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Nursing Case Study

Q1

The wound healing process is crucial because it focuses on restoring the normal functioning of the tissues. It is important to educate the 89-old patient and wife to understand the healing process of stage III decubitus ulcer to his coccyx before being discharged to a long-term facility. Understanding of the healing process helps the patient and wife appreciate the systematic process and careful management. The types of healing include,

Primary Intention

The type of healing occurs in small pierced wounds, which are close together like that pierced by a scalpel. The primary intention is faster during healing that the secondary one. The four stages under primary intention include,

Hemostasis

This stage is characterized by blood clotting, which occurs due to the action of platelets and cytokines forming hematoma, which initiate vasoconstriction, causing clotting blood to limit loss from the injured area. Formation of scab and ease of blood clot is possible due to the proximity of wound edge.

Inflammation

The purpose of this stage is to respond by removing any available cell debris or pathogens present.

Proliferation

In this stage, fibroblasts are proliferated, and formation of granulated tissues occurs through the aide of cytokines that were released by inflammatory cells (Montandon, 2019). The wound closure occurs in a week due to the presence of fibroblasts produced by collagen.

Remodeling

This stage is where devascularization process occurs in the injury area, and the fibroblasts undergo apoptosis. The completion of all the stages during the healing process results in a complete return to function, leaving minimal scarring.

Secondary Intention

The healing by secondary intention occurs in a wound that its sides are unopposed and healing occurs from beneath/bottom upwards (Thomas, 2016). The healing process is slow and follows similar stages as a primary intention.

Haemostasis

The stage is characterized by the formation of large fibrin mesh which fills and covers the injury surface.

Inflammatory Response

The response of inflammation removes debris and pathogens present. Debris and pathogens are more compared to primary intention.

Proliferation

The formation of granulated tissue covers the bottom of the wound. When the injury is entirely covered by granulated tissue to the original epithelium level, then epithelia takes over and completely covers the wound.

Remodelling

The inflammatory response in this stage started to resolve and wound contraction occurs.

Q2

Factors that delay wound healing

The factors causing delays during wound healing is worth sharing to the patient (89-year old) and wife to ensure that they understand what slows down the healing of the wound and strategies to speed up.

Age

Ageing is known to affect everything in the body, including wound healing. The phases of healing also slow, and the skin becomes thinner. The inflammatory response, which is an important mechanism, decreases, making the healing process slower as an individual gets older.

Poor Nutrition

Poor nutrition also causes delays in healing because of lacking necessary nutrients for cell repair and growth.

Chronic Diseases

Chronic illnesses have a direct impact on affecting the haling process. The healing of a wound is slowed down mostly by cardiovascular conditions which affect the blood circulation. Diabetes condition also slows down the healing process of an injury (Montandon, 2019).

The patient need to adhere to regular exercises, avoiding smoking, getting enough rest and finally proper nutrition to ensure healing is faster.

Q3

The wound healing process of decubitus ulcer patient will undergo the following stages and due the age (89-years) the process might be slow. The wound need careful protection during cleaning to ensure that the healing phases are not interfered.

Hemostasis Phase

It is the first stage and occurs immediately after injury, and it focuses on stopping the bleeding. The stage is characterized by an emergency repair system, blood clotting and blockage of dam drainage. The formation of stable clot occurs after the enzyme thrombin initiate formation of fibrin mesh strengthening platelet to clump.

Defensive Phase

The stage targets debris removal and killing of pathogens. The step supports the preparation of the injured area for growth and development of a fresh tissue (Montandon, 2019). The removal of debris and destroying bacteria is the role of white blood cells. The optimum presence of the cells is between 24 and 48 hours.

Proliferate phase

The phase is characterized by filling and covering the wound. The filling of the wound bed using connective tissue occurs due to the presence of red granulated tissue forming new blood cells. The wound contraction occurs then due to the presence of epithelial cells which moves to the wound and cover with epithelium.

Maturation Phase

The newly developed tissue starts gaining strengthened. Collagen fibres are responsible in organizing tissue models, increasing tensile strength.

Extracellular matrix provides the structural integrity of the matrix in the four stages. It is responsible in cellular function regulations and coordinates interactions between cells and the matrix (Uusitalo, 2014). It finally serves as a reservoir of cytokines and the action of growth actions.

References

Montandon, D. (2019). At the Core of Surgery, the Fascinating Process of Wound

Healing. Journal Of Craniofacial Surgery, 1. doi: 10.1097/scs.0000000000005889.

Thomas, J. (2016). Healing by Secondary Intention. JAMA Facial Plastic Surgery, 18(3), 232.

doi: 10.1001/jamafacial.2016.0057.

Uusitalo, H. (2014). The role of inflammation and extracellular matrix in the wound healing

after glaucoma surgery. Acta Ophthalmologica, 92, 0-0. doi: 10.1111/j.1755-3768.2014.2773.x