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How to perform a simple wound assessment | Royal College of Nursing

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Specimen collection: swab sampling

Definition

Sterile swabs are commonly used in clinical practice to obtain samples of material from skin and mucous membranes. They are utilized to identify micro-organisms in suspected infection or as part of a screening programme to identify patients who may be carrying pathogens without displaying clinical signs or symptoms. Swab cultures provide useful data that can be used to augment diagnostic and therapeutic decision making (Bonham 2009, Panpradist et al. 2014).

Swabbing is aimed at collection of body fluid or cutaneous material for the purpose of obtaining a specimen for microbiological analysis; when properly performed, a swab is a simple, non-invasive and cost-effective method of culturing in clinical practice (Bonham 2009, Panpradist et al. 2014). Samples of infected material can be obtained from any accessible part of the body by using a sterile swab tipped with cotton wool or synthetic material (Chernecky and Berger 2013, Huddleston Cross 2014, Pagana and Pagana 2017).

Evidence-based approaches

Indications

Taking a swab is indicated:

﻿﻿if there are clinical signs of infection, which may manifest as symptoms such as pain, redness, inflammation, heat, pus or odour

﻿﻿if a patient shows signs of systemic infection or has a pyrexia of unknown origin

﻿﻿as part of a screening programme.

Contraindications

Taking a swab is not indicated:

﻿﻿as routine use (unless part of a screening regimen)

﻿﻿on chronic wounds, which will be colonized with skin flora.

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How to use a body map chart | Edyn.Care Help Center

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This ebook covers the basics of body maps in care, including the benefits, how they are used, the role technology can play and top tips.

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Moisturise regularly: Apply emollients (moisturising creams or ointments) at least twice daily, even when the skin appears healthy. This helps maintain and restore the skin’s protective barrier.

Use gentle cleansers: Replace soaps, shower gels, and bubble baths with an emollient cleanser or mild, non-soap alternative to avoid irritation.

Dry skin carefully: After washing, gently pat the skin dry with a soft towel rather than rubbing, which can cause friction and irritation.

Avoid very hot water: Use lukewarm water for bathing or showering, as hot water can dry and irritate the skin.

Apply creams in the direction of the hairs to stop build up and potentially blocking the hair follicles.

Health professionals applying for a patient - PPE gloves and apron.

Managing Flare-Ups

Begin treatment as soon as signs of a flare-up appear to help reduce severity and discomfort.

Apply topical corticosteroids: Use prescribed steroid creams or ointments sparingly on affected areas to reduce inflammation and itching. Follow the guidance provided by a healthcare professional. If applying this for someone else then use gloves.

Use “wet wrap” therapy (if advised): In more severe cases, healthcare providers may recommend applying emollient and steroid treatments under damp bandages to increase skin hydration and absorption.

Avoiding Triggers

Choose appropriate fabrics: Wear loose-fitting, breathable clothing made from soft materials such as cotton. Avoid synthetic fibres like polyester or spandex, which may irritate the skin.

Avoid fragranced products: Use fragrance-free soaps, detergents, and cosmetics to prevent irritation from perfumes and additives.

Keep body temperature stable: Avoid overheating, as heat can make itching worse.

Reduce scratching: Keep nails short and clean. If itching occurs, tap or press the area gently rather than scratching. For infants, mittens may help prevent skin damage.

Protect hands: Wear gloves when using cleaning products or doing housework to reduce contact with irritants.

Additional Considerations

Prevent contamination: Use a clean spoon, spatula, or pump dispenser when applying emollients from a tub to avoid introducing bacteria.

Manage stress: Emotional stress can make eczema symptoms worse, so relaxation and stress management techniques may help.

Fire safety: Emollients can be highly flammable, especially when absorbed into fabrics. Avoid smoking or being near open flames after applying these products.

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Guy's and St Thomas' NHS Foundation Trust

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The acronym above stands for :-

a - assess risk

S - SKIN INSPECTION - can use the Braden II and Waterlow tool to support assessing and documentation.

S - SURFACE - Consider patient’s positioning (for example, sitting and lying down) and current preventative measures.

K - KEEP MOVING - consider the patient’s mobility and ability to reposition themselves.

I - INCONTINENCE - status of urine and faeces control and/or retention.

N - NUTRITION - MST assessment. Nutrition and fluids monitoring.

g - GIVING INFORMATION - giving information to patients and carers.

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South Tees Hospitals NHS Foundation Trust

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Wet wrap bandaging - South Tees Hospitals NHS Foundation Trust

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Information and advice on the application of wet wrap bandaging, a technique used in the acute stage of eczema.

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Wound Dressing Types - OSCE Guide | Geeky Medics

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This guide provides an overview of the types of wound dressing types including the advantages and disadvantages of each.

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5 Manual Handling Principles for good practice.

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5 Manual Handling Principles for good practice.

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PLAN -

Prepare the environment.

Free of hazards.

Gather equipment needed. Ensure it is in good working order. Report any concerns about worn or faulty equipment.

Think about the process before beginning any movement. Encourage active participation.

At least 2 members of staff required.

Assess the task.

POSITION -

Stable base * stay as close to the load as possible *feet usually hip width apart *feet usually pointing in the direction of travel.

PICK -

Bend your knees

Keep your back straight

Maintain a firm grip

Keep the load close

PROCEED -

Agreed countdown between all people.

Move smoothly in the direction of the destination.

Do not twist your body.

Turn your feet to change direction.

PLACE -

Lower with control. Use your leg muscles to lower the load gently.

Bend your knees when placing the object. Keep your back straight.

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Care of the Elderly prevention of pressure ulcers support videos

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Care of the Elderly prevention of pressure ulcers support videos

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Torbay and South Devon NHS Foundation Trust

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Pressure ulcers are a real risk for the elderly and as part of our care and treatment programmes, we have prepared some videos that will support people who are coping with the effects of ageing or who are looking after someone who is growing older.

We hope that you will be able to share these videos with your friends, family and carers so that it makes their life, and your life, a little easier.

If you have any questions, the main Care of the Elderly page will provide you with more details about our services, and who to contact.

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Care of the Elderly prevention of pressure ulcers support videos

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Pressure ulcers are a risk for the elderly. As part of our care and treatment, we have support videos for people who are coping with the effects of ageing.

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Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales.
These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.

Most people are only affected with small patches. In some cases, the patches can be itchy or sore.

Psoriasis affects around 2% of people in the UK. It can start at any age, but most often develops in adults under 35 years old, and affects men and women equally.

The severity of psoriasis varies greatly from person to person. For some it's just a minor irritation, but for others it can majorly affect their quality of life.

Psoriasis is a long-lasting (chronic) disease that usually involves periods when you have no symptoms or mild symptoms, followed by periods when symptoms are more severe.

Why it happens

People with psoriasis have an increased production of skin cells.

Skin cells are normally made and replaced every 3 to 4 weeks, but in psoriasis this process only takes about 3 to 7 days.

The resulting build-up of skin cells is what creates the patches associated with psoriasis.

Although the process is not fully understood, it's thought to be related to a problem with the immune system.

The immune system is your body's defence against disease and infection, but it attacks healthy skin cells by mistake in people with psoriasis.

Psoriasis can run in families, although the exact role genetics plays in causing psoriasis is unclear.

Many people's psoriasis symptoms start or become worse because of a certain event, known as a trigger.

Possible triggers of psoriasis include an injury to your skin, throat infections and using certain medicines.

The condition is not contagious, so it cannot be spread from person to person.

How psoriasis is diagnosed

A GP can often diagnose psoriasis based on the appearance of your skin.

In rare cases, a small sample of skin called a biopsy will be sent to the laboratory for examination under a microscope.

This determines the exact type of psoriasis and rules out other skin disorders, such as seborrhoeic dermatitis, lichen planus, lichen simplex and pityriasis rosea.

You may be referred to a specialist in diagnosing and treating skin conditions (dermatologist) if your doctor is uncertain about your diagnosis, or if your condition is severe.

If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a doctor who specialises in arthritis (rheumatologist).

You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and X-rays of the affected joints may be taken.

Treating psoriasis

There's no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches.

In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids. Topical treatments are creams and ointments applied to the skin.

If these are not effective, or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of ultraviolet light.

In severe cases, where the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body.

Living with psoriasis

Although psoriasis is just a minor irritation for some people, it can have a significant impact on quality of life for those more severely affected.

For example, some people with psoriasis have low self-esteem because of the effect the condition has on their appearance.

It's also quite common to develop tenderness, pain and swelling in the joints and connective tissue. This is known as psoriatic arthritis.

Speak to a GP or your healthcare team if you have psoriasis and you have any concerns about your physical and mental wellbeing. They can offer advice and further treatment if necessary.

There are also support groups for people with psoriasis, such as The Psoriasis Association, where you can speak to other people with the condition.
Find out more about living with psoriasis

Further information

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Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales. These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. Most people are only affected with small patches. In some cases, the patches can be itchy or sore.

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An example of a tissue viability risk assessment.

It uses a scoring system to predict the likelihood of a patient developing a pressure injury.

Should be completed within 6 hours of an admission and then at regular planned intervals.

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Psoriasis: Treatment Overview

No cure – psoriasis is a chronic skin condition that can be treated and managed.

Individualised condition – symptoms and effective treatments vary between individuals.

Trial and error process – treatment effectiveness differs; finding the right one may take time.

Emotional impact – can affect motivation and wellbeing; ongoing support is important.

Person-centred care – regular reviews with a GP are essential to adjust treatments and maintain communication.

Role of the GP

First point of contact for most patients.

Initial management through topical treatments (applied to skin).

Treatment options include:

Moisturisers and emollients – soothe and protect the skin.

Vitamin D–based treatments – slow skin cell growth.

Topical steroids – reduce inflammation and redness.

Coal tar preparations – reduce scaling and itching.

Dithranol – slows down skin cell production.

Calcineurin inhibitors – suppress immune response in the skin.

Monitoring and review – GPs evaluate response and adjust treatment accordingly.

Referral – if psoriasis is severe or unresponsive to topical treatments.

Role of the Dermatologist (Specialist Care)

Referral pathway – patients with severe or resistant psoriasis are referred to dermatology.

Advanced treatments include:

Ultraviolet (UV) light therapy – controlled light exposure to slow cell growth.

Systemic treatments – oral or injected medicines affecting the whole body (e.g. methotrexate).

Biologic treatments – target specific parts of the immune system.

Ongoing specialist monitoring – ensures effectiveness and minimises side effects.

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Psoriasis is a clinical condition with a similar appearance to eczema but has different causes and presents in some different locations on the body.

Psoriasis is more common between the ages of 15 and 25 years.

Stress may cause “flare ups”.

Common sites - knees, elbows creases, lower back, scalp.

Generally less itchy than eczema, but can cause a burning, itching sensation. Itchiness can cause the person to scratch and then subsequent bleeding, with potential for infection.

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Waterlow Score - assesses risk of development of a pressure sore

Observe skin, monitor mobility and continence.

Assess state of wound to prescribe appropriate treatment supported by skin integrity assessment.

Skin integrity assessment (body mapping) undertaken.

Ensuring the accuracy and precision required in recording and interpreting skin integrity assessments.

Use appropriate technical terms.

Apply knowledge of skin function and structure to objectively assess skin conditions.

Dressings, ointments or simple wound dressings applied as prescribed/needed.

Applying and removing dressings where directed.

Taking swabs when indicated.

Pathophysiology of skin ageing and factors affecting skin integrity ie lifestyle, environmental, medical.

Pain assessment - assesses pain levels to diagnose and determine suitable treatment, supported by a range of pain assessment tools.

Bed comfort/specialist mattresses/ seating cushions.

Preventative measures for pressure injuries.

Types of treatment used for skin care and prevent or treat skin conditions eg phototherapy, hydrocolloid dressings, oral treatments, topical treatments, massage.

Communicate effectively - how to prevent pressure injuries to individuals and carers.

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Psoriasis and Psoriatic Arthritis Alliance (PAPAA)

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Do you want to know what psoriasis is and the different types?

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The commonest form is plaque psoriasis and features red, raised, scaly plaques, there are a number of other types of psoriasis, including guttate, scalp and nails. Psoriatic arthritis affects around 20% of those with psoriasis.

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Nursing guidelines : Wound assessment and management

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A wound is a disruption to the integrity of the skin that leaves the body vulnerable to pain and infection. The skin is the body’s largest organ and is responsible for protection, sensation, thermoregulation, metabolism, excretion and cosmetic. Poorly managed wounds are one of the leading causes of increased morbidity and extended hospital stays. Therefore, wound assessment and management is fundamental to providing nursing care to the paediatric population.

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Introduction to Skin Anatomy and Physiology

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NICE Guidance - Pressure Redistribution Devices

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NICE Guidance - Pressure Redistribution Devices

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Quality statement 8: Pressure redistribution devices | Pressure ulcers | Quality standards | NICE

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This quality standard covers preventing, assessing and managing pressure ulcers (bed sores) in adults, young people and children. It includes risk assessment and support to prevent pressure ulcers. It applies to all settings, including hospitals, care homes (with and without nursing care) and people’s own homes

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Post-operative Wound Care Information for Patients

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Post-operative Wound Care Information for Patients

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Braden Scale II assessment and how to complete it - website

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Braden Scale II assessment and how to complete it - website

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Open Resources for Nursing (Open RN)

Several factors place a patient at risk for developing a pressure injury, in addition to shear and friction. These factors include decreased sensory perception, increased moisture, decreased activity, impaired mobility, and inadequate nutrition. The Braden Scale is a standardized, evidence-based assessment tool commonly used in health care to assess and document a patient's risk for developing pressure injuries. See Figure 10.21 for an image of a Braden Scale. Risk factors are rated on a scale from 1 to 4, with 1 being "completely limited" and 4 being "no impairment." The scores from the six categories are added, and the total score indicates a patient's risk for developing a pressure injury based on these ranges:

Mild risk: 15-18

Moderate risk: 13-14

High risk: 10-12

Severe risk: less than 9

How to Score the Braden Scale

Each risk factor on the Braden Scale is rated from 1 to 4 based on the patient's assessment findings. When using the Braden Scale, start with the first category and review each description listed across the row for each of the ratings from 1 to 4, and choose the one that best describes the patient's current status. Continue this process for all rows. Add all six numbers to determine a total score, and then use the total score to determine if the patient is at mild, moderate, high, or severe risk for developing a pressure injury. The lower the score, the higher the risk of developing a pressure injury. Additionally, customized nursing interventions are implemented based on the rating in each category. The higher the score, the more aggressive actions are taken to prevent or heal a pressure injury. Descriptions of the ratings from 1-4 for each risk factor, along with targeted interventions for each rating, are further described in the following subsections.

Sensory Perception

Table 10.5a Descriptions and Interventions by Level of Risk for Sensory Perception

Moisture

Table 10.5b Interventions by Level of Risk for Moisture

Activity

The activity risk factor is defined as the degree of physical activity. For example, walking or moving from a bed to a chair reduces a patient's risk of developing a pressure injury by redistributing pressure points and increasing blood and oxygen flow to areas at risk.

Mobility

Nutrition

Friction/Shear

Assessment Category

Rating Description

Interventions

Friction/Shear

3-No Apparent Problem

Moves in bed and chair independently and has sufficient muscle strength to lift up completely during move. Maintains good position in bed or chair at all times.

Keep bed linens clean, dry, and wrinkle free.

Friction/Shear

2-Potential Problem

Moves feebly or requires minimal assistance. During a move, skin probably slides to some extent against sheets, chair, restraints, or other devices. Maintains a relatively good position in a chair or bed most of the time but occasionally slides down.

All interventions mentioned in 3-No Apparent Problem plus:

Avoid massaging pressure points.

Apply transparent dressing or elbow/heel protectors to intact skin over elbows and heels.

Friction/Shear

1-Problem

Requires moderate to maximum assistance in moving. Complete lifting without sliding against sheets is impossible. Frequently slides down in bed or chair, requiring frequent repositioning with maximum assistance. Spasticity, contractures, or agitation leads to almost constant friction.

Team Member Roles to Prevent Pressure Injuries

Each member of the health care team has an important role in preventing the development of pressure injuries in at-risk patients. A registered nurse can delegate many interventions for preventing and treating a pressure injury to a licensed practical nurse (LPN) or to unlicensed assistive personnel such as a certified nursing assistant (CNA). See Table 10.5g for an explanation of the role of the RN in preventing pressure injuries, as well as tasks that can be delegated to LPNs and CNAs.

RN

Conducts or supervises accurate assessment and documentation of head-to-toe skin assessment and pressure injury risk (Braden Scale or Braden Risk Assessment) on admission, daily, and if condition deteriorates (or according to facility policy)

Documents care plan tied to identified risk:

Sensory perception

Moisture

Activity

Mobility

Nutrition

Friction/Shear

Performs or supervises performance of care plan procedures or treatments

Collaborates with other staff to ensure timely and accurate reporting of any skin issues

Notifies wound nurse of any skin conditions or high-risk patients

Notifies physician of any skin problems

Educates patient/family about risk factors

LPN

Conducts accurate assessment and documentation of head-to-toe skin assessment and pressure injury risk (Braden Scale) on admission, daily, and if condition deteriorates (or according to facility policy)

Documents care plan tied to identified risk:

Sensory perception

Moisture

Activity

Mobility

Nutrition

Friction/Shear

Performs care for risk as needed

Informs RN of any skin issues

CNA

Checks skin each time person is turned or cleaned or bed is changed

Reports any skin issues to nurse

Turns/repositions patient as ordered

Offers liquids each time in room

Keeps skin clean and reapplies protective skin barrier

Applies products (lotion, cream, skin sealant, etc.) as needed

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Open Resources for Nursing (Open RN) Several factors place a patient at risk for developing a pressure injury, in addition to shear and friction. These factors include decreased sensory perception, increased moisture, decreased activity, impaired mobility, and inadequate nutrition.

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Prone Positioning in Severe Acute Respiratory Distress Syndrome | NEJM

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Pressure ulcer prevention: A guide for patients, carers and healthcare professionals

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Pressure ulcer prevention: A guide for patients, carers and healthcare professionals

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Kingston and Richmond NHS Foundation Trust

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Pressure ulcer prevention: A guide for patients, carers and healthcare professionals

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Repositioning a patient in bed with minimal assistance - moving up a bed using sliding sheet

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Repositioning a patient in bed with minimal assistance - moving up a bed using sliding sheet

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NHS Lothian induction : repositioning a patient in bed with minimal assistance

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The patient is able to assist the single member of staff who is performing the manoeuvre. One glide sheet and verbal prompting are required for this task.

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Psoriasis is a common immune-mediated skin condition. There is no cure for psoriasis, but thankfully it can be treated and managed. There are numerous different types of psoriasis, and it can occur on any area of the body.

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Psoriasis is a common immune-mediated skin condition. There is no cure for psoriasis, but thankfully it can be treated and managed. Find out more about treatments that are available from a GP and Dermatologist.

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This guideline covers assessing and managing psoriasis in adults, young people and children. It aims to improve long-term disease control and quality of life for people with psoriasis

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Burns and scalds are damage to the skin usually by heat but can be caused by

-radiation

-electricity

-friction

-contact with chemicals

Burns are measured in degrees. The degrees relate to how many skin layers have been damaged.

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Hives -

Allergic reaction causing an area of skin swelling. Body produces histamine.

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Pressure injuries - Caused by excessive pressure to a specific part of the body, usually over bony prominences.

Can often cause patients to remain in hospital longer than their condition would dictate.

Reduced mobility, or particular health conditions that prevent a person from moving independently are at greater risk of developing pressure injuries.

Also look at ageing and other factors discussed during our class discussion and refresher on the structure and function of skin.

Pseudomonas Aeruginosa is a type of germ that can cause skin infections.

It is a common hospital pathogen.

Transmission is reduced by standard infection control precautions such as frequent handwashing, using hand sanitiser and PPE.

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Cachexia is a complex wasting syndrome characterized by muscle mass loss (with or without fat loss) and progressive functional impairment due to an underlying illness, such as cancer or heart failure. It's more than just not eating; it involves abnormal metabolism, inflammation, and a metabolic state where the body breaks down muscle for energy, even when eating normally. This often leads to extreme weight loss, weakness, and a severe decline in quality of life

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BMI is a calculation using weight and height:

in metric terms, BMI = kg/m2, where kg is a

person's weight in kilograms and m2 is their height in metres

alternatively, in non-metric format the formula

for BMI = weight in pounds divided by a person's

height in inches, squared and then multiplied by 703.

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Health T Level Occupational Specialism: Skin Integrity

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Safeguarding Adults : pressure ulcers and raising a safeguarding concern. 

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Safeguarding Adults : pressure ulcers and raising a safeguarding concern. 

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Safeguarding adults protocol: pressure ulcers and raising a safeguarding concern

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I am delighted to publish this updated guidance with the aim of assisting practitioners and managers across health and care organisations to provide caring, speedy and appropriate responses to individuals at risk of developing pressure ulcers. Prevention of pressure ulcers is not only ideal but, in most cases, perfectly possible. Taking a proactive approach will reduce harm to individuals and secure efficiencies to the wider health and social care system.

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There are four important phases in the process of wound healing.

1. ﻿﻿Haemostasis phase: starts at the onset of the injury, for example a deep cut, when the body initiates its emergency repair system starting with the blood's clotting process. The location, depth and size of the wound affect which blood vessels are damaged and the hole that needs to be plugged. Platelets, collagen and an enzyme called thrombin initiate the formation of a fibrin mesh, the clot. This will begin the tissue repair process. The injured vessel such as a vein will constrict to prevent any further blood loss. Blood loss which collects under the skin is known as a haematoma - or bruise. A patient's overall health, such as nutrition level, blood thinning medication and medical condition (for example haemophilia), can slow down the initial response, causing a greater amount of blood to be lost.

2. ﻿﻿Inflammatory phase: this starts the defence mechanism to expel debris and destroy bacteria.

Neutrophil cells peak between 24 and 48 hours after the injury occurs but are not always able to dear the site of pathogens. Macrophage cells are increased at the cut and secrete proteins to increase the immune reaction and facilitate skin and tissue repair. The characteristics of this phase are oedema, fluid swelling, erythema (visible redness), pain and generation of heat.

3. Proliferative phase: contraction of the wound's skin and tissue edges begin to come together following the formation of a scab, which protects the surface and prevents contamination. New blood cells are made to replace those lost, granulation tissue fills the wound bed from the bottom up; this prevents the formation of an abscess. Factors such as depth and location of the wound will have an impact on the length of time it takes to fully heal.

4. Remodelling (maturation) phase: new tissue progressively gains strength and flexibility, although scarred skin is thicker and less flexible. The skin's strength following repair may be limited and may not return to the pre-injury level.

Figure above shows the risk factors that influence the rate of the healing process.

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Improve Article 👀

This guide provides an overview of the stages of wound healing.

The skin's natural barrier to the external environment is provided by two distinct layers, the epidermis (surface) and the dermis (slightly deeper).

The wound healing process involves the following key stages:

Haemostasis

Inflammation

Cell proliferation

Epithelialisation

Tissue remodelling

Haemostasis phase

The process of haemostasis is initiated within seconds of injury to the skin via vasoconstriction thus reducing the potential for significant blood loss.

Then, as blood leaks into the open wound, platelets are exposed to collagen, which triggers the coagulation cascade, ultimately resulting in the formation of a fibrin clot. Clot formation prevents further bleeding from the damaged blood vessels within the tissue.

The inflammation phase lasts approximately 3 days.

As well as triggering the coagulation cascade, platelets also release growth factors which attract neutrophils, macrophages, monocytes, fibroblasts and other cell types which are required for effective wound healing.

During the inflammation stage, blood vessels within the wound also become more permeable due to the release of prostaglandins and histamine. Serous fluid leaks through the permeable blood vessel walls into the wound and surrounding tissue, causing oedema.

Neutrophils slowly undergo apoptosis (programmed cell death) over the following 2-3 days. Monocytes then become activated and turn into wound macrophages to further facilitate wound cleansing by mopping up the neutrophils and debris via phagocytosis and attracting other cell types that are key to wound healing including fibroblasts, vascular endothelial cells and smooth muscle cells.

The primary aims of the inflammation phase are to maintain control of blood loss and the cleanliness of the wound bed.

The proliferative phase involves the production of highly vascular granulation tissue (a form of connective tissue) which fills the wound and provides a scaffold for further healing.

The proliferative process is triggered by an environment of low wound pH, reduced PaO₂ and increased lactate (due to reduced blood supply to the wound).

As new blood vessels form, the blood supply to the tissue within the wound improves, oxygen tension within the wound subsequently increases and VEGF is inhibited through negative feedback. Fibroblasts also begin to produce collagen to replace the original extracellular matrix scaffold that is formed at the beginning of the proliferative phase.

Contraction occurs in the context of open wounds to assist the healing process, as it results in a smaller deficit to be filled with connective tissue. The underlying process of contraction is still poorly understood, but it likely involves c ontractile forces generated by fibroblasts within the wound.

Epithelialisation phase

Epithelial cells migrate from the wound edges to cover the wound defect. This only occurs once the wound has been filled with granulation tissue, in the context of wound healing by secondary intention. Epithelial cells require a moist, well-vascularised wound surface to migrate across the tissue. As a result, if the wound is dry or necrotic, epithelialisation will not occur.

Re-modelling phase

The re-modelling phase involves the iterative breakdown and rebuilding of the wound's extracellular matrix by matrix metalloproteinases.

The remodelling phase can sometimes give rise to abnormal scar formation due to imbalances in the process. Abnormalities can include hypertrophic scarring (a.k.a. keloid scarring) in which the formation of scar tissue is excessive resulting in raised areas of scar tissue.

References

1. Pauline Beldon. Basic science of wound healing. Surgery (Oxford). Volume 28, Issue 9, 2010, Pages 409-412, ISSN 0263-9319.

2. Htirgan. Adapted by Geeky Medics. License: [CC BY-SA]

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Wound Healing | Stages of Wound Healing | Geeky Medics

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An overview of the stages of wound healing including haemostasis, inflammation, proliferation, epithelialisation and re-modelling.

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Critical analysis of Body Maps - by Ellen Vasey (T level Yr2 student)

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Critical analysis of Body Maps - by Ellen Vasey (T level Yr2 student)

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Tasks you will demonstrate:

*Carry out a Braden Scale assessment on a

70-year-old male patient who is sedated, ventilated and in the intensive care unit (ICU).

He is malnourished and has open wounds on the tailbone area, elbow and the back of the head.

Dress the three areas of open pressure injury wound. Describe interventions to protect heels and further pressure injuries, and describe the importance of good nutrition and continence care.

*Carry out a Waterlow assessment for a 42-year-old female patient with an estimated BMI of 34.

Her diet is high in fats and sugars, and she tends to overeat. She has been diagnosed with type 2 diabetes, has stress incontinence when getting up, and has restricted movement due to her weight and oedema in the lower leg, wrists and hands. Inform the dermatologist of risk rating and make suggestions of how to support the patient to improve her situation.

*Describe how the following skin conditions present in the different parts of the body listed, and explain the potential causes of these conditions:

~psoriasis observed on the torso and scalp ~eczema in elbow creases and on the back of knees

~contact dermatitis around the neck and wrist

~hives on the throat, upper arms and legs.

*Describe the purpose of steroid creams, moisturisers and barrier creams.

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An emollient is a type of moisturizer used to soothe and hydrate the skin by forming a protective film that traps moisture . They are commonly used to manage dry, itchy skin conditions like eczema and psoriasis. Emollients come in various forms, such as creams, ointments, and gels, and can also be used instead of soap for washing.

Types of emollient

Creams:

Lighter and cooler on the skin, often preferred for daytime use or for mild to moderate dryness.

Lotions:

Contain a lower lipid (oil) content than creams.

Gels:

Tend to be better at moisturizing than creams, though they may take longer to absorb.

Ointments:

Greasier and stickier, with a higher lipid content, which makes them good for very dry skin and overnight use.

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We are registered as a charity in England and Wales and in Scotland. We are dedicated to improving the quality of life of people with eczema and their carers.

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Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, dry and cracked.
Atopic eczema is more common in children, often developing before their first birthday. But it may also develop for the first time in adults.

It's usually a long-term (chronic) condition, although it can improve significantly, or even clear completely, in some children as they get older.

Symptoms of atopic eczema

Atopic eczema causes the skin to become itchy, dry, cracked and sore.

Some people only have small patches of dry skin, but others may experience widespread inflamed skin all over the body.

Inflamed skin can become red on lighter skin, and darker brown, purple or grey on darker skin. This can also be more difficult to see on darker skin.

Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.

People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups).

When to seek medical advice

See a GP if you have symptoms of atopic eczema. They'll usually be able to diagnose atopic eczema by looking at your skin and asking questions, such as:

whether the rash is itchy and where it appears

when the symptoms first began

whether it comes and goes over time

whether there's a history of atopic eczema in your family

whether you have any other conditions, such as allergies or asthma

whether something in your diet or lifestyle may be contributing to your symptoms

Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and 3 or more of the following:

visibly irritated red skin in the creases of your skin - such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional

a history of skin irritation occurring in the same areas mentioned above

generally dry skin in the last 12 months

a history of asthma or hay fever - children under 4 must have an immediate relative, such as a parent, brother or sister, who has 1 of these conditions

the condition started before the age of 2 (this does not apply to children under the age of 4)

Causes of atopic eczema

The exact cause of atopic eczema is unknown, but it's clear it is not down to one single thing.

Atopic eczema often occurs in people who get allergies. "Atopic" means sensitivity to allergens.

It can run in families, and often develops alongside other conditions, such as asthma and hay fever.

The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather.

Sometimes food allergies can play a part, especially in young children with severe eczema.

You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse.

Allergy tests are not usually needed, although they're sometimes helpful in identifying whether a food allergy may be triggering symptoms.

Treating atopic eczema

Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time.

But there's currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally.

There's also an increased risk of skin infections.

Many different treatments can be used to control symptoms and manage eczema, including:

self-care techniques, such as reducing scratching and avoiding triggers

emollients (moisturising treatments) - used on a daily basis for dry skin

topical corticosteroids - used to reduce swelling, redness and itching during flare-ups

Other types of eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin.

Other types of eczema include:

discoid eczema - a type of eczema that occurs in circular or oval patches on the skin

contact dermatitis - a type of eczema that occurs when the body comes into contact with a particular substance

varicose eczema - a type of eczema that most often affects the lower legs and is caused by problems with the flow of blood through the leg veins

seborrhoeic eczema - a type of eczema where red, scaly patches develop on the sides of the nose, eyebrows, ears and scalp

dyshidrotic eczema (pompholyx) - a type of eczema that causes tiny blisters to erupt across the palms of the hands

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Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, dry and cracked. Atopic eczema is more common in children, often developing before their first birthday. But it may also develop for the first time in adults.

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Skin Integrity: Introduction to assessments