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Zdrava koža sastoji se od epidermisa, dermisa i subkutisa, i sadrži oko 18% ukupne tjelesne težine. Kada govorimo o rani, obrambena funkcija kože je zapravo smanjena. Razlikujemo akutne rane od kronične, jer prilikom skrbi za bolesnike s takvim ranama, liječenje i sestrinske intervencije su zapravo različite. Kirurška rana nastaje u aseptičnim uvjetima, planirana je i nastala s jasno određenim ciljem da bi se pomoglo bolesniku uz maksimalnu poštedu tkiva. Cijeljenje rane je normalan odgovor organizma na ozljedu, a odvija se kroz četiri faze: hemostaza, upala, proliferacija i faza remodeliranja. Kronične rane su rane koje ne zarastaju unutar 6 tjedana, a danas predstavljaju teret bolesnicima i medicinskom osoblju, te cijelom zdravstvenom sustavu. Među njih ubrajamo dekubitus, arterijske i venske ulkuse na potkoljenicama i rane kod dijabetičkog stopala. Koliko često će se rana previjati, kod svakog bolesnika je to individualno i ovisi o vrsti rane, količini eksudata. Medicinske sestre/ tehničari, uz liječnika tvore tim koji sudjeluje u zbrinjavanju kronične rane, odnosno previjanju rane. Razlikujemo dvije tehnike koje se koriste kod previjanja rane, to su sterilna i aseptična. Sterilna podrazumijeva korištenje sterilnih rukavica, korištenje sterilnog pokrivala za ranu i instrumente, no prije svega kirurško pranje ruku. Aseptična tehnika obuhvaća higijensko pranje ruku, čišćenje rane i okoline, čiste rukavice i sterilne instrumente. Liječenje kroničnih rana suportivnim oblogama skraćuje vrijeme cijeljenja rane, a jedna od zadaća im je osigurati vlažno cijeljenje. Razlikujemo više obloga koje se stavljaju na ranu: hidrokolidi, hidrogel, alginati, poliuretanska pjena, hidrofiber, alginatna obloga s medom. Odabir obloge ovisi o stupanju cijeljenja rane, infekciji, količini eksudata i apsorpciji. Uloga prehrane u zacjeljivanju rana jako je važna, ali često i zanemariva u liječenju rane. Optimalna prehrana osigurava potrebnu imunološku funkciju, sintezu kolagena i samim time čvrstoću rane, sve ono što je potrebno u procesu cijeljenja rane. Učinkovita i učestala edukacija medicinskih sestara/ tehničara od velikog je značaja za skrb o ranama, kirurškim ili kroničnim. Healthy skin consists of the epidermis, dermis, and subcutis, and contains about 18% of total body weight. When we talk about the wound, the defensive function of the skin is actually reduced. We distinguish acute wounds from chronic ones because when caring for patients with such wounds, treatment and nursing interventions are actually different. The surgical wound is created in aseptic conditions, planned and created with a clearly defined goal to help the patient with maximum tissue sparing. Wound healing is the body’s normal response to injury, and takes place through four phases: hemostasis, inflammation, proliferation, and the remodeling phase. Chronic wounds are wounds that do not heal within 6 weeks, and today they represent a burden to patients and medical staff, and to the entire health care system. Among them we include pressure ulcers, arterial and venous ulcers on the lower legs and wounds in diabetic foot. How often the wound will be bandaged, in each patient it is individual and depends on the type of wound, the amount of exudate. Nurses / technicians, with the doctor, form a team that participates in the care of chronic wounds, or wound bandaging. We differentiate two techniques used in wound bandaging, these are sterile and aseptic. Sterile implies the use of sterile gloves, the use of sterile wound dressings and instruments, but above all surgical hand washing. Aseptic technique includes hygienic hand washing, wound and environment cleaning, clean gloves and sterile instruments. Treating chronic wounds with supportive dressings shortens the healing time of the wound, and one of their tasks is to ensure moist healing. We distinguish several dressings that are placed on the wound: hydrocollides, hydrogel, alginates, polyurethane foam, hydrofiber, alginate coating with honey. The choice of coating depends on the degree of wound healing, infection, amount of exudate, and absorption. The role of diet in wound healing is very important, but often negligible in wound healing. Optimal nutrition ensures the necessary immune function, collagen synthesis and thus wound strength, all that is needed in the process of wound healing. Effective and frequent education of nurses / technicians is of great importance for wound care, surgical or chronic. |
