Wound and skin care

‫رﻋﺎﯾﮫ اﻟﺠﺮح واﻟﺠﻠﺪ‬

Dr. Gehan Hefnawy

 LEARNING OBJECTIVES
On completion of this chapter, the patient will
! Define the term wound.
! Name three phases of wound repair.
! Identify five signs and symptoms classically associated with the inflammatory response.
! Discuss the purpose of phagocytosis, including the two types of cells involved.
! Name three ways in which the integrity of a wound is restored.
! Explain first-, second-, and third-intention healing.
! Name two types of wounds.
! State at least three purposes for using a dressing.
! Explain the rationale for keeping wounds moist.
! Describe two types of drains, including the purpose of each.
! Name the two major methods for securing surgical wounds together until they heal.
! Explain three reasons for using a bandage or binder.
! Discuss the purpose for using one type of binder.
! Give examples of four methods used to remove nonliving tissue from a wound.
! List three commonly irrigated structures.
! State two uses each for applying heat and for applying cold.
! Identify at least four methods for applying heat and cold.
! List at least five risk factors for developing pressure ulcers.
! Discuss three techniques for preventing pressure ulcers.
 ‫ﺗﻌﺮﯾﻒ اﻟﺠﺮح‬Definition of wound
A wound is damaged skin or soft tissue results
from trauma. )‫اﻟﺟرح ھو ﺟﻠد او ﻧﺳﯾﺞ رﺧو ﻣدﻣر ﻧﺎﺗﺞ ﻣن ﺻدﻣﮫ) أﺻﺎﺑﮫ‬

Examples of tissue trauma include cuts, blows, poor

circulation, strong chemicals, and excessive heat or cold. ‫اﻣﺛﻠﮫ‬
‫ﺻدﻣﮫ اﻟﻧﺳﯾﺞ ﺗﺷﻣل اﻟﻘطﻊ أواﻟﺿرﺑﺎت أوﻧﻘص اﻟدوره اﻟدﻣوﯾﮫ أوﻣواد ﻛﯾﻣﯾﺎﺋﯾﺔ‬
‫ﻗوﯾﮫ او ﺣراره او ﺑروده ﺷدﯾده‬

Such trauma produces two basic types of wounds:

open and closed. ‫ ﻣﻔﺗوح‬-: ‫اي ﺻدﻣﮫ ﺗﻧﺗﺞ ﻧوﻋﯾن أﺳﺎﺳﯾﯾن ﻣن اﻟﺟروح‬
‫وﻣﻐﻠق‬
 ‫ﻧﻮع اﻟﺠﺮح‬Type of wound
1- An open wound: ‫ﺟرح ﻣﻔﺗوح‬
is one in which the surface of the skin or mucous membrane is no
longer intact. .‫ھو اﻟذي ﻟم ﯾﻌد ﻓﯾﮫ ﺳطﺢ اﻟﺟﻠد أو اﻟﻐﺷﺎء اﻟﻣﺧﺎطﻲ ﺳﻠﯾًﻣﺎ‬
It may be caused accidentally or intentionally, as when a surgeon
incises the tissue. ‫ ﻛﻣﺎ ﯾﺣدث ﻋﻧدﻣﺎ ﯾﻘطﻊ‬، ‫ﻗد ﯾﻛون ﺳﺑﺑﮭﺎ ﻋرﺿﯾًﺎ أو ﻣﺗﻌﻣدًا‬
.‫اﻟﺟراح اﻟﻧﺳﯾﺞ‬
2- A closed wound,:‫ﺟرح ﻣﻐﻠق‬
there is no opening in the skin or mucous membrane.
Closed wounds occur more often from blunt trauma or pressure.
.‫ﻻ ﺗوﺟد ﻓﺗﺣﺔ ﻓﻲ اﻟﺟﻠد أو اﻟﻐﺷﺎء اﻟﻣﺧﺎطﻲ‬
‫ﺗﺣدث اﻟﺟروح اﻟﻣﻐﻠﻘﺔ ﻓﻲ ﻛﺛﯾر ﻣن اﻷﺣﯾﺎن ﺑﺳﺑب اﻟﺻدﻣﺔ اﻟرﺿﯾﮫ ) ﺿرﺑﮫ ﺑﻘوه‬
.‫ﻛﺑﯾره ( أو اﻟﺿﻐط‬
 ‫أﻧﻮاع اﻟﺠﺮوح‬
‫اﻟوﺻف‬ ‫أﻧواع اﻟﺟرح‬
‫ﺟروح ﻣﻔﺗوﺣﮫ‬
‫ﻓﺻل ﻧظﯾف ﻟﻠﺟﻠد واﻟﻧﺳﯾﺞ وﻟﮫ ﺣواف ﻣﺗﺳﺎوﯾﮫ وﻧﺎﻋﻣﮫ‬ ‫اﻟﺷق‬
‫ﻓﺻل اﻟﺟﻠد واﻟﻧﺳﯾﺞ وﺑﮫ اﻟﺣواف ﻣﺗﻘطﻌﮫ و ﻏﯾر‬ ‫ا ﻟ ﻘط ﻊ‬
‫ﻣﻧﺗظﻣﮫ‬
‫ﺟرح ﻓﯾﮫ اﻟطﺑﻘﺎت اﻟﺳطﺣﯾﮫ ﻟﻠﺟﻠد ﻣﺧدوﺷﮫ ) ﻣﻧزوﻋﮫ(‬ ‫ﺳﺣﺟﺎت‬
‫ﻧزع ﻣﺳﺎﺣﺎت ﻛﺑﯾره ﻣن اﻟﺟﻠد واﻟﻧﺳﯾﺞ اﻟﻣﺑطن وﯾﺗرك‬ ‫اﻟﺳﺣب )اﻟﺑﺛور(‬
‫اﻟﻐﺿﺎرﯾف واﻟﻌظﺎم ظﺎھره‬
‫ﺣﻔره ﺿﺣﻠﮫ ﻻ ﯾوﺟد ﺑﮭﺎ ﺟﻠد وﻻ ﻏﺷﺎء ﻣﺧﺎطﻲ‬ ‫ﺗﻘرح‬
‫ﻓﺗﺢ ﻓﻲ اﻟﺟﻠد واﻟﻧﺳﯾﺞ اﻟﻣﺑطن واﻟﻐﺷﺎء اﻟﻣﺧﺎطﻲ ﺑﺳﺑب‬ ‫وﺧز ) ﺛﻘب(‬
‫ﺷﻲء ﺣﺎد وﺿﯾق وﻣدﺑب‬
‫ﺟروح ﻣﻐﻠﻘﮫ‬
‫أﺻﺎﺑﮫ اﻟﻧﺳﯾﺞ اﻟرﺧو اﻟﻣﺑطن ﻟﻠﺟﻠد ﻣن ﻗوه اﻟﺗﻼﻣس ﻣﻊ‬ ‫ﻛ د ﻣ ﺎت‬
‫ﺟﺳم ﺣﺎد واﺣﯾﺎﻧﺎ ﯾﺳﻣﻲ ﻛدﻣﮫ‬
 ‫ﻋﻤﻠﯿﮫ إﻟﺘﺌﺎم‬Process of wound healing
‫اﻟﺠﺮح‬
Regardless of the type of wound, the body
immediately attempts to repair the injury and heal
the wound. ‫ ﯾﺣﺎول اﻟﺟﺳم ﻋﻠﻰ‬، ‫ﺑﻐض اﻟﻧظر ﻋن ﻧوع اﻟﺟرح‬
.‫اﻟﻔور إﺻﻼح اﻹﺻﺎﺑﺔ وإﻟﺗﺋﺎم اﻟﺟرح‬

The process of wound repair proceeds in three

sequential phases: ‫ﺗﺗم ﻋﻣﻠﯾﺔ إﺻﻼح اﻟﺟرح ﻓﻲ ﺛﻼث ﻣراﺣل‬
:‫ﻣﺗﺗﺎﻟﯾﺔ‬
1- inflammation phase ‫ﻣرﺣﻠﮫ اﻻﻟﺗﮭﺎب‬
2- proliferation phase ‫ﻣرﺣﻠﮫ اﻟﺗﻛﺎﺛر‬
3- remodeling phase ‫ﻣرﺣﻠﮫ اﻋﺎده اﻹﺻﻼح‬
 ‫ﻣﺮﺣﻠﮫ اﻹﻟﺘﮭﺎب‬Inflammation phase
Inflammation is the physiologic defense immediately
after tissue injury, lasts approximately 2 to 5 days.
‫ وﯾﺳﺗﻣر‬، ‫اﻻﻟﺗﮭﺎب ھو دﻓﺎع ﻓﺳﯾوﻟوﺟﻲ ﺑﻌد إﺻﺎﺑﺔ اﻷﻧﺳﺟﺔ ﻣﺑﺎﺷرة‬
.‫ أﯾﺎم ﺗﻘرﯾﺑًﺎ‬5 ‫ إﻟﻰ‬2 ‫ﻣن‬
Its purposes are to: ‫اﻏراﺿﮭﺎ ھﻲ‬
(1) limit the local damage, ‫ﺗﻘﯾد اﻟﺗدﻣﯾر اﻟﻣوﺿﻌﻲ‬
(2) remove injured cells and debris, ‫ازاﻟﮫ اﻟﺧﻼﯾﺎ اﻟﻣﺻﺎﺑﮫ‬
‫و ا ﻟ ﺑ ﻘﺎﯾ ﺎ‬
(3) prepare the wound for healing. ‫ﯾﺣﺿر اﻟﺟرح ﻟﻺﻟﺗﺋﺎم‬
 ‫ﻣﺮﺣﻠﮫ اﻹﻟﺘﮭﺎب‬Inflammation phase
Inflammation progresses through several stages. ‫اﻻﻟﺗﮭﺎب ﯾﺣدث ﺧﻼل ﻣراﺣل ﻣﺗﻌدده‬
1- first stage ‫اﻟﻣرﺣﻠﮫ اﻻوﻟﻲ‬, “local changes” ‫ﺗﻐﯾرات ﻣوﺿﻌﯾﮫ‬
local changes occur Immediately following an injury: ‫اﻟﺗﻐﯾرات اﻟﻣوﺿﻌﯾﮫ ﺗﺣدث ﻓورا‬
‫ﺑﻌد اﻻﺻﺎﺑﮫ‬
A- blood vessels constrict to control blood loss and confine the damage. ‫ﺗﺿﯾق‬
‫اﻻوﻋﯾﮫ اﻟدﻣوﯾﮫ ﻟﻠﺗﺣﻛم ﻓﻲ ﻓﻘد اﻟدم وﺗﻘﻠل ) ﺗﺣد( اﻟﺗدﻣﯾر‬
B- blood vessels dilate to deliver platelets that form a loose clot. ‫اﻻوﻋﯾﮫ اﻟدﻣوﯾﮫ‬
‫ﺗﺗﺳﻊ ﻟﺗوﺻﯾل اﻟﺻﻔﺎﺋﺢ اﻟدﻣوﯾﮫ اﻟﺗﻲ ﺗﻛون ﺟﻠطﮫ رﺧوه‬
C- Membranes of the damaged cells become more permeable, ‫أﻏﻠﻔﮫ اﻟﺧﻼﯾﺎ‬
‫ اﻟﻣدﻣره ﺗﺻﺑﺢ اﻛﺛر ﻧﻔﺎذﯾﮫ‬causing release of plasma and chemical substances that
transmit a sensation of discomfort. ‫ﺗﺳﺑب ﺧروج اﻟﺑﻼزﻣﺎ و ﻣواد ﻛﯾﻣﯾﺎﺋﯾﺔ اﻟﺗﻲ ﺗﻧﻘل‬
‫إﺣﺳﺎس ﻋدم اﻟراﺣﮫ‬

The local response produces the characteristic signs and symptoms of

inflammation: ‫اﻻﺳﺗﺟﺎﺑﮫ اﻟﻣوﺿﻌﯾﮫ ﺗﻧﺗﺞ اﻟﻌﻼﻣﺎت واﻻﻋراض اﻟﻣﻣﯾزه ﻟﻼﻟﺗﮭﺎب‬
Swelling ‫ﺗورم‬, redness ‫اﺣﻣرار‬, warmth ‫دﻓﺊ‬, pain ‫أﻟم‬, and decreased
function. ‫ﻗﺻور اﻟوظﯾﻔﮫ‬
1- second stage, ‫ اﻟﻣرﺣﻠﮫ اﻟﺛﺎﻧﯾﮫ‬follows the local changes ‫ﺗﺗﺑﻊ اﻟﺗﻐﯾرات‬
‫اﻟﻣوﺿﻌﯾﮫ‬
A- Increased white blood cells leukocytes, neutrophils and
macrophages (types of white blood cells) migrate to the site of
injury. ‫زﯾﺎده ﺧﻼﯾﺎ اﻟدم اﻟﺑﯾﺿﺎء و اﻟﺧﻼﯾﺎ اﻟﻣﺗﻌﺎدﻟﮫ و اﻟﺧﻼﯾﺎ اﻻﻛوﻟﮫ ) أﻧواع ﻣن‬
‫ﺧﻼﯾﺎ اﻟدم اﻟﺑﯾﺿﺎء (ﺗﻧﺗﻘل اﻟﻲ ﻣوﻗﻊ اﻻﺻﺎﺑﮫ‬
B- Neutrophils and monocytes, responsible for phagocytosis,
which is a process by which these cells consume pathogens,
coagulated blood, and cellular debris. Collectively, neutrophils and
monocytes clean the injured area and prepare the site for wound
healing. ‫ وھﻲ ﻋﻣﻠﯾﺔ‬، ‫اﻟﺧﻼﯾﺎ اﻟﻣﺗﻌﺎدﻟﮫ واﻟﺧﻼﯾﺎ اﻟوﺣﯾدة ﻣﺳﺋوﻟﯾن ﻋن اﻟﺑﻠﻌﻣﺔ‬
.‫ﺗﺳﺗﮭﻠك ﻣن ﺧﻼﻟﮭﺎ ھذه اﻟﺧﻼﯾﺎ ﻣﺳﺑﺑﺎت اﻷﻣراض واﻟدم اﻟﻣﺗﺧﺛر واﻟﺣطﺎم اﻟﺧﻠوي‬
‫ ﺗﻘوم اﻟﺧﻼﯾﺎ اﻟﻣﺗﻌﺎدﻟﮫ واﻟوﺣﯾده ﺑﺗﻧظﯾف اﻟﻣﻧطﻘﺔ اﻟﻣﺻﺎﺑﺔ وإﻋداد اﻟﻣوﻗﻊ‬، ‫ﺑﺷﻛل ﺟﻣﺎﻋﻲ‬
.‫ﻻﻟﺗﺋﺎم اﻟﺟروح‬
 ‫أﺻﺎﺑﮫ اﻟﻧﺳﯾﺞ‬

‫اﺳﺗﺟﺎﺑﮫ ﺧﻠوﯾﮫ‬

‫زﯾﺎده ﻧﻔﺎذﯾﮫ اﻟﻐﺷﺎء‬

‫ﺗورم‬

‫اﻧﺧﻔﺎض اﻟدوره‬
‫اﻟدﻣوﯾﮫ اﻟﻣوﺿﻌﯾﮫ‬
‫اﺳﺗﺟﺎﺑﮫ وﻋﺎﺋﯾﮫ‪.‬‬
‫اﺳﺗﺟﺎﺑﮫ ﻛﯾﻣﯾﺎﺋﯾﮫ‬
‫اﺗﺳﺎع اﻻوﻋﯾﮫ اﻟدﻣوﯾﮫ‬ ‫أﻟم‬
‫واﺣﻣرار ودﻓﺊ‬

‫ﻗﺻور اﻟوظﯾﻔﮫ‬

‫زﯾﺎده ﺧﻼﯾﺎ اﻟدم‬

‫اﻟﺑﯾﺿﺎء‬
‫ﺑﻠﻌﻣﮫ‬

‫اﺻﻼح اﻟﺟرح‬
 ‫ﻣﺮﺣﻠﮫ اﻟﺘﻜﺎﺛﺮ‬Proliferation phase
Proliferation (period during which new cells fill and seal a
wound) occurs from 2 days to 3 weeks after the
inflammatory phase. ‫ﯾﺣدث اﻟﺗﻛﺎﺛر )اﻟﻔﺗرة اﻟﺗﻲ ﺗﻣﻸ ﻓﯾﮭﺎ اﻟﺧﻼﯾﺎ‬
.‫ أﺳﺎﺑﯾﻊ ﺑﻌد اﻟﻣرﺣﻠﺔ اﻻﻟﺗﮭﺎﺑﯾﺔ‬3 ‫اﻟﺟدﯾدة اﻟﺟرح وﺗﻐﻠﻘﮫ( ﻣن ﯾوﻣﯾن إﻟﻰ‬

It is characterized by the appearance of granulation tissue

(combination of new blood vessels, fibroblasts, and
epithelial cells), which is bright pink to red because of the
extensive projections of capillaries in the area. ‫ﯾﺗﻣﯾز ﺑظﮭور‬
)‫ واﻷروﻣﺎت اﻟﻠﯾﻔﯾﺔ‬، ‫اﻟﻧﺳﯾﺞ اﻟﺣﺑﯾﺑﻲ )ﻣزﯾﺞ ﻣن اﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ اﻟﺟدﯾدة‬
‫ وھو ﻟون زھري ﻓﺎﺗﺢ إﻟﻰ‬، (‫ واﻟﺧﻼﯾﺎ اﻟطﻼﺋﯾﮫ‬، ( ‫اﻟﺧﻼﯾﺎ اﻟﻣﻛوﻧﮫ ﻟﻸﻟﯾﺎف‬
.‫أﺣﻣر ﺑﺳﺑب اﻟﻧﺗوءات اﻟواﺳﻌﺔ ﻟﻠﺷﻌﯾرات اﻟدﻣوﯾﺔ ﻓﻲ اﻟﻣﻧطﻘﺔ‬
 ‫ﻣﺮﺣﻠﮫ اﻋﺎده اﻹﺻﻼح‬Remodeling phase
Remodeling (period during which the wound
undergoes changes and maturation) follows the
proliferative phase and may last 6 months to 2
years. During this time, the wound contracts, and
the scar shrinks. ‫إﻋﺎدة اﻹﺻﻼح )اﻟﻔﺗرة اﻟﺗﻲ ﯾﺧﺿﻊ ﻓﯾﮭﺎ‬
6 ‫اﻟﺟرح ﻟﻠﺗﻐﯾﯾرات واﻟﻧﺿﺞ( ﺗﺗﺑﻊ ﻣرﺣﻠﺔ اﻟﺗﻛﺎﺛر وﻗد ﺗﺳﺗﻣر ﻣن‬
.‫ ﯾﻧﻘﺑض اﻟﺟرح وﺗﻧﻛﻣش اﻟﻧدﺑﺔ‬، ‫ ﺧﻼل ھذا اﻟوﻗت‬.‫أﺷﮭر إﻟﻰ ﺳﻧﺗﯾن‬
 factors affect wound healing ‫اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻲ إﻟﺘﺌﺎم اﻟﺠﺮح‬

Several factors affect wound healing: ‫ﻋواﻣل ﻋدﯾده‬

‫ﺗؤﺛر ﻋﻠﻲ إﻟﺗﺋﺎم اﻟﺟرح‬
• Type of wound injury ‫ﻧوع أﺻﺎﺑﮫ اﻟﺟرح‬
• Expanse or depth of wound ‫ﻣدي او ﻋﻣق اﻟﺟرح‬
• Quality of circulation ‫ﺟوده) ﻛﻔﺎءه( اﻟدوره اﻟدﻣوﯾﮫ‬
• Amount of wound debris ‫ﻛﻣﯾﮫ ﺣطﺎم ) ﺑﻘﺎﯾﺎ( اﻟﺟرح‬
• Presence of infection ‫وﺟود ﻋدوي‬
• Status of the client’s health‫اﻟﺣﺎﻟﮫ اﻟﺻﺣﯾﮫ ﻟﻠﻣرﯾض‬
 WOUND HEALING COMPLICATIONS ‫ﻣﻀﺎﻋﻔﺎت إﻟﺘﺌﺎم اﻟﺠﺮح‬
Two potential surgical wound complications include: ‫اﺛﻧﯾن ﻣن ﻣﺿﺎﻋﻔﺎت اﻟﺟرح‬
‫اﻟﺟراﺣﻲ اﻟﻣﺣﺗﻣﻠﮫ ھﻲ‬
1- Dehiscence ‫( ﺗﻔﻛك‬separation of wound edges ‫)ﻓﺻل ﺣواف اﻟﺟرح‬
2- Evisceration ‫( ﺧروج اﻻﺣﺷﺎء‬wound separation with protrusion of organs ‫ﻓﺻل‬
‫)اﻟﺟرح وﺧروج اﻷﻋﺿﺎء‬

These complications are most likely within 7 to 10 days after surgery. They may
be caused by insufficient dietary intake of protein and sources of vitamin C;
premature removal of sutures or staples; unusual strain on the incision from
severe coughing, sneezing, vomiting, dry heaves, or hiccupping; weak tissue or
muscular support secondary to obesity; distention of the abdomen from
accumulated intestinal gas; or compromised tissue integrity from previous
surgical procedures in the same area. 7 ‫ﺗزداد اﺣﺗﻣﺎﻟﯾﺔ ﺣدوث ھذه اﻟﻣﺿﺎﻋﻔﺎت ﻓﻲ ﻏﺿون‬
‫ ﻗد ﺗﻛون ﺑﺳﺑب ﻋدم ﻛﻔﺎﯾﺔ اﻟﺗﻧﺎول اﻟﻐذاﺋﻲ ﻟﻠﺑروﺗﯾن وﻣﺻﺎدر ﻓﯾﺗﺎﻣﯾن ﺳﻲ ؛‬.‫ أﯾﺎم ﺑﻌد اﻟﺟراﺣﺔ‬10 ‫إﻟﻰ‬
‫اﻹزاﻟﺔ اﻟﻣﺑﻛرة ﻟﻠﺧﯾوط اﻟﺟراﺣﯾﺔ أو اﻟدﺑﺎﺑﯾس ؛ إﺟﮭﺎد ﻏﯾر ﻋﺎدي ﻋﻠﻰ اﻟﺷق) اﻟﺟرح( ﻣن اﻟﺳﻌﺎل اﻟﺷدﯾد‬
‫أو اﻟﻌطس أو اﻟﻘﻲء أو اﻟرﺷف اﻟﺟﺎف أو اﻟﻔواق) اﻟزﻏوطﮫ( ؛ ﺿﻌف اﻷﻧﺳﺟﺔ أو اﻟﻌﺿﻼت ﻧﺗﯾﺟﺔ ﻟﻠﺳﻣﻧﺔ‬
‫ أو ﺗﺿرر ﺳﻼﻣﺔ اﻷﻧﺳﺟﺔ ﻣن اﻟﻌﻣﻠﯾﺎت اﻟﺟراﺣﯾﺔ اﻟﺳﺎﺑﻘﺔ‬.‫؛ اﻧﺗﻔﺎخ اﻟﺑطن ﻣن ﻏﺎزات اﻷﻣﻌﺎء اﻟﻣﺗراﻛﻣﺔ‬
.‫ﻓﻲ ﻧﻔس اﻟﻣﻧطﻘﺔ‬
 Nursing role in wound complications ‫دور اﻟﺘﻤﺮﯾﺾ ﻓﻲ‬
‫ﻣﻀﺎﻋﻔﺎت اﻟﺠﺮح‬
If evisceration occurs, the nurse places sterile dressings
moistened with normal saline over the protruding organs and
tissues. ) ‫ اﻟﻣﻣرﺿﮫ ﺗﺿﻊ ﺿﻣﺎدات ﻣﻌﻘﻣﮫ ﻣرطﺑﮫ‬، ‫اذا ﺣدث ﺧروج اﻻﺣﺷﺎء‬
‫وﺿﻌﻧﺎ ﻋﻠﯾﮭﺎ(ﺑﺳﺎﻟﯾن طﺑﯾﻌﻲ ﻓوق اﻻﺣﺷﺎء اﻟﺗﻲ ﺧرﺟت‬
For any wound disruption, the nurse notifies the physician
immediately. The nurse must be alert for
signs and symptoms of impaired blood flow such as
swelling, localized pallor or mottled appearance, and coolness
of the tissue in the area around the wound. ‫ﻓﻲ ﺣﺎﻟﺔ ﺣدوث أي‬
‫ ﯾﺟب أن‬.‫ ﺗﻘوم اﻟﻣﻣرﺿﺔ ﺑﺈﺧطﺎر اﻟطﺑﯾب ﻋﻠﻰ اﻟﻔور‬، ‫اﺿطراب ﻓﻲ اﻟﺟرح‬
‫ﺗﻛون اﻟﻣﻣرﺿﺔ ﻓﻲ ﺣﺎﻟﺔ اﻧﺗﺑﺎه ﻟﻌﻼﻣﺎت وأﻋراض ﺿﻌف ﺗدﻓق اﻟدم ﻣﺛل‬
‫اﻧﺗﻔﺎخ وﺷﺣوب ﻣوﺿﻌﻲ أو ﻣظﮭر ﻣﻧﻘط وﺑرودة اﻷﻧﺳﺟﺔ ﻓﻲ اﻟﻣﻧطﻘﺔ اﻟﻣﺣﯾطﺔ‬
.‫ﺑﺎﻟﺟرح‬
 WOUND MANAGEMENT ‫اداره ) اﻟﺘﻌﺎﻣﻞ ﻣﻊ( اﻟﺠﺮح‬
A pressure ulcer is a wound caused by prolonged capillary compression
that is sufficient to impair circulation to the skin and underlying tissue.
The primary goal in managing pressure ulcers is prevention. Once a
pressure ulcer forms, however, the nurse implements measures to
reduce its size and to restore skin and tissue integrity. ‫ﻗرﺣﺔ اﻟﺿﻐط ھﻲ‬
‫ﺟرح ﻧﺎﺗﺞ ﻋن ﺿﻐط اﻟﺷﻌﯾرات اﻟدﻣوﯾﺔ ﻟﻔﺗرات طوﯾﻠﺔ وھو ﻣﺎ ﯾﻛﻔﻲ ﻹﻋﺎﻗﺔ اﻟدورة اﻟدﻣوﯾﺔ‬
.‫ اﻟﮭدف اﻷﺳﺎﺳﻲ ﻓﻲ اﻟﺗﻌﺎﻣل ﻣﻊ ﺗﻘرﺣﺎت اﻟﺿﻐط ھو اﻟوﻗﺎﯾﺔ‬.‫ﻓﻲ اﻟﺟﻠد واﻷﻧﺳﺟﺔ اﻟﻣﺑطﻧﮫ ﻟﮫ‬
‫ ﺗﺗﺧذ اﻟﻣﻣرﺿﺔ ﺗداﺑﯾر ﻟﺗﻘﻠﯾل ﺣﺟﻣﮭﺎ واﺳﺗﻌﺎدة ﺳﻼﻣﺔ‬، ‫ ﺑﻣﺟرد ظﮭور ﻗرﺣﺔ اﻟﺿﻐط‬، ‫وﻣﻊ ذﻟك‬
.‫اﻟﺟﻠد واﻷﻧﺳﺟﺔ‬
Wound management involves changing dressings, caring for drains,
removing sutures or staples when directed by the surgeon, applying
bandages and binders, and administering irrigations. ‫ﺗﺷﻣل إدارة اﻟﺟروح‬
‫ وإزاﻟﺔ اﻟﻐرز أو اﻟدﺑﺎﺑﯾس ﻋﻧد ﺗوﺟﯾﮭﮭﺎ‬، (‫ واﻟﻌﻧﺎﯾﺔ ﺑﺎﻟﺻرف) اﻻﻓرازات‬، ‫ﺗﻐﯾﯾر اﻟﺿﻣﺎدات‬
. (‫ وإدارة اﻟﻐﺳل ) اﻟري‬، ‫ وﺗطﺑﯾق اﻟﺿﻣﺎدات واﻟرﺑط‬، ‫ﺑواﺳطﮫ اﻟﺟراح‬
 ‫اﻟﺪرﻧﻘﮫ‬Drains
Drains are tubes “open or close” that provide a means for
removing blood and drainage from a wound. They promote
wound healing by removing fluid and cellular debris. ‫اﻟدرﻧﻘﮫ ھﻲ‬
‫ أﻧﮭﺎ ﺗﻌزز‬.‫أﻧﺎﺑﯾب "ﺗﻔﺗﺢ أو ﺗﻐﻠق" ﺗوﻓر وﺳﯾﻠﺔ ﻹزاﻟﺔ اﻟدم واﻟﺻرف ﻣن اﻟﺟرح‬
.‫اﻟﺗﺋﺎم اﻟﺟروح ﻋن طرﯾق إزاﻟﺔ اﻟﺳواﺋل واﻟﺣطﺎم اﻟﺧﻠوي‬
 ‫اﻟﻀﻤﺎدات‬Dressings
A dressing (cover over a wound). ‫اﻟﺿﻣﺎده ) ﻏطﺎء ﻓوق اﻟﺟرح‬
(

Purposes of dressing: ‫أﻏراض اﻟﺿﻣﺎده‬

• Keeping the wound clean ‫اﻟﺣﻔﺎظ ﻋﻠﻲ اﻟﺟرح ﻧظﯾف‬
• Absorbing drainage (‫اﻣﺗﺻﺎص اﻟﺻرف ) اﻻﻓرازات‬
• Controlling bleeding ‫اﻟﺗﺣﻛم ﻓﻲ اﻟﻧزﯾف‬
• Protecting the wound from further injury ‫ﺣﻣﺎﯾﮫ اﻟﺟرح‬
‫ﻣن أﺻﺎﺑﮫ اﺧري‬
• Holding medication in place ‫ﺗﺛﺑﯾت اﻟدواء ﻓﻲ ﻣﻛﺎﻧﮫ‬
• Maintaining a moist environment ‫اﻟﺣﻔﺎظ ﻋﻠﻲ ﺑﯾﺋﮫ رطﺑﮫ‬
 ‫اﻧﻮاع وأﺣﺠﺎم‬Types and sizes of dressings
‫اﻟﻀﻤﺎدات‬
The most common wound coverings are gauze,
transparent, and hydrocolloid dressings. ‫أﻛﺛر أﻏطﯾﺔ‬
.‫ﻋﺎ ھﻲ اﻟﺿﻣﺎدات اﻟﺷﺎش واﻟﺷﻔﺎﻓﺔ واﻟﻐرواﻧﯾﺔ اﻟﻣﺎﺋﯾﺔ‬
ً ‫اﻟﺟروح ﺷﯾو‬
 ‫ازاﻟﮫ اﻟﻨﺴﯿﺞ اﻟﻤﯿﺖ ) ﺗﻨﻈﯿﻒ‬Debridement
( ‫اﻟﺠﺮح‬
some wounds require debridement (removal of
dead tissue) to promote healing. The four methods
for debriding a wound are sharp, enzymatic,
autolytic, and mechanical ‫ﺗﺗطﻠب ﺑﻌض اﻟﺟروح )إزاﻟﺔ‬
‫ اﻟطرق اﻷرﺑﻌﺔ ﻟﺗﻧظﯾف اﻟﺟرح‬. ‫اﻷﻧﺳﺟﺔ اﻟﻣﯾﺗﺔ( ﻟﺗﻌزﯾز اﻹﻟﺗﺋﺎم‬
‫ھﻲ طرق ﺣﺎدة وإﻧزﯾﻣﯾﺔ وﻣﺣﻠﻠﺔ ذاﺗﯾﺎ وﻣﯾﻛﺎﻧﯾﻛﯾﺔ‬
 ‫طﺮق ازاﻟﮫ اﻻﻧﺴﺠﮫ‬Methods of debriding
( ‫اﻟﻤﯿﺘﮫ) ﺗﻨﻈﯿﻒ اﻟﺠﺮح‬
Sharp Debridement ‫ﺗﻧظﯾف ﺣﺎد‬: is the removal of necrotic
tissue (nonliving tissue) from the healthy areas of a
wound with sterile scissors, forceps, or other
instruments. ‫ھو إزاﻟﺔ اﻷﻧﺳﺟﺔ اﻟﻣﯾﺗﺔ )اﻷﻧﺳﺟﺔ ﻏﯾر اﻟﺣﯾﺔ( ﻣن‬
.‫اﻟﻣﻧﺎطق اﻟﺻﺣﯾﺔ ﻟﻠﺟرح ﺑﺎﺳﺗﺧدام ﻣﻘص أو ﻣﻠﻘط أو أدوات أﺧرى‬

Enzymatic Debridement: ‫ﺗﻧظﯾف اﻧزﯾﻣﻲ‬Enzymatic

debridement involves the use of topically applied
chemical substances that break down and liquefy
wound debris. ‫ﯾﺷﻣل اﻟﺗﻧظﯾف اﻹﻧزﯾﻣﻲ اﺳﺗﺧدام اﻟﻣواد اﻟﻛﯾﻣﯾﺎﺋﯾﺔ‬
.‫اﻟﻣوﺿﻌﯾﺔ اﻟﺗﻲ ﺗﻌﻣل ﻋﻠﻰ ﺗﻛﺳﯾر ﺣطﺎم اﻟﺟرح وﺗﺳﯾﯾﻠﮫ‬
Autolytic Debridement ‫اﻟﺗﺣﻠل اﻟذاﺗﻲ‬: Autolytic debridement, or self-
dissolution, is a painless, natural physiologic process that allows the
body’s enzymes to soften, liquefy, and release devitalized tissue. It is
used when a wound is small and free of infection. ‫ أو اﻟﺗﺣﻠل‬، ‫اﻟﺗﺗظﯾف اﻟذاﺗﻲ‬
‫ ھو ﻋﻣﻠﯾﺔ ﻓﺳﯾوﻟوﺟﯾﺔ طﺑﯾﻌﯾﺔ ﻏﯾر ﻣؤﻟﻣﺔ ﺗﺳﻣﺢ ﻹﻧزﯾﻣﺎت اﻟﺟﺳم ﺑﺗﻠﯾﯾن اﻷﻧﺳﺟﺔ اﻟﻣﯾﺗﮫ‬، ‫اﻟذاﺗﻲ‬
.‫ ﯾﺗم اﺳﺗﺧداﻣﮫ ﻋﻧدﻣﺎ ﯾﻛون اﻟﺟرح ﺻﻐﯾًرا وﺧﺎﻟﯾًﺎ ﻣن اﻟﻌدوى‬.‫وﺗﺳﯾﯾﻠﮭﺎ وإطﻼﻗﮭﺎ‬

Mechanical Debridement ‫اﻟﺗﻧظﯾف اﻟﻣﯾﻛﺎﻧﯾﻛﻲ‬: involves physical removal of

debris from a deep wound. One technique is the application of wet-to-
dry dressings. The wound is packed with moist gauze, which is removed
approximately 4 to 6 hours later when the gauze is dry. Dead tissue
adheres to the meshwork of the gauze and is removed when the
dressing is changed. ‫ إﺣدى اﻟﺗﻘﻧﯾﺎت‬.‫ﺗﺷﻣل اﻹزاﻟﺔ اﻟﺟﺳدﯾﺔ ﻟﻠﺣطﺎم ﻣن اﻟﺟرح اﻟﻌﻣﯾق‬
6 ‫ إﻟﻰ‬4 ‫ ﯾﺗم ﺗﻌﺑﺋﺔ اﻟﺟرح ﺑﺷﺎش ﻣﺑﻠل ﯾﺗم إزاﻟﺗﮫ ﺑﻌد‬.‫ھﻲ ﺗطﺑﯾق اﻟﺿﻣﺎدات اﻟرطﺑﺔ إﻟﻰ اﻟﺟﺎﻓﺔ‬
‫ ﺗﻠﺗﺻق اﻷﻧﺳﺟﺔ اﻟﻣﯾﺗﺔ ﺑﺷﺑﻛﺔ اﻟﺷﺎش وﺗﺗم إزاﻟﺗﮭﺎ ﻋﻧد ﺗﻐﯾﯾر‬.‫ﺳﺎﻋﺎت ﺗﻘرﯾﺑًﺎ ﻋﻧدﻣﺎ ﯾﺟف اﻟﺷﺎش‬
.‫اﻟﺿﻣﺎدة‬