Question

You are a nurse working the day shift and have been assigned to five patients. One of your patients is an 89-year-old male with a stage III decubitus ulcer to his coccyx. The healthcare provider is planning to discharge him to a long-term facility today and would like you to discuss wound healing with him and his wife. Please use the following prompts to guide your analysis, and use evidence from the literature to support your answers.

Distinguish between the main types of healing: first-intention and second-intention.

Discuss at least three factors that can delay wound healing, and identify some strategies to improve wound healing.

Explain the four phases of wound healing, identifying the role that the extracellular matrix plays in the process.

Answer 1

first-intention healing:

This type of healing occurs when the tissue loss is of very little and the tissue surfaces were approximated or closed. It can be either done by surgical incision, tapes, stitches, skin glues etc.

second-intention healing.

A wound which is extensive and have greater tissue loss and the tissue surfaces were not closed or we cant able to bring the edges of tissue surface together. Pressure ulcer heals of this type. Scar and chance of infection is greater.

Factors delay and promote wound healing:

Nutrition- patients need carbohydrate, protein, lipids, minerals like iron, zinc, copper, vitamin A and C,rich diet

Developmental factors- Healthy individual and adults heal quickly compared with elders

Lifestyle- Individual who exercise, tend to heal quickly because of good circulation

Anti inflammatory drugs- delays healing most likely to develop wound infections

4 phases of healing:

Hemostasis phase- platelets will help in formation of clot

Inflammatory phase-inflammatory cells debride the injured cells

Proliferative phase-occrence of epithelialization, fibroplasia, and angiogenesis

Maturation phase-cross link between collagen and protein molecules and increase the strength of scar

Wound gets strengthened by proliferation fibroblasts and myofibroblasts which get structural support from extracellular matrix. And also, it directs migration,attachment, differentiation and organization of cells