Healing Skin Breakdown

Healing Skin Breakdown Quickly Is Essential

Healing Skin Breakdown Quickly Before It Gets Worse Is Essential 

    Healing skin breakdown quickly and successfully is essential to prevent the development of serious consequences to your family member’s health.  Skin breakdown often leads to full-body infection (sepsis), which can lead to death.  Therefore, as we have previously reviewed (1) prevent skin breakdown from happening ( Preventing Skin Breakdown ) (2) recognize it quickly (Recognizing Skin Breakdown) and now, (3) healing skin breakdown promptly.

 

Healing Skin Breakdown Once Discovered

The first step in healing skin breakdown is to remove the cause.

    • Do you need to change their position more often?
    • Is moisture from leaking catheters, incontinence, or excess sweating irritating the skin?
    • Is friction from rubbing against the sheets with movement the cause?

Next, you want to clean the wound thoroughly so that you know the exact location of your edges, the type of drainage present, and if there is an infection or new tissue growth.

    • The doctor may order specific cleaning solutions and ointments or may simply say clean it. If he leaves the cleaning up to you, I recommend the following: Use newly opened gauze pads soaked in almost sterile saline (a bottle of saline as close as possible to sterile.
    • Start in the center making small circles outward until the entire area is wiped clean. Touch gently.
    • If you discover a wound, measure the width, length, and depth of the wound in centimeters. Depth can be measured using a clean Q-tip. Take the Q-tip and guide it carefully into the hole. Mark the distance on the Q-tip and measure against a ruler. Also, take a picture for comparison.
    • Cover with a clean dressing.

Stages of healing skin breakdown

Stage I            Stop the Bleeding (Hemostasis)

When you get a cut, scratch, or open wound, it usually starts to bleed. The first stage of wound healing by the body is to stop the bleeding.  The blood uses clotting factors within seconds to minutes to stop the bleeding. Once the clot forms, it becomes a scab and protective covering.

Stage II Scabbing Over (Clotting)

  • Blood vessels narrow to stop the flow of blood to the injured area to reduce blood loss.
  • Platelets (the blood cells that help clot blood) clump together to make a plug in the wound.
  • Clotting or coagulation includes a protein called fibrin. The fibrin is a blood glue added to the plug creating a net over the entire thing. The net is what becomes a scab.
  • This process creates inflammation, which involves cleaning and healing. The inflammation looks red, swollen, and a little warm. Is that a bad thing? No. The inflammation means that fresh oxygen, nutrients, and white blood cells are cleaning up the area. The white blood cells (WBC) are working hard to clean out the damage; therefore, creating heat. They fight infection with chemicals.

Once the WBC cleans up the area, your body can start building back tissue. Oxygen-rich blood comes to the area with elements that tell cells to make elastic tissues called collagen. The collagen helps to repair skin and tissues in wounds. Collagen makes scars.

Even after the wound looks like it’s closed, it’s still healing inside. It might look pink, puckered, or stretched, feel tight, itchy, or tingly. However, it hasn’t quite gotten all its strength back yet.

     One of the reasons I recommend taking a measurement when you first find a wound is to know if the wound is healing.  Wounds heal slowly along the edges. Often you don’t see big changes.  It’s a gradual process. However, if you measure the size of the area and compare the numbers, you can tell if you are making progress by the new measurement.  

 

     If the wound has drainage, you can also determine progress by the amount of drainage, color, or odor.   If the amount is getting bigger, it begins to smell bad or has drainage that is yellowish/ashen/greenish, thick and sticky-like, probably pus (an infection), which is a clear sign of the wound getting much worse. If there are red streaks or a fever occurring, that’s a sign that the infection is spreading beyond just the wound and indicates that you must call the doctor promptly. 

Depending on how large and how deep a wound was initially, it may take a few years to completely heal. An open wound takes longer than a closed one. Most wounds are about 80% healed at three months. If an open wound is sewn shut, it heals better. Surgery cuts usually take 6-8 weeks to heal.

Wounds heal faster if covered and if you keep them clean, but they also need moister to heal. Adequate blood flow is essential to wound healing as well as good nutrition. Individuals with diabetes, obesity, high blood pressure, or vascular disease have difficulty with wound healing.

  • Slow healing or no healing
  • Swelling
  • Redness
  • Pain or tenderness
  • Hot or warn
  • Oozing pus or liquid
  • Clean the wound
  • Remove dead or damaged tissue
  • Antibiotic medication
  • Antibiotic skin ointment
open wound needing cleaning
Four stages of pressure ulcers

How to do a wound Irrigation

  1. Perform wound irrigation when you need to clear out debris and drainage from a wound.  When you irrigate a wound, you direct a steady flow of irrigation solution (usually normal saline unless the doctor ordered something else) across the open wound.  You can request a wound irrigation kit that comes with everything you need in it or gather individual pieces.

    Supplies Needed:

    • a wound irrigation device (usually a 30-60 ml catheter-tip syringe),
    • the solution you will use to irrigate,
    • a container to hold the solution,
    • gloves and a gown to keep you dry,
    • chucks or bed protectors to keep the bed and patient dry,
    • something to collect the run-off irrigation solution
    • dressing, tape, and packing materials, if indicated to cover the wound afterward.   

    The procedure:

    • After gathering your supplies, drape all surfaces to keep the area around the wound dry and limit cross-contamination.
    • Remove the old dressing and discard it.
    • Assess the wound for any progress or changes.
    • Pull up the solution into the syringe. Gain the cooperation of your family member to start the process.
    • Gently depress the plunger of syringe spraying the wound.  Move from the cleanest point to dirtiest.  Do not move back over the rinsed area once you have cleaned it until you start a new sweep.
    • Repeat the irrigation process until the solution returns clear.
    • Dry off area by blotting with sterile gauze.
    • Pack wound if ordered or apply a dressing as directed.

    Lippincott Nursing Procedures (2019) 8th Ed. Philadelphia: Wolters Kluwer (836)

How to Pack a Wound

  1. After cleaning the wound following the process noted above, pack the inside of the wound with sterile gauze.
  2. Open the gauze completely and dip it into saline or the other solution if ordered by the doctor.
  3. Spread it open so that it covers a large area. Gently insert the gauze into the wound so that it is covering most of the inside surface but not touching the outside. Using a cotton-tip applicator can help you push the gauze underneath the lip of skin folds that may be present. 
  4. Confirm that you covered all surfaces evenly.
  5. Wipe around the outside of the wound with clean gauze to remove liquid that may have seeped out.
  6. Cover the packing with dry gauze.
  7. Apply dressing over the top of the packing to hold it in place. 

YouTube Video Resources

Wound Irrigation

This video provides a demonstration of how to irrigate an open wound.

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Wound PACKING

The wound packing video continues from where the wound irrigation video left off and shows you how to pack the wound with gauze before dressing it to help absorb excess drainage. 

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Jackson-Pratt JP Drain Wound Care

 

Published on Nov 4, 2015
This video discusses how to care for (includes emptying & milking) a Jackson-Pratt drain (aka JP Drain) as a nurse and nursing student. It is great refresher for students and nurses. I discuss how a JP drain works, how to empty a JP drain, how to milk a JP drain, how to secure a JP drain, how to document about a JP drain, and potential complications from a JP drain.
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YouTube Video Information Regarding Wound Treatment Product Options

Gauze Wound Dressings

Some of the areas covered in the video; sterile gauze, actcel hemostatic gauze, surgical gauze, fibers from gauze left in wound, removing gauze from healed wound, bandages, xeroform, tubular, mep, rolls, vaseline, pads, iodoform, quick clot combat, nu, invacare non adherent sterile gauze.

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Transparent Film Wound Dressings

The transparent dressings are see-through and allow you to see the fluid accumulate.  It looks nasty but the fluid actually helps the tissue to heal faster. 

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Hydrocolloid Wound Dressing 

Some topics covered are hydrocolloid bandages, adhesive pads, gel, exoderm, pros and cons, absorptive dressing, and tegaderm.

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Foam Wound Dressings

Topics covered; foam tape wound dressing complications, open cellular, kci, smith nephew, wound care foam ring, and wound vac foam.

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Alginate Wound Dressings 

Topics included; sodium alginate dressings, calcium alginate dressings.

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Hydrogel Wound Dressing

More information is available at http:woundeducators.com

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Composite Wound Dressing 

Composite dressings combine multiple components of wound protection into a single product to provide for a multi-funcional barrier such as one that has an anti-bacterial component, absorption and adhesion. 

 

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