General Concepts of Edema, Fracture, wound,Neoplasia- Bsc Nursing Notes

Edema/Oedema

• abnormal accumulation of fluid in interstitial tissues, spaces, or body cavities
• Can be
• localized in an organ
• a part of the body or  whole body system  (anasarca)

Causes of edema

• Obstruction of venous or lymphatic drainage
• Congestive cardiac failure
• Nephrotic syndrome
• Cirrhosis of liver
• Drug-induced edema
• Renal failure

Types of edema

According to clinical

• Pitting
• Non-Pitting

Based on the site & distribution

Localized edema

•  pulmonary edema, ascites, pleural effusion

Generalized edema

– cardiac, hepatic

Based on the nature of the fluid

Exudate

• Inflammatory fluid

Transudate

• Non-inflammatory fluid

Pitting vs Nonpitting Edema

• Pitting edema
• Temporary depression forms in the skin when pressure is applied
• Non-pitting edema
• No depression formed

Pitting edema

• Example- CCF, nephrotic syndrome

Non-Pitting edema

• Occurs when excess fluid builds up in the body causing swelling
• No depression when pressure applied
• Example- elephantiasis

Pathophysiology of edema

• Increased hydrostatic pressure
• Reduced plasma osmotic pressure
• Lymphatic obstruction
• Increased capillary permeability

Pathophysiology of edema

A)     Increased hydrostatic pressure

• Impaired venous return- CCF, thrombosis
• Arteriolar dilation- heat

B) Reduced plasma osmotic pressure

• Due to a decrease in plasma protein, a decrease in plasma oncotic pressure
• Common seen in liver disease

C) Lymphatic obstruction

• Normally, interstitial fluid is drained by lymphatics but if lymph vessels are obstructed, lymphoedema occurs
• Causes-inflammation of lymphatics vessels

D)Increased capillary permeability

• Toxins, drugs, chemicals such as histamine, etc can cause injury to capillary endothelium
• Increased movement of plasma from the capillary wall into interstitial space causes edema

Fracture

• break or disruption in the continuity of bone
• or it is a disruption of the normal architecture of the bone

Causes of fracture

• Direct blows and fall
• crushing forces,
• sudden twisting motions,
• extreme muscle contractions

Types of Fracture

• Complete- fracture
• Break across the entire cross-section of the bone
• Incomplete Fracture
•  The break occurs only in part of the bone

Fracture healing

• Fracture healing is a regenerative process in which bone is restored  to normal form

Stages of Fracture Healing (Stages I to V)

• Hematoma formation
• Inflammation and granulation
• Soft callus formation
• Hard callus formation
• Remodeling

Stage I  Hematoma formation(7 days)

• Haematoma is formed immediately after a fracture
• Haematoma takes a fusiform shape
• The site is swollen, painful, and inflamed

Stage II Inflammation & granulation formation (2-3 weeks) 

• Acute inflammation occurs
• Fluid exudates and neutrophil infiltration occur
• In macrophage activity, neutrophils are replaced by monocytes

stage III soft callus formation

• Formation of granulation tissue (soft tissue callus) in the space between the fracture site
• Granulation tissue differentiates and creates osteoblasts

stage IV Hard callus formation

• Osteoblasts and chondroblasts are derived from periosteum and endosteum
• The calcified hard tissue called bony callus
• Lamellar bone formation, woven bone, and cartilage are removed
• progressive calcification and formation of the Haversian system

• Remodeling stage
• Remodeling occurs- the original structure of bone by osteoclastic removal and osteoblastic laying down of bone
• An intermediate callus is covered into compact bone, the external callus is removed and the internal callus is hollowed out into the marrow cavity

Wound

• Cut or break in the continuity of a tissue
• Defined as a physical injury where the skin or mucous membrane is torn, pierced, cut, or otherwise broken
• due to external violence or some mechanical agency rather than disease
• Types of wounds

Based of time

Acute wound

• Caused by trauma
• Example- surgical wound, accident

Chronic wound

• Respond to treatment over the normal expected healing time
• Example- nutrition, medication

On the Based of surface

Open wound

• Break in skin or mucous membrane
• Caused by a sharp object
• Contamination
• Example- surgical incision, gunshot wound

Closed wound

• Have no break in the skin integrity
• Caused by twisting, straining,
• Example- a tear in visceral organ

Based of causes

Intentional

• Result of planned surgical or medical intervention
• Example- vein puncture

Accidental

• Occurs when unexpected conditions such as trauma, chemical
• Example- accidents, knife

Type of wound according to injury

Abrasion

• superficial wound  with superficial  loss of skin
• resulting from friction, rubbing, or scraping the skin over a rough or uneven surface

Laceration

• tearing of tissues which occurs with irregular wound edges
• For example animal bites, machinery cut

Contusion

• It is a closed wound caused by a blow by some blunt object

Puncture wound

• It is a wound that occurs when the skin is penetrated by an appointed or sharp object such as a nail, bullet
• pierces deeper tissues and enters a body cavity or organs
•  

Incisional wound

• It is an open wound with clean, straight edges usually by a sharp instrument

Avulsion wound

• It involves tearing off or loss of a flap of skin

Amputated wound

• Tearing or cutting off a part of the body such as a leg, finger

Wound healing

• Healing of damaged tissues
•  replaces and restores normal structure and function

Types of Wound Healing

• Primary healing (healing by 1st intention )
• Secondary healing (healing by 2nd intention )
• Tertiary healing (healing by 1st and 2nd intention)

Primary intention

Secondary healing

• Heal with granulation tissue,
• These wounds take longer to heal resulting in
• form scar and
• re-epithelialization occurs primarily from wound edges

• Example
• pressure ulcers, dehisced surgical wounds

Tertiary intention

• When a wound is intentionally kept open to allow edema or infection to resolve or to permit removal of exudate, the wound heals by tertiary intention or delayed primary intention
• These wounds result in more scarring than wounds that heal by primary intentions
•  but less than wounds that heal by secondary intention

Process of wound healing

• Hemostasis
• Inflammation Phase (0-3 days)
• Proliferative phase (2-24 days)
• Remodeling phase (24 days – 1 year)
• Process of wound healing

Factors influencing the healing process

Complications of wound healing

Neoplasia

• This term means new growth
• The new growth produced is called ‘Neoplasm’ or ‘Tumor’
• Not all new growth is neoplasm depends upon regeneration, repair, hyperplasia, hormonal stimulation, etc
• It is an abnormal mass of tissue, the growth which is excess and is uncoordinated with normal tissues
• “An abnormal mass of tissue formed as a result of the abnormal, excessive, uncoordinated, autonomous and purposeless proliferation of cells even after cessation of stimulus for growth which caused it”
• Oncology- Branch of science dealing with the study of neoplasms or tumors
• Neoplasm or Tumor is of two types
• benign
• malignant

Benign Tumors

• Encapsulated or well-circumscribed, small in size usually resembles the parent tissue
• Slow-growing and localised
• Noninvasive and no sign of metastasis
• Example- adenoma, papilloma, lipoma

Malignant Tumors

• Poorly differentiated
• Proliferate rapidly, spread throughout the body
• May eventually cause the death of the host
• Common term used for all malignant tumors is “Cancer”
• Example- Squamous cell carcinomas, Fibrosarcoma

TNM classifications

Staging of cancer is a system for describing the size and extent of spread of a malignant tumor, used to plan treatment and predict prognosis

• T- Tumor size
• N- Lymph node involvement
• M- Metastases

 (Union Internationale Contre Cancer, Geneve)

T₀ to T₄ –In situ lesion to largest and most extensive primary tumour

N₀ to N₃ – No nodal involvement to widespread lymph node involvement

M₀ to M₂ – No metastasis to disseminated haematogenous metastases

Warning Signs of Cancer-CAUTION

C– Change in bowel or bladder habits

A– A sore that does not heal

U– Unusual bleeding or discharge

T– Thickening or lump in the breast or elsewhere

I– Indigestion or difficulty in swallowing

O– Obvious changes in the size of wart or mole or sore

N– Nagging cough or hoarseness