Raczek Abeekahmed

A wedding anniversary is the anniversary of the date that a wedding took place. Couples often mark the occasion by celebrating their relationship, either privately or with a larger party. Special celebrations and gifts are often given for particular anniversary milestones (e.g., 10, 15, 20, or 25 years). In some cultures, traditional names exist for milestone anniversaries; for instance, fifty years of marriage may be known variously as a "golden wedding anniversary", "golden anniversary" or "golden wedding".

Associating a wedding anniversary with precious metals such as "gold" (50 years) or "silver" (25 years) has been documented in Germanic countries since the 1500s. In English-speaking countries, the tradition of associating gift-giving with wedding anniversaries became more prevalent in the nineteenth century, alongside the emergence of the Victorian era. In the twentieth century, increased commercialization led to the inclusion of more anniversaries to a list of predetermined gifts.

In some parts of the world, couples can receive special recognition from government officials for particular milestones. In the Commonwealth realms, a couple can receive a message from the monarch for 60th, 65th and 70th wedding anniversaries and for any wedding anniversary after that. This is done by applying to Buckingham Palace in the United Kingdom or to the governor-general's office in the other Commonwealth realms.

In Australia, couples can receive a congratulatory letter from the governor-general on the 50th and all subsequent wedding anniversaries. The prime minister, the Leader of the Opposition, local members of both state and federal parliaments as well as state governors may also send salutations for the same anniversaries.

In Canada, couples can also receive a message from the governor-general for the 50th anniversary and every fifth anniversary after that.

In the United States, a couple can receive an anniversary greeting card from the president for the 50th and all subsequent anniversaries.

Roman Catholics may apply for a papal blessing through their local diocese for wedding anniversaries of a special nature (25th, 50th, 60th, etc.).

Some significant anniversaries have names that suggest appropriate or traditional gifts, such as a silver or platinum jubilee. Gifts may be exchanged by spouses or given by guests at parties; they may also influence an anniversary party's theme or decoration. These gifts vary in different countries, but some anniversary years now have well-established connections common to many nations; a popular analogy are the numerous jubilees thrown to celebrate anniversary milestones in the reigns of English monarchs, all of which are also associated with precious stones or metals.

In English-speaking countries, the fifth-year gift (wood) was cut on the day of celebration and then presented to the wife as a finished item before the next two quarter days had passed.

In 1937, the American National Retail Jeweler Association (now known as Jewelers of America as a result of an organizational merger) introduced an expanded list of gifts. The revamped list gave a gift for each year up to the 25th and then for every fifth anniversary after that.

In South India, 60th and 80th wedding anniversaries are accompanied by large celebrations similar to weddings. In Tamil Nadu, there is a famous Thirukadaiyur Temple where special pujas are conducted for wedding anniversaries.

Flowers are also associated with wedding anniversaries up to and including the 50th anniversary.

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The criteria that we must now evaluate are listed.

In the last fifty years, research on healing led to the creation of "moist cure", an option based on the use of products that create and maintain the wound bed. CAH dressings have the ability to induce autolytic debridement.

The evidence shows that wounds treated with CAH dressings heal quicker and are less likely to be injured than those exposed to air.

This evidence has been followed by a series of works that confirm this fact, Vrankx et al. They make an extensive review of the subject and state that the humid environment has biological effects such as preventing cell desiccation, favoring cell migration, promoting angiogenesis, stimulating collagen synthesis and favoring intercellular communication.

All these elements are translated into clinical effects such as: less pain, thermal isolation, autolytic debridement, greater speed of healing and better quality of the scar; Given this evidence, it seems clear that a humid environment should be used for healing, since it provides the wound with the most natural environment possible so that tissue repair processes can be carried out without alterations. By providing a moist environment with a slightly acidic pH and low oxygen tension, the wound surface can be stimulated and the cells can migrate and debride the tissue. The same characteristics that a wound has in the early stages of its evolution are provided by the new advanced healing concepts.

The cure in humid environment has advantages.

The humid environment can cause wounds to heal quickly.

Local treatment aims to achieve certain things.

Although it's not often done mechanically, wound cleaning is important in wound care procedures. Cleaning a wound correctly will have a direct relationship with the optimal conditions for it to heal correctly and to reduce the risk of infections, since necrotic material is removed from the wound bed.

The Guide for the Treatment of Pressure Ulcers of the North American AHCPR has a series of recommendations on how to clean pressure Ulcers, which can cause physical and chemical trauma, as well as reducing the physical and chemical trauma that cleaning actions can represent. There are some recommendations listed.

Of these recommendations, perhaps the most unknown, is the one that refers to the use of antiseptics, mainly povidone-iodine, sodium hypochlorite, hydrogen peroxide and acetic acid, all of which are known to be toxic and aggressive towards granulocytes, monocytes, fibroblasts and the granulation tissue and in some cases for the body of patients undergoing long-term treatments.

This evidence-based review of Wound Cleaning is offered by the Center for Evidence-Based Nursing Practice.

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There are recommendations for cleaning the ulcers.

Clean wounds at the beginning of treatment and during each dressing change.

When cleaning wounds, use minimal force.

Do not use antiseptic agents, such as povidone iodine, iodophors, sodium hypochlorite solutions, hydrogen peroxide and acetic acid.

Use isotonic saline solution to clean wounds.

Administer the cleaning product at a sufficient pressure that does not cause trauma to the wound bed but facilitates the mechanical removal of necrotic debris.

Agency for Health Care Policy and Research.

The following cleaning recommendations for skin ulcers are made by the GNEAUPP.

At each dressing, clean the skin. The standard is to use physiological saline. The minimum mechanical force should be used to clean the ulcer and its subsequent drying.

An effective washing pressure can be used to facilitate the removal of debris, but without the ability to cause trauma to healthy tissue. The most effective washing pressure is provided by gravity, for example, or through a 35 liter needle.

The ulcer lavage pressures range from 1 to 4 kilogrammes/ cm2. Do not use local antiseptics or skin cleanser on the wound.

Some of the chemicals can cause systemic problems due to their absorption into the body, and they are all cytotoxic chemicals.

summary

At each cure, cleaning of the lesions must be carried out first.

Cleaning will be done with a solution. It can be done with tap water that can be drunk.

Warm water and soap can be used if there is a closed injury. Certainty C

When cleaning or irrigating an ulcer, use minimal mechanical force. The most suitable method is sweeps.

An effective washing pressure can be used to facilitate the removal of debris and previous cures, avoiding trauma to healthy tissue.

The effective washing pressure is provided by gravity, or that which we perform through a needle or catheter that is between 20 and 50 cm in length, and that projects a pressure of 2 kilogrammes per cm2 on the wound. It is certainty B.

Irrigation can be useful for cleaning.

Antiseptics should not be used to clean chronic lesions.

In cases where control of the bacterial load is required, consider the use of antiseptics only in those cases.

It is advisable to take into account the existence of cleaning and decontaminating solutions such as POLYHEXANIDE SOLUTION 0.1%.

We can use this solution to clean, rehydrate and decontaminate pressure ulcers that present a risk of infection since they help to eliminatebacteria, residues and eliminate biofilm, being effective against a wide spectrum of microorganisms.

Technique: To optimize its use, we will carry out the previous elimination of detritus with physiological saline in each cure and then we will expose the wound to intimate contact for at least one minute, impregnating a gauze or compress (fomentation) and in case of deep cavities we will instill the product .

There is a professional consensus document on cleaning and decontamination of wounds.

The document is called a professional consensus document.

It's an important phase in wound healing. An inflammatory response is produced if the wound presents with necrotic or dead tissue, and this will help to prevent the spread of germs that can cause infections.

Chronic wounds contain cells andbacteria because of the lack of vascularization, which impedes the healing process.

Depending on its appearance, we can distinguish between necrotic or eschar tissue, which is made up of proteins such as collagen, fibrin and elastin, among others, as well as various types of cells and bacterial bodies that constitute a hard and dehydrated scab, often colored black, brown and even grayish and sloughed tissue that has a composition similar to necrotic tissue but with a greater amount of fibrin and moisture, forming a viscous, yellow or whitish layer, difficult to apprehend due to its soft consistency.

The presence of necrotic tissue in the ulcer bed makes it difficult to evaluate and heal it. To cure the ulcer, it is necessary to remove this type of tissue through debridement, choosing the most convenient debridement technique in each case.

Debridement is the removal of non-viable tissues and materials from the wound bed.

There are intermediate stages between the two types of plaque in a wound.

The tissue had been removed.

The NECROTIC PLAQUE is made of wood.

The debridement methods are compatible with each other and recommend the combination of several of them to make the process more efficient.

Certainty C

The debridement method must be appropriate to the condition of the lesion, individual condition, and the objectives of care. It's certain A.

We need to assess the general situation of the person, possibilities of healing the process, life expectancy, problems and benefits for them to decide the technique to use.

People in a terminal situation of their disease need to be considered. The characteristics of the lesion will be assessed in the same way as the characteristics of the tissue.

Debridement done.

The complete removal of necrotic tissue can be done in the operating room or surgical room under anesthesia.

It is indicated for thick, very adherent bedsores, devitalized tissue of extensive, deep lesions, in special locations, and with signs of cellulitis or sepsis, the latter being considered an urgent need for debridement. There is a word for it.

In the presence of advanced cellulitis, crepitus, fluctuation, and/or sepsis, surgical debridement is indicated. Certainty C.

sharp debridement

The procedure is carried out at the foot of the bed and involves removing devitalized tissue in different sessions and up to the level of viable tissue.

Sharp discharge.

It is performed with sterile instruments and taking asepsis measures to the extreme, since it is a phase of special bacterial proliferation and the use of antiseptics can be assessed.

People with coagulopathies should be taken care of. Certainty C.

In the event of bleeding, we must use dressings. The advisability of maintaining the dressings should be assessed during the first 24 hours.

It would be best to use a dry dressing for 8 to 24 hours after the bleeding is controlled. Certainty C.

The debridement method is not recommended in non-healing ulcers. Certainty C.

The administration of analgesia is recommended before performing the procedure because of the pain it can cause.

Certainty C.

In the case of necrotic plaques located on the heels, which do not show any signs of injury, immediate debridement may not be necessary. Certainty C

If there is a fluid collection below, debride the heels with a dry eschar. Certainty C

The debridement is done using enzymatic methods.

This method is based on the local application of the exogenous enzymes which work together with the endogenous ones to promote tissue growth.

EnzyMATIC DEBRIDEMENT.

EnzyMATIC DEBRIDEMENT.

It is a method that can be used with other methods.

It is recommended to increase the level of humidity in the wound to increase its action and protect the periulcer skin with barrier films or zinc oxide ointments, due to the risk of maceration.

Its action can be mitigated with soapy solutions, heavy metals and antiseptics. It is certain B.

Since it favors debridement and tissue growth, lysine is the most widely used enzyme.

Certainty C