Nursing Pathophysiology: Managing Stage 3 Decubitus Ulcer in Elderly

This report delves into the pathophysiology of wound healing, specifically focusing on the management of a stage 3 decubitus ulcer in an 89-year-old patient. It discusses the differences between first and second intention healing, highlighting that the patient's condition necessitates the latter due to the severity of the wound. The report identifies factors delaying wound healing, such as age, skin moisture levels, and polypharmacy, and proposes strategies for improvement, including regular dressing changes and maintaining adequate moisture. Furthermore, it outlines the four phases of wound healing: hemostasis, inflammation, proliferation, and maturation, emphasizing the importance of tailoring treatment to the specific stage and individual patient factors. The report concludes by stressing the need for a personalized care plan that considers the patient's age, medication regimen, and wound stage for effective wound management.

Running head: NURSING PATHOPHYSIOLOGY
NURSING PATHOPHYSIOLOGY
Name of the Student:
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Introduction
Pressure ulcers, commonly known as bed sores, are caused due to resting over prolonged
periods, such as lying or sitting in a single position for long hours resulting in disruption of blood
circulation and associated loss of tissue functioning and integrity. Pressure ulcers need to be
treated based on their various degrees of severity. Hence for administering appropriate wound
healing, especially of an 89 year old patient with stage 3 decubitus ulcer, the following aspects
have been considered (Moore & Cowman, 2015).
Discussion
First-intention and Second-intention Healing
Wound healing or the processes of closure, occurs with through various steps, which can
be primarily categorized as first and second intention healing. Primary wound closure, also
known as first intention healing is one of the quickest processes of wound healing, and is
prevalent across minor injuries such as paper cuts, negligible cutaneous wounds or stage 1
pressure ulcers and surgical incisions (Theoret, 2016). The reason for such rapid healing is the
fact that keratinocytes and fresh blood vessels will be required to cover only a minor distance of
wound closure. Secondary wound closure or second-intention healing is a more prolonged
processes for deeper and severe wounds and is characterized formulation of a granulation tissue
matrix round the wound resulting in greater scar tissue formation. Hence, it is evident that the
stage 3 ulcer wound in the 89 year old patient will encounter second intention healing due to its
increased severity (Bischofberger et al., 2015).

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Factors delaying Wound Healing
Firstly, ageing is a key factor associated with the delay in wound healing. With age, the
wound healing process of the body loses its efficiency along with thinning of skin and greater
sensitivity towards inflammation. Moisture levels of the skin is another key factor associated
with delayed wound healing since a an excessively dry skin (common in ageing) as well as
excessively moist skin increases risk of thickening of skin as well as infections resulting in
delays. Additionally, consumption of several medications (as noted in polypharmacy in the
elderly) results in delayed wound healing, especially in medications like anticoagulants and non-
steroidal anti-inflammatory drugs (Dumville et al., 2015).
Strategies improving Would Healing
One of the key strategies to improve wound healing is by regularly changing the dressing
of the same to prevent the acquisition of infections. Additionally, the maintaining adequate
moisture levels in the dressing to prevent dryness is another key strategy which must be
considered to promote wound healing. Hence, for quick healing of the stage 3 decubitus ulcer,
the 89 year old patient must be provided with adequate dressing. Additionally, his specialized
conditions associated with old age and medications must be taken into consideration in the
wound healing plan (O'Mathúna, 2016).
Four Phases of Wound Healing
The first stage of hemostasis is characterized by activation of blood clotting process
where platelets react with the collagen to form a fibrin mesh to allow improved blood clotting.
The second stage of inflammation is characterized by neutrophils in the extra cellular matrix
acting to remove debris and destroy pathogens. The third stage of proliferation granulation
tissues administer extra cellular connective tissue to the wound bed resulting in emergence of

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epithelial cells. The fourth phase of maturation results in collagen fibers administer strength and
flexibility to the tissue (Xue & Jackson, 2015).
Conclusion
Hence, to conclude, wound healing treatments must be provided as per the unique stage
of healing as well as personalized patient factors. The care plan must take into consideration age,
medication and wound stage of the patient.

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References
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Moore, Z. E., & Cowman, S. (2015). Repositioning for treating pressure ulcers. Cochrane
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