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Rely to two peers

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Rely to two peers. These replies should be at least a paragraph in length and contain substantive addition to the discussion.

peer 1 :   There are different categories of wound healing. Two of these include primary and secondary intention. Tissues approximated by surgical sutures or tapes with minimal loss of tissue are considered healed by primary intention. These wounds will typically heal with a clean and neat scar (Chhabra et. al, 2017). Wounds of the face and scalp are typically closed with primary intention, as long as no infection is present (Chhabra et. al, 2017). An example of this would be our patient with the laceration on his scalp after tripping. “Surgical wounds healing by secondary intention are open surgical wounds that are left to heal from the base up. They are often slow to heal and are prone to infection” (McCaughan et. al, 2018). The patient’s large stage 3 ulcer over his sacral area sounds like an example of a secondary intention healing process.   Many factors can impair the healing process for patients. For starters, the patient’s history of diabetes can have a lot of impacts on how this patient heals with any type of wound. Diabetics are at increased risk for comorbid conditions.  A main consequence of diabetes is the impairment of self-repairing abilities (Spampinato et. al, 2020). The patient’s history of hypertension, COPD, and smoking also probably contribute to the poor wound healing. Healing tissues need proper oxygen and blood supply, and these comorbidities will affect that. Also, seeing that the patient is 110 pounds and 5’7” leads us to believe the patient is probably malnourished. Being malnourished and not having proper nutrients the body is supposed to have will also affect wound healing.     Wound healing consists of three different phases. Wound healing consists of the Inflammatory phase, Proliferative phase, and the Remodeling phase. The first phase, the inflammatory phase begins at the time of the injury and last up to a few days. This includes clotting of platelets and constriction of blood to stop blood loss and the initial cells that come to kill bacteria and naturally clean the wound site. Next the proliferative phase begins a few days after injury and it helps create new collagen and tissues to repair the damaged tissue. The remodeling phase continues 6 months to a year after injury and is the continuation of the skin tissues “remodeling” themselves. Occasionally scar tissue will be left behind. This patient is 74 years old and is considered to be a geriatric patient. Older adults are at higher risk for developing wounds and having impaired wound healing due to numerous changes that occurs with aging. With older age the body will have intrinsic alterations to it. The blood flow decreases, the body’s capacity to repair skin diminishes, and healing process will become slower.

peer 2: Primary intention refers to the healing of a wound where the edges are brought together and sutured or stapled (Norris, 2020, pp. 205-207).  An example of this in the given patient would be the laceration to the scalp.  Though not stated, one would assume that this wound would be closed in this manner.  Norris (2020, p. 207) goes on to describe secondary intention as the healing of a wound with greater tissue loss where the edges are not brought together and the wound is left open to heal from the bottom up.  The stage 3 decubitus sacral ulcer exemplifies this.  This broad and deep type of wound, likely unable to be closed by primary intention, heals in this manner.

Factors that may impair the healing process in this scenario include the client's age, malnutrition (this is assumed due to his stated weight of 110 pounds relative to his height), diabetes, hypertension, COPD, kidney transplant, and generalized edema.  All of these factors can affect blood flow and oxygenation to the wound which is needed to provide nutrients for tissue healing and to remove waste from the site of injury (Norris, 2020, p. 209).  The stage 3 decubitus ulcer is a significant impairment as it is a deep wound with a high risk for infection.  Also impairing the patient’s healing process is that he is a smoker.  Smoking creates a recurring insult to the body which elicits an immune response, further taxing an immune system probably already compromised. 

The three phases of healing are the inflammatory phase, the proliferative phase, and the remodeling phase.  The inflammatory phase begins immediately after an injury and involves the release of inflammatory mediators to cleanse and protect the wound.  The proliferative phase involves new cell growth and the formation of granulation tissue.  Finally, the remodeling phase is characterized by the reorganization and contraction of collagen fibers, leading to the formation of mature scar tissue if direct replacement of the original tissue type cannot be achieved (Norris, 2020, pp. 207-208).

Aging can affect the immune system in several ways that might affect this client's ability to heal.  These include a decrease in the number and function of immune cells, a decrease in the production of antibodies, and an increase in inflammation.  All of these changes can make the individual more susceptible to infection and delay healing.  Regarding the immune system, as humans age there appears to be diminished production of B and T cells in the bone marrow and thymus (Montecino-Rodriguez et al., 2013).  The reduction in the number of these cells contributes to decreased immune efficiency and overall function.  Additionally, older adults are more likely to have chronic health conditions such as diabetes and hypertension, which can also impede wound healing.