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E N D Presentation Transcript Best Practices in Community Wound Care YANGAMA JOKWIRO BScNS MSc Physiology Challenges in community wound care Availability of expertise Cultural practices Reimbursement of products used and labour involved Cost effectiveness Red tape in acquiring wound care products Difficulty in coordinating care with Specialists Mobility status Urinary continence Bowel continence Feeding assistance needed Pressure ulcer history Recent weight loss Height & weight Skin exam Admission assessment for community risk factors Recapping on prior knowledge Skin is the largest organ which provides protection, sensation, communication, thermoregulation, metabolic synthesis and COSMESIS Three layers epidermis, dermis and hypodermis Physiology of wound healing Haemostasis Vasoconstriction Platelet response Biochemical response intrinsic clotting pathway extrinsic clotting pathway clot retraction and fibrinolysis Physiology of wound healing Tissue Repair Highly orchestrated process Soluble mediators, blood and parenchymal cells, and extracellular matrix Three Phases Inflammation phase (0-3 days) Reconstruction/proliferation phase (2-24 days) Maturation/remodeling phase (24days-1 year) (wound never gain 80% of their original strength)_ Modes of Healing Primary intention Delayed Primary intention Secondary intention Skin graft Flap Importance of moisture balance in wound care Insufficient moisture in exposed wound tissues causes desiccation and cell death, and prevents epithelial migration and matrix deposition Excessive moisture due to exudate inhibits cell proliferation and breaks down matrix components Moisture balance in the wound bed is maintained by appropriate choice of dressings Wet to wet or wet to dry dressing Although normal saline is isotonic, as it evaporates from the dressing, it becomes hypertonic and tissue fluid is drawn into the dressing Blood and proteins eventually accumulate on dressing surface and dressing dries out completely Has to be applied at least three times a day Chronic wounds Diabetic ulcer Decubitus ulcer Venous stasis ulcer Neuropathic foot Pressure ulcers Malignant wounds Why is the chronic wound chronic