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Samenvatting Heelkunde
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Verpleegkundig Redeneren & HandelenTheorie Heelkunde
Inleiding............................................................................................................................11
Anatomie en fysiologie......................................................................................................11
1 Het proces van de normale wondheling..........................................................................11
1.1 Inleiding......................................................................................................................................11
1.2 Inflammatoire fase.....................................................................................................................11
1.2.1 Vasodilatatie........................................................................................................................11
1.2.2 Vasoconstrictie....................................................................................................................11
1.2.3 Vasodilatatie........................................................................................................................12
1.3 Granulatiefase............................................................................................................................12
1.4 Maturatiefase.............................................................................................................................12
1.4.1 Bindweefselreorganisatie....................................................................................................12
1.4.2 Wondretractie.....................................................................................................................12
1.4.3 Epithelialisatie......................................................................................................................12
1.5 Littekenvorming..........................................................................................................................13
1.6 Definitie van een wonde.............................................................................................................13
1.6.1 Acute wonden......................................................................................................................13
1.6.2 Chronische wonden.............................................................................................................13
1.7 Factoren die de wondgenezing belemmering.............................................................................13
1.7.1 Factoren eigen aan de wond................................................................................................13
1.7.2 Voedingstoestand................................................................................................................14
1.7.3 Onderliggende pathologie...................................................................................................14
1.7.4 Psychologische toestand en lichaamsbeeld.........................................................................14
1.7.5 Medicijnen en behandeling.................................................................................................15
1.7.6 Leeftijd.................................................................................................................................15
1.7.7 Roken en druggebruik..........................................................................................................15
1.8 Kenmerken van een chronische wonde......................................................................................15
2 Verschillende types wondgenezing.................................................................................15
2.1 Genezing per primam.................................................................................................................16
Primaire wondgenezing................................................................................................................16
2.2 Genezing per secundam.............................................................................................................16
Secundaire wondgenezing............................................................................................................16
2.3 Regeneratieve wondheling.........................................................................................................16
3 Wondclassificatie...........................................................................................................17
1
,3.1 Inleiding......................................................................................................................................17
3.2 Uitzicht en vorm.........................................................................................................................17
3.2.1 Continuïteit van de huid......................................................................................................17
3.2.2 Diepte..................................................................................................................................17
Erosie............................................................................................................................................17
Partial tickness skin loss: verlies van epidermis............................................................................17
Full tickness skin loss: verlies van epidermis en dermis................................................................17
Full tickniss skin loss met blootliggende botten............................................................................17
Brandwonde 1e graad...................................................................................................................17
Brandwonde 2e graad...................................................................................................................17
Brandwonde 3e graad...................................................................................................................17
Brandwonde 4e graad...................................................................................................................17
3.3 Uitgebreidheid............................................................................................................................17
Brandwonden...............................................................................................................................17
3.4 Oorzaak.......................................................................................................................................18
3.4.1 Intentionele wonde.............................................................................................................18
3.4.2 Accidentele of traumatische wonde....................................................................................18
3.4.3 Bestralingswonde................................................................................................................18
3.4.4 Mechanische wonde............................................................................................................18
Snijwonde...................................................................................................................................................18
Steekwonde................................................................................................................................................19
Schaafwonde..............................................................................................................................................19
3.4.5 Chemische wonde................................................................................................................19
3.4.6 Fysische of thermische wonde.............................................................................................20
3.4.7 Ulcus cruris..........................................................................................................................20
3.5 Infectiegraad...............................................................................................................................20
3.5.1 Contaminatie.......................................................................................................................20
3.5.2 Kolonisatie...........................................................................................................................20
3.5.3 Kritische kolonisatie.............................................................................................................20
3.5.4 Evolutie van kolonisatie tot infectie.....................................................................................21
3.5.5 Infectie.................................................................................................................................21
3.5.6 Onderzoek van de wond......................................................................................................22
Lokale tekenen van infectie.......................................................................................................................22
Cultuurafname van wondvocht.................................................................................................................22
Biofilms.......................................................................................................................................................22
3.6 Kleur...........................................................................................................................................23
2
,4 Principes van wondzorg..................................................................................................23
4.1 Inleiding......................................................................................................................................24
4.2 Theorie van vochtige wondgenezing..........................................................................................24
4.3 Wondbedvoorbereiding volgens het TIME-principe...................................................................24
4.3.1 Tissue management.............................................................................................................24
4.3.2 Infection management.........................................................................................................24
4.3.3 Moisture imbalance.............................................................................................................24
4.3.4 Edge of the wound...............................................................................................................25
4.4 Wondreiniging en wondontsmetting..........................................................................................25
Wondreiniging..............................................................................................................................25
Wondontsmetting.........................................................................................................................25
WAR-score....................................................................................................................................26
5 De chirurgische wonde...................................................................................................26
5.1 Inleiding......................................................................................................................................26
5.2 Observatie van chirurgische wonden..........................................................................................26
5.3 Classificatie van chirurgische wonden naar infectierisico...........................................................26
5.3.1 Zuivere wonden...................................................................................................................26
5.3.2 Zuiver-besmette wonden.....................................................................................................27
5.3.3 Besmette wonden................................................................................................................27
5.3.4 Vuile geïnfecteerde wonde..................................................................................................27
5.4 Classificatie van postoperatieve wondinfecties naar locatie (POWI)..........................................27
5.4.1 Oppervlakkige incisionele postoperatieve wondinfectie.....................................................27
5.4.2 Diepe incisionele postoperatieve wondinfectie...................................................................28
5.4.3 Postoperatieve wondinfectie van organen en anatomische ruimten..................................28
5.5 Factoren die de chirurgische wondheling belemmeren..............................................................28
5.6 Verwijderen van hechtingen.......................................................................................................28
6 Wondbehandeling..........................................................................................................29
6.1 Inleiding......................................................................................................................................29
6.2 Debridement...............................................................................................................................29
6.2.1 Definitie...............................................................................................................................29
6.2.2 Indicatie en contra-indicatie................................................................................................30
6.2.3 Soorten debridement..........................................................................................................30
Autolytisch debrideren...............................................................................................................................30
Osmotisch debrideren................................................................................................................................30
Chirurgisch debrideren...............................................................................................................................31
Mechanisch debrideren.............................................................................................................................31
3
, Enzymatisch debrideren.............................................................................................................................32
Biochirurgisch debrideren..........................................................................................................................32
6.3 Het ideale wondverband............................................................................................................33
Inhibeert het fysiologisch wondhelingsproces niet......................................................................33
Bewaart de vochtige omgeving en laat gasuitwisseling toe..........................................................33
Biedt thermische isolatie..............................................................................................................33
Biedt mechanische bescherming..................................................................................................33
Is vrij van specifieke contaminanten.............................................................................................33
Is patiëntvriendelijk......................................................................................................................33
Is kosteneffectief..........................................................................................................................33
Laat inspectie van de wond en een correcte wondevaluatie toe..................................................33
Kan langere tijd ter plaatse blijven...............................................................................................34
6.4 Soorten wondverbanden............................................................................................................34
6.4.1 Anti-infectieuze middelen....................................................................................................34
Samenstelling.............................................................................................................................................34
Werkingsmechanisme................................................................................................................................34
Indicaties....................................................................................................................................................34
Contra-indicaties........................................................................................................................................34
Ongewenste effecten.................................................................................................................................34
Voorzorgen.................................................................................................................................................34
Praktisch.....................................................................................................................................................34
Samenstelling.............................................................................................................................................35
Werkingsmechanisme................................................................................................................................35
Indicaties....................................................................................................................................................35
Contra-indicaties........................................................................................................................................35
Gebruiksaanwijzing....................................................................................................................................35
Vaak ten onrechte gebruikt.......................................................................................................................35
6.4.2 Primaire wondverbanden (actief)........................................................................................35
Doel............................................................................................................................................................35
Voordelen...................................................................................................................................................35
Nadelen......................................................................................................................................................35
Indicaties (TIME).........................................................................................................................................35
Behandeling infectie..................................................................................................................................36
Indicaties (kleur).........................................................................................................................................36
Voorbereiding en gebruik..........................................................................................................................36
Indicaties....................................................................................................................................................36
Indicaties....................................................................................................................................................36
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