitor for signs of healing and infection. 9 Corticosteroids • Poor tissue perfusion
    • Treat for pain prophylactically prior to procedures. 9 Anticoagulants • Diabetes
    • Perform wound cleaning/irrigation as ordered. 9 Immunosuppressants • Malnutrition
    • Obtain wound culture if ordered. 9 Chemotherapy • Obesity
    • Select appropriate dressing. 9 NSAIDs • Genetic conditions
    • Perform dressing changes.
    • Educate client on wound care.

    Client Education
    Provide anticipatory Inform client when Educate client
    Instruct client how
    guidance. Inform client stitches, staples, or on signs of
    to clean wound
    that soreness, tingling, steri-strips should be infection and
    and perform
    and/or itching can be removed. Schedule when to call
    dressing changes.
    normal during healing. follow-up. provider.

    NOTES

    www.lecturio.com/nursing Watch Video

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