Nursing Assignment on Wound Care

Running head: NURSING ASSIGNMENT ON WOUND CARE
Nursing Assignment on Wound Care
Name of the student
Name of the university
Author note

1NURSING ASSIGNMENT ON WOUND CARE
Introduction
By the truest definition, a wound is considered as a breakdown of the protective layers
of the skin, leading to loss of epithelial continuity. Wounds develop from a blow or a cut or
friction or any kind of traumatic injury to the skin or underlying soft tissues. Healing of
wounds is a dynamic process that is usually divided into three different phases: Inflammatory
phase, Proliferative phase and Maturation phase. Inflammation begins the healing through a
wide variety of systems of attack and destruction targeting all invading pathogens (Clark,
2013). During this phase, blood vessels at the site of the wound carry several phagocytic
cells, growth factors, cytokines and nutrients to promote the healing process. The wound in
the inflammatory stage faces danger if disabled from progressing to proliferation and finally
maturation. Progression could be slowed down or even stopped by many obstacles, such as
lack of essential nutrients in the blood. However, malnutrition can be prevented or controlled
by a wide choice of supplements and nutrients, giving the individual hope for recovery
(Carville, 2012). The following discussion aims to provide a detailed understanding of the
inflammatory process of wound healing, elucidate the roles of several factors involved in the
process and assess the risks of malnutrition in preventing the progression of the healing
process.
Goal of the Inflammatory Phase of Wound Healing
Inflammatory phase accounts for the first and foremost response of the body to an
injury. It is one of the body's natural defence mechanisms to instigate healing in the areas of
injury from trauma, illness or disease. Following an incident, responses to the injury will
move into action immediately to re-instate the normal continuity of the skin (Darby et al.,
2014). Inflammation encourages the appropriate cells to arrive to the injured area and clean

2NURSING ASSIGNMENT ON WOUND CARE
the area of bacteria, pathogens and debris. Inflammation is responsible for the bleeding
control and for the prevention of infection at the site of injury. Normal healing of a wound
without interruption follows an ordered unidirectional sequence. During the initial stage of
wound healing, platelets play a significant role in clot formation and establishment of
homeostasis. Once homeostasis is achieved, various inflammatory cells such as natural killer
(NK) cells, neutrophils, lymphocytes come into the play. Tissue damage evokes
inflammatory stimuli which activate the NK cells (Tanno et al., 2015). T-lymphocytes play a
crucial role in healing cutaneous wounds. T-lymphocytes that utilise the NK cells to clear the
pathogens are responsive to antigens and express some proteins to attract cytokines to the
ECM. The fluid engorgement brings in these cells through the blood vessels to the site of the
wound which then expresses characteristic signs of inflammation such as oedema, warmth,
irritation and pain, resulting from the action of the white blood cells (WBCs), cytokines,
growth factors and nutrients. Production of chemo-attractant molecules at the site of injury
keeps the kinetics of the inflammatory cell infiltration.
Cellular Processes during Inflammatory Phase
The inflammatory phase is consisted of haemostasis, chemotaxis and increase in
vascular permeability. It limits any further damage to the wound, forms clot at the site to
prevent further blood loss, clears the site of any cellular debris, pathogens and bacteria and
fosters the infiltration of the phagocytic cells. It involves both a vascular as well as a cellular
response to the injury. Immediately after the injury, vasoconstriction occurs at the site of the
wound, mediated by inflammatory factors such as epinephrine, norepinephrine,
thromboxanes and prostaglandin. After that, the platelets coalesce at the site, forms the fibrin
which is well-known as the blood clot formation. The aggregated platelets attach to the
exposed collagen surfaces and get activated. Once activated, the platelets degranulate and

3NURSING ASSIGNMENT ON WOUND CARE
release several chemotactic factors and growth factors such as Platelet Derived Growth
Factors (PDGF), serotonin and histamine. Histamine causes vasodilation and results in
oedema (I de la Torre, 2017). This enables the PDGFs to attract other cells that are necessary
for the healing process. These cells include several white blood cells (WBCs) or leukocytes
such as neutrophills, macrophages and lymphocytes. Neutrophils are the first cells to enter
the site of injury and fight infections. The neutrophils phagocytise the cellular remains and
the harmful bacteria. Once in the wound, the neutrophils attract the macrophages that engulf
the necrotic debris of the wounds and activate fibroblast responses. Fibroblasts break down
the fibrin clot, reform extra-cellular matrix (ECM) and collagen structures to provide the
necessary support to the tissues associated with the wound healing (Bainbridge, 2013).
Helper-T lymphocytes secrete the cytokines that are responsible for generating more T-cells
and involving them at the site of injury to enhance the inflammatory response through
activation of macrophages. Macrophages are the major cellular players involved in the
process of wound healing (Koh & DiPietro, 2011). Macrophages secrete a type of
metalloprotease that promotes autolysis the necrotic tissues (McCarty & Percival, 2013).
They boost the defence system of the host, promote inflammation at the site of injury, remove
cellular debris by phagocytosis and restore the epithelial tissues. The entire inflammatory
process lasts for about a week (Velnar, Bailey & Smrkolj, 2009). If under unavoidable
circumstances, the wound does not progress through the phases of Inflammation,
Proliferation and Maturation within approximately three months it would be classified as
chronic (Holloway et al., 2012).