Unit 1 : INTRODUCTION
Question no : 1
1. Explain the stages of wound healing
INTRODUCTION
Wound healing and care is important to understand because the incidence of poor wound
healing, wound infection, excessive scarring is considered as a main cause of morbidity and
mortality.
DEFINITION
Wound healing is a complex but well coordinated process which attempts to restore normal
structure and function of the injured tissue/organ.
STAGES OF WOUND HEALING
● Hemostasis
● Inflammation
● Proliferation
● Remodeling
The detailed explanation of stages are as follows :
1. Hemostasis : It is the first stage in wound healing that can last for 2 days.
● As soon as there is a wound on the body, the blood vessels in the around area constrict
to reduce the blood flow. This is known as vasoconstriction.
● At the same time, clotting factors are released at the wound site to coagulate with
fibrin, resulting in a thrombus, which is more commonly known as a blood clot.
● The blood clot act as a seal between the broken blood vessels to prevent blood loss.
2. Inflammation : The 2nd phase of wound healing
● It involves phagocytic cells that release reactive oxygen species.
● During this phase of wound healing, WBC and some enzymes enter the wound area to
stave off infection by cleaning bacteria and debris and preparing the wound bed for
new tissue growth.
3. Proliferation : This stage focuses on filling and covering the wound.
● An inflammatory cells undergo apoptosis, wound healing progress to the proliferation
phase, which is characterized by formation of granulation tissue, angiogenesis, wound
contraction, and process of epithelialization.
● New tissue is generally red/pink in appearance.
● This phase of wound healing can last for 4 days to upto 3 weeks or more.
4. Remodeling :
● Scar tissue formation characterizes the final remodeling stage.
, ● During this phase, the new tissue gradually becomes stronger and more flexible.
Collagen production continues to build the tensile strength and elasticity of skin.
● The build-up of collagen in the granulation tissue leads to scar tissue formation, which
is 20% weaker and less elastic than pre injured skin.
CONCLUSION
Tissue healing is a complex and dynamic system which enables effective repair of damaged
tissue. Appropriate surgical technique has the capacity to influence the process in a positive
way.
REFERENCE :
Brunner and siddharth
Textbook of Medical Surgical Nursing
Page no : 45
Qn2- Explain the inflammatory response
Ans.
Inflammatory response
Introduction
Inflammation is the immune systems response to harmful stimuli such as pathogens, damaged
cells, toxic compound or irradiation & acts by removing injurious stimuli &initiating the
healing process. Inflammation is therefore a defense mechanism that is vital to health.
Definition
Inflammatory response is a sequential reaction to cell injury. It neutralize and dilute the
inflammatory agent remove nercotic material and establish an environmental suitable for
healing and repair
Steps in Inflammatory response
Vascular response
Cellular response
Exudate formation
Healing response
1.vascular response
Cell injury cause
______________ ____________________
,Cell death vasoconstruction
Release of histamine,
Kinins, prostoglandin
Vasodialation
Hyperaemia
Increased capillary
Permeability
Exudates formation
2.cellular response
Cell injury cause cellular response
________________ ____________________
Chemotaxis margination,diapedesis
| Of blood leukocytes
|_______________ ___________________|
Migration of blood leukocytes
to injury site
_________________|______________________
Neutrophi monocytes lymphocytes
| |
| Macrophages |
|
| Phagocytosis immune response
|
|_____ Cellular exudates
Response
3.Exudates formation
Exudates is consists of fluid, leukocytes that more form circulation to site of injury
*Types of exudates
1.hemorrhage
2.fibrosis
, 3.purulent
4.catarrhal
5.serious fluid
4.Healing response
It is a final phase of inflammatory response. It consists of 2 types
1.regeneration : it is replacement of lost cell and tissue with
Cells of some type
2.repair : lost cell being replaced by connective tissue
*According to different criteria, inflammatory response can be divided into several
categories
1.Time : hyperacute, acute, subacute & chronic
Inflammation
2.The degree of tissue damage : superficial, profound
3.characteristic picture : nonspecific, specific
4.the main inflammatory manifestations : alteration,
exudation, inflammation
Conclusion
Usually during acute inflammatory responses, cellular and molecular events and
interaction efficiently minimize impending in injury or infection.
Reference
B. Venkatesan, Textbook of Medical Surgical Nursing
Vol-1,Sixth edition, EMESS Medical Publisher’s
4.Explain the pre operative preparation
Answer
Introduction
The preoperative phase begins when the decision to proceed with surgical intervention is
made and ends with the transfer of the patient onto the operating room table. The scope of
nursing activities during this time can include establishing a baseline evaluation of the patient
before the day of surgery by carrying out a preoperative interview.
Definition
Preoperative phase can be defined as the period of time from the decision for surgical
intervention is made to when the patient is transferred to the operating room table.
HISTORY COLLECTION
• A standard history should be taken. A set of fixed questions are needed to determine
‘fitness’ for surgery. Surgery-specific symptoms (including features not present), onset,
duration and exacerbating and relieving factors should also be documented.
PATIENT ASSESSMENT
• Cardiovascular history : High blood pressure, chest pains, palpitations, syncope, dyspnea
and poor exercise tolerance
Question no : 1
1. Explain the stages of wound healing
INTRODUCTION
Wound healing and care is important to understand because the incidence of poor wound
healing, wound infection, excessive scarring is considered as a main cause of morbidity and
mortality.
DEFINITION
Wound healing is a complex but well coordinated process which attempts to restore normal
structure and function of the injured tissue/organ.
STAGES OF WOUND HEALING
● Hemostasis
● Inflammation
● Proliferation
● Remodeling
The detailed explanation of stages are as follows :
1. Hemostasis : It is the first stage in wound healing that can last for 2 days.
● As soon as there is a wound on the body, the blood vessels in the around area constrict
to reduce the blood flow. This is known as vasoconstriction.
● At the same time, clotting factors are released at the wound site to coagulate with
fibrin, resulting in a thrombus, which is more commonly known as a blood clot.
● The blood clot act as a seal between the broken blood vessels to prevent blood loss.
2. Inflammation : The 2nd phase of wound healing
● It involves phagocytic cells that release reactive oxygen species.
● During this phase of wound healing, WBC and some enzymes enter the wound area to
stave off infection by cleaning bacteria and debris and preparing the wound bed for
new tissue growth.
3. Proliferation : This stage focuses on filling and covering the wound.
● An inflammatory cells undergo apoptosis, wound healing progress to the proliferation
phase, which is characterized by formation of granulation tissue, angiogenesis, wound
contraction, and process of epithelialization.
● New tissue is generally red/pink in appearance.
● This phase of wound healing can last for 4 days to upto 3 weeks or more.
4. Remodeling :
● Scar tissue formation characterizes the final remodeling stage.
, ● During this phase, the new tissue gradually becomes stronger and more flexible.
Collagen production continues to build the tensile strength and elasticity of skin.
● The build-up of collagen in the granulation tissue leads to scar tissue formation, which
is 20% weaker and less elastic than pre injured skin.
CONCLUSION
Tissue healing is a complex and dynamic system which enables effective repair of damaged
tissue. Appropriate surgical technique has the capacity to influence the process in a positive
way.
REFERENCE :
Brunner and siddharth
Textbook of Medical Surgical Nursing
Page no : 45
Qn2- Explain the inflammatory response
Ans.
Inflammatory response
Introduction
Inflammation is the immune systems response to harmful stimuli such as pathogens, damaged
cells, toxic compound or irradiation & acts by removing injurious stimuli &initiating the
healing process. Inflammation is therefore a defense mechanism that is vital to health.
Definition
Inflammatory response is a sequential reaction to cell injury. It neutralize and dilute the
inflammatory agent remove nercotic material and establish an environmental suitable for
healing and repair
Steps in Inflammatory response
Vascular response
Cellular response
Exudate formation
Healing response
1.vascular response
Cell injury cause
______________ ____________________
,Cell death vasoconstruction
Release of histamine,
Kinins, prostoglandin
Vasodialation
Hyperaemia
Increased capillary
Permeability
Exudates formation
2.cellular response
Cell injury cause cellular response
________________ ____________________
Chemotaxis margination,diapedesis
| Of blood leukocytes
|_______________ ___________________|
Migration of blood leukocytes
to injury site
_________________|______________________
Neutrophi monocytes lymphocytes
| |
| Macrophages |
|
| Phagocytosis immune response
|
|_____ Cellular exudates
Response
3.Exudates formation
Exudates is consists of fluid, leukocytes that more form circulation to site of injury
*Types of exudates
1.hemorrhage
2.fibrosis
, 3.purulent
4.catarrhal
5.serious fluid
4.Healing response
It is a final phase of inflammatory response. It consists of 2 types
1.regeneration : it is replacement of lost cell and tissue with
Cells of some type
2.repair : lost cell being replaced by connective tissue
*According to different criteria, inflammatory response can be divided into several
categories
1.Time : hyperacute, acute, subacute & chronic
Inflammation
2.The degree of tissue damage : superficial, profound
3.characteristic picture : nonspecific, specific
4.the main inflammatory manifestations : alteration,
exudation, inflammation
Conclusion
Usually during acute inflammatory responses, cellular and molecular events and
interaction efficiently minimize impending in injury or infection.
Reference
B. Venkatesan, Textbook of Medical Surgical Nursing
Vol-1,Sixth edition, EMESS Medical Publisher’s
4.Explain the pre operative preparation
Answer
Introduction
The preoperative phase begins when the decision to proceed with surgical intervention is
made and ends with the transfer of the patient onto the operating room table. The scope of
nursing activities during this time can include establishing a baseline evaluation of the patient
before the day of surgery by carrying out a preoperative interview.
Definition
Preoperative phase can be defined as the period of time from the decision for surgical
intervention is made to when the patient is transferred to the operating room table.
HISTORY COLLECTION
• A standard history should be taken. A set of fixed questions are needed to determine
‘fitness’ for surgery. Surgery-specific symptoms (including features not present), onset,
duration and exacerbating and relieving factors should also be documented.
PATIENT ASSESSMENT
• Cardiovascular history : High blood pressure, chest pains, palpitations, syncope, dyspnea
and poor exercise tolerance
