Principles of Wound Management - Case Study Example

PRINCIPLES OF WOUND MANAGEMENT By: Presented Principles of Wound Management Wound Care Case Study No. One a) Review this picture and advise what stage is this wound and why? Explain you answer. This wound is at a stage known as the proliferative stage. In this stage of a wound, there is likely to be a pinkish-whitish tissue that is formed at the base and is a connective tissue. Since the tissue is new, it is likely to bleed once there is pressure on it or subject to rough handling. As the wound continues to heal, the tissue known as granular tissue becomes developed and there are no signs of bleeding as easily as earlier (Dealey & Cameron 2008, p. 15). b) Name 3 actual diagnoses for this patient and 3 potential diagnosis? Some of the actual diagnoses for this patient include wound infection, Congestive cardiac Failure and Osteoarthritis. The potential diagnosis for this patient could be inability to move easily, further risk of wound injury and dejection. The potential diagnosis could result to further harm on the wound causing it to have poor healing (Davis 1991, p. 22). c) State 7 implementations you would put into place to assist this person and provide a rationale for each implementation? Gorgia (1995, p. 40) notes that individuals with CCF have a risk of having difficulties in breathing, fatigue and tachycardia because the condition can cause pulmonary congestion and cardiac output abnormalities. Of the interventions that are viable for Mr. Jones, 7 are listed below together with their rationales. Intervention: administer oxygen Rationale: this helps to keep the tissues oxygenated which prevents insufficiency of oxygen in tissues and the blood. Intervention: Physical rest Rationale: prevents excessive consumption of oxygen by the body and eliminates fatigue in Mr. Jones. Intervention: Emotional relaxation Rationale: This is an effort to reduce anxiety levels in the patient. Intervention: White Blood cells count and check for wound reactions such as pain, swelling, redness. Rationale: such an intervention would show infection levels and the body‘s efforts to fight them through increased WBCs. Intervention: Monitoring of cardiorespiratory sequences in the patient’s body Rationale: it shows the activity levels that can be undertaken. Intervention: reduction of demanding activities from the patient Rationale: To reduce the cardiac amount of work. Intervention: Maintenance of appropriate sitting and resting positions. Rationale: this helps in pain management. d) What is the patient’s Braden score, please elaborate on why you made this decision. A Braden score of 16 would be appropriate for Mr. Jones’s case. In giving this score, it is considered that the patient has a host of medical frailties that affect his health such as congestive cardiac failure, acopia, and osteoarthritis. His movement capability is curtailed and is painful for him to do so with ease. He has pain from his ulcer that is very active. It becomes imperative for him to have an assistant all the time. According to Wright and Miller (2005, p. 32), scores that are below 16 show high risk while 16-23 are moderate to minimum risk. Mr. Jones case is at 16 with escalation moving the scale further towards 6. e) What is the Braden score and why is it important? The Braden scale is a reliable and medically valid tool that is used to point out those persons that have the greatest risk of having pressure ulcers (Wright & Miller 2005, p. 28). Identification of these individuals helps in implementation of appropriate intervention measures. It cuts across six domains that entail friction and shear, sensory perception, mobility, nutrition, skin moisture and activity. It is ranked from 6-23. The higher the numeric score, the less risk of pressure cancer while the lower the score the higher the risk. The classification is as follows 9 and below- at very high risk 10-12- high risk 13-14-moderate risk 15-18-at risk 19-23-no risk Wound Care Case Study No. Two a) Review this picture and advise what stage is this wound and why? Explain you answer. This wound is at two distinct stages of pressure ulcer. The ulcer in the left Ischial area and that located just above the anal verge (Sacral area) is on stage III of pressure ulcer. This is evidenced by the total loss of the epidermis and the dermis, as well as the visibility of the hypodermis. Conversely, on the right Ischial pressure ulcer, there is total loss of the epidermis but partial loss of the dermis and the ulcer appears to be pinkish-red in color, this is evidence of stage II of pressure ulcer (Wound and Pressure Ulcer Management n.d). There also seems to be some evidence of disruption of wound healing process. b) Name 3 actual diagnosis for this patient and 3 potential diagnosis? Some actual diagnosis for this patient would include: pressure ulcers, Urinary Tract Infection (UTI) and addiction of alcohol and drugs. Also, the potential diagnosis for this patient would be: infection spreading to kidney, depression and risk of fall (Davis 1991, p. 35). All this diagnoses are necessary in order to restore the patient to an acceptable level of physical and mental health. c) State 7 implementations you would put into place to assist this person and provide a rationale for each implementation? Mr. George has quite a number of critical health issues which would generally cause him a significant deal of discomfort. He suffers paralysis from the waist downwards, and has numerous wound infections. As a result, he will likely experience both acute and chronic pain. He is also diagnosed with urinary tract infection, thus, inflammation of the bladder, urethra or any other urinary parts would cause him acute pain. Any urination, whether frequent, urgent or hesitant will be painful. He is also likely to have disturbed sleep and high body temperatures. The suitable nursing intervention for Mr. George would be as follows: Intervention: Encourage intake of fluids Rationale: fluids help in renal blood flow and flushing out bacteria from the urinary tract (Myers 2004, p. 58). Intervention: Introduce things that are fun to divert attention Rationale: fun brings about relaxation and helps in avoiding feelings of pain. Intervention: Use of analgesic Rationale: analgesic control and minimize pain on the patient. Intervention: Encourage consumption of food rich in calorie and protein Rationale: this helps in maintaining a balanced nutritional status (Myers 2004, p. 30). Intervention: Monitoring results of urinalysis, changes in the color of urine and voiding patterns. Rationale: to use expected results to determine progress or variations. Intervention: monitoring nutritional status including serum albumin and weight loss Rationale: the cellular immune response of a patient with insufficient nutritional status is very low and this increases the risk of infection. Intervention: White Blood cells count and check for signs of infection such as pain, swelling, redness. Rationale: Counting White Blood Cells helps in signify an infection. Increased White Blood Cells shows that the body is fighting pathogens; reduced White Blood Cells show the body’s inability fight pathogens. The degree of infection is determined by any other observation. d) What is the patient’s Braden score, please elaborate on why you made this decision. Mr. George’s appropriate Braden score would be 13 (Wright & Miller 2005, p. 45). To arrive at this, the following considerations were made. Mr. George is paraplegic from the waist downwards. Thus, his sensory perception did not function normally and he had difficulties with physical activities such as movement. In addition, he was found unconscious due to influence of alcohol and drugs. e) Please describe what the difference is between a sacral and an Ischial pressure ulcer? The sacral ulcer and the Ischial ulcer are pressure sores but differ in that, the sacral ulcer results from the prolonged positioning or overbearing of an individual’s weight by the sacral parts of the body, while the Ischial ulcer affects the Ischial part of the body (Myers 2004, p. 24). f) What discharge services would this patient benefit from and give examples of services that provide these in your local area. Ensure you provide a rationale for the discharge services you suggest. Mr. George’s situation requires some assistance from other people because he lives alone. Luckily, there are independent living services available for him and which he can greatly benefit from. This include: home care services which have carers, home care aid, and visiting nurses. There are also the meals on wheels services (Jeter & Tintle 1988). I would suggest those services to Mr. George for the following reasons. Mr. George has a history of neglecting himself. He was found unconscious in his house for over 12 hours. In addition, he was under the influence of alcohol and drugs. He is also paraplegic which exposes him to various manners of potential injuries. Things get worse considering his numerous wound infections and frequent pressure ulcers. For all those reasons, Mr. George needs someone who will keep a keen look at him and monitor his progress. Community services would be most appropriate towards helping him recover his health. g) Review this picture and advise what stage is this wound and why? Explain your answer. This wound is healing progressively and is in the wound healing stage called proliferate stage. This is because in or around the wound, there is absence of inflammation, infection or moisture, and the pink granulation tissues are visible at the base of the wound. Further observation reveals that new connective tissues have completely formed at the base of the wound and epithelial tissues have started forming which culminates the process of wound healing. Also, there is a fully developed skin island which indicates total healing of that particular area and further symbolizes that other areas will follow the same direction (Davis 1991, p. 36). Wound Care Case Study No. Three a) Review this picture and advise what stage is this wound and why? Explain your answer. A look at this wound shows that it is in the wounding or bleeding stage. Bleeding reveals that the damage is on the dermis. Also, the epidermis and the dermis have been lost. Presence of thick blood around the wound signifies blood clotting. Poor quality of skin and redness around the wound also characterize a healing wound (Davis 1991, p. 44). b) What does debridement mean and why do they perform this procedure? Debridement is the medical process of removing damaged, infected or dead tissues from a wound so as to increase the healthy tissue’s chances of healing. This process can be done either surgically, mechanically, chemically or autolytically. Debridement is performed to eliminate tissues with bacterial infection, dead cells, or crusting. It is also done to a neat wound to minimize scaring. In other cases, debridement is done purposely for collecting a sample of the wound (Levin n.d). c) What is lymphedema? Please explain. Lymphoedema is a tissue swelling which occurs as a result of a flawed lymphatic system. It may also result from an improper development of the lymphatic system or improper draining of the vessels, leading to a buildup of fluids rich in proteins in the tissues (Tretbar 2008, p. 10). d) What is the purpose of compression stockings especially in relation to Patricia and her previous medical history? Compression or surgical stockings are given to patients for a specific time frame and are part of their treatment. These stockings are used to control the blood flow in the upward direction by gently squeezing the area they are applied. They improve venous return by applying graduated pressure to the legs. Various reasons necessitate the prescription of these stockings. These are: deep vein thrombosis (DVT) among others. However, in the case of Patricia, lymphedema and hematoma (accumulation of blood outside the blood vessels) are the main reason this stockings are used, so as to prevent blood clots and swelling in the legs (Hormans 1940, p. 40). e) What is a skin graft and how do they harvest the skin for grafting? A skin graft is a surgical operation in which a healthy skin in one’s part of the body is transplanted to another part of the same body where skin damage has occurred as a result of injury or illness (Skouge 1991, p. 18). Skin grafts are basically of two types: full thickness and split-level thickness grafts. Full thickness grafts, are normally for small wounds in highly noticeable parts of the body, for instance, the face. They involve removal of the blood vessels, top layers of the skin and the muscles. Conversely, split-level thickness grafts involve removal of the dermis and the epidermis from the donor site and are usually used for covering large areas. They generally appear shiny and smooth. f) Review the above diagram and advise what stage is this wound and why? Explain your answer. A thorough look at the base of the wound suggests that the wound is in the healing stage called proliferate stage. This is because there are new connective tissues being formed and their color is pinkish-white which is due to lack of melanin. The presence of some redness around the wound does not offer any refuting evidence of the wound being in the phase of proliferation, because most of it is healing (Gorgia 1995, p. 39). g) Name 3 actual diagnosis for this patient and 3 potential diagnosis? Some of the actual diagnosis for this patient is: hypothyroidism, lymphedema, and Gastro-Oesophageal Reflux Risorder (GORD). On the other hand, some potential diagnosis is: infection, risk of fall and weakness or dizziness (Hormans 1940, p. 88). h) With your knowledge of Braden scales, what is Patricia’s Braden score, please elaborate on why you made this decision. Considering Patricia’s case, the most suitable score for her in the Braden score is 16. This is because of the following reasons. She fell and fractured her left distal radius. In addition, she has an open wound in her left knee which resulted from a blister (hematoma). The combination of a fracture and an open wound would render her incapable of walking which in turn would expose her to the risk of developing friction and sheer. The fact that she is always moist due to her sufficient nutrition, lives alone and the impairment of her sensory perception cannot be determined adds to the risk. Then there is consideration of her current and previous diagnosis which largely contributed to that Braden score (Wright & Miller 2005, p. 25). i) What is a volar # of the left distal radius? Explain. The forearm has two large bones, the radius and the ulna. The radius is the larger of the two bones while the distal end is the end towards the wrist. In addition, volar plate’s source is ligamentous and on the proximal phalanx forms the PIP joint’s floor (interphalangeal connection with the hand are the hinge joints between the hand’s phalanges). The volar plate thus creates a separation between the flexor tendons and joint space. Thus, a volar fracture of the distal radius is a fracture of the forearm involving both the volar plate and distal radius (Pavletic n.d). j) Patricia has a BMI of 34. What does BMI stand for and how do you calculate an individual’s BMI? What risks can this place on Patricia’s health with reference to what other health issues she has, elaborate? BMI stands for Body Mass Index. It is calculated using a mathematical formula, that is, weight in kilograms divided by the square of the height in meters and is expressed in kg/m2 (Wilcox 1994). According to Wilcox (1994), the BMI between 20.0 and 24.9 is considered normal and that above 30.0 is regarded risky. This is because being overweight increases the chances of death, despite other factors such as smoking and illnesses such as cancer. Bibliography AAWM.ORG. (n.d.). Retrieved November 13, 2014, from http://aawm.org/ Davis, J. (1991). Principles and management of surgical infection. Philadelphia: Lippincott. Dealey, C., & Cameron, J. (2008). Wound management. Chichester, UK: Wiley-Blackwell. Gogia, P. (1995). Clinical wound management. Thorofare, N.J.: Slack. Homans, J. (1940). Lymphedema Of The Limbs. Archives of Surgery, 232-252. Jeter, K., & Tintle, T. (1988). Principles of wound cleaning and wound care. Home Health Care Management & Practice, 43-47. Levin, L. (n.d.). Debridement. Techniques in Orthopaedics, 104-108. Myers, B. (2004). Wound management: Principles and practice. Upper Saddle River, N.J.: Prentice Hall. Pavletic, M. (n.d.). Wound management principles and techniques. Veterinary Quarterly, 22-24. Skouge, J. (1991). Skin grafting. New York: Churchill Livingstone. Tretbar, L. (2008). Lymphedema diagnosis and treatment. London: Springer. Wardrope, J., & Smith, J. (1992). The management of wounds and burns. Oxford: Oxford University Press. Wilcox, K. (1994). BMI improving its ability to predict body fat. Wound and Pressure Ulcer Management. (n.d.). Retrieved November 13, 2014, from http://www.hopkinsmedicine.org/gec/series/wound_care.html Wright, H., & Miller, M. (2005). The braden scale and nusing document: A secondary analysis. Read More