The Role of Assessment of the Whole Patient's to Come Up with an Efficient Nursing Plan in Wound Healing - Case Study Example

SKILLS ANALYSIS FRAMEWORK, PERFORMANCE AND SELF-REFLECTION Introduction Framework within which this particular case study is critiqued is on the assessment of the skills of the registered nurse taking care of the patient in this particular study. The researcher’s inquiry and learning will be on how the treatment of the problem wounds creates a complex set of challenges for the one executing the activities for the treatment. The plan of care to be conducted is composed of the comprehensive services to be provided which are designed to ensure efficient care with the flexibility to develop treatment plans. Professional nursing care to be provided includes a full range of services for effective wound treatment and management and appropriate adjunctive therapies. All patient care will be well-communicated to ensure an integrated treatment plan for the patient's overall well-being. The framework that has been chosen to guide this paper will be used for future study in nursing care. Assessment and Planning Discussed below are relevant literature and theoretical framework used to support the discussion in the case study. Pressure sores may be superficial, caused by localized skin irritation with subsequent surface maceration, originating in the underlying tissue (Carney, 2002). In the Stage 3 pressure sore, a hole develops that oozes foul-smelling yellow or green fluid. The skin becomes necrotic with exposure of fat which extends into the muscle. The sore may develop a black, leathery crust at its edges and eventually at the center. The nerves at the site are deadened. Healing may take months. It is a primary site for a serious infection to occur (Carney, 2002). Figure 3. Stage 3 Pressure Sore The nursing care needs of Mr. Wong include preventive measures such as turning and repositioning, range of motion exercises as well as proper nutrition and skin care. These may be difficult to comply with but are necessary. Also things like pressure from wrinkles in sheets and clothing, ill-fitting braces and casts, or even crumbs in bed could exacerbate a patient’s problems of pressure sores. The goal of this study is to assess the level of skills of the nursing care provider in giving the appropriate nursing care strategies. The goal achievement indicator is the improvement in the health status of the patient. These care strategies for the identified nursing care needs are conduct of risk assessment, maximization of mobility status, assurance of adequate nutrition, development of skin care program and keeping the skin clean and dry, protection against skin friction against surfaces, pressure and shear, and assessment of the patient’s status changes. Assessment if the goals have been met or achieved will be through the latter. The wound healing process as it relates to Mr. Wong’s wound will be recorded properly so as to come up with an efficient assessment of the health status of Mr. Wong. The ultimate aim is for the nutritional and overall health status of Mr. Wong to improve. Rationales for Decisions I. Nursing skills and principles applied to each component of the complex wound care in this case study In this case, it is important to provide for good moist interactive wound healing for the wounds of Mr. Wong. This can be done by dressing the wound regularly by removing excess exudate and toxins, providing high humidity at the dressing wound interface, allowing for gaseous exchange, providing thermal insulation, protecting against secondary infection, and freeing the wound from particulate and toxic components. When the wound becomes necrotic, it should be debrided through the use of scalpel or any other sharp debridement, enzymatic debriders or medication placed in the wound bed to “eat” away the dead tissue, or pressurized saline to loosen the tissue. The ability to heal Mr. Wong’s wound depends on a number of variables like the patient’s vascular competency, adequate nutritional intake to maintain positive nitrogen balance, and many others. II. Infection Control Measures Prevention is the first course of action in the case of Mr. Wong. Movement and exercise can improve circulation and prevent sores of the patient. A healthy diet keeps skin healthy and better able to resist breakdown. Protective skin care should a pressure sore develop needs proper cleansing, treatment, and dressing procedures. Good nutrition is essential to healing too (Keast & Orsted, 2000). Proper position can also be done Passive range of motion exercises such as neck exercises, shoulder exercise elbow exercise, forearm exercise, wrist exercise, finger exercise, hip and knee exercise, ankle exercise and foot exercise should be performed. Then check the sore, put on sterile gloves and clean the wound. III. Communication Recording the time and date of initial and subsequent treatments is essential through documentation. Initially, document the wound’s location, size (length, width, depth), and color, amount, odor and color of drainage, and condition of the surrounding skin. Update daily the treatment noting any change in the condition or the size of the wound, or any elevation of skin temperature. The success of the wound care program to be given to Mr. Wong is dependent upon communicating clearly and consistently the nursing care information and data with all stakeholders during all phases of the process. It should be noted that the end point communication should reflect the importance of the outcome measurement process, outline a plan for improvement, and confirm a commitment to repeat the process (Wounds, 2007). Reflection Using the critical thinking and reflective practice framework, my own values and attitudes influences practically and theoretically the complex wound care that I gave for this patient. Of the many years that I have been a nurse, majority of the wounds that I have encountered are pressure-related. I believe that wounds such as these needs ultimate attention. With regards to the dexterity required to pack the wound and keep it uncontaminated, these require patience. Proper packing of the wound is important to as not to cause damage and avoid proliferation of microbial contaminants, dusts, and other foreign materials in the wound. Differentiating between infection and contamination in pressure wounds is sometimes hard. Hence, this requires careful study and diagnosis. On the other hand, with regards to the problem solving and planning needed while doing this type of dressing, I have learned that this entails careful planning, analysis and efficient problem-solving skills are essential. Every problem that arises while on the course of regular dressing of the wounds has to be carefully studied and addressed. The assessment on the stage of healing is that it is in the stage of healing. Improvement on the wound recovery was determined through decrease in the lesion size and the improvement in the health status of the patient. In this case, after the cutting of the necrosis, the wound bed became clean. Since improvement was shown within two weeks, then it can be deduced that the wound is on its way to healing. Likewise, there are no signs of infection observed. The benefits of wound care involve effective treatment of the problem and eventual improvement. The disadvantage of this type of wound care is the economic cost involve in this type of medical problem. Failure to resolve the treatment of this type of problem would result to more complicated process (Wound Healing Center, 2005). By undertaking a complex wound dressing, I feel that it would provide comfort and treatment in the condition of the patient. I think the patient feel (Mr. Wong’s perspective) very uncomfortable with these pressure sores. I could make the process less distressing for the patient by carefully executing the plan, taking into considerations all the variables in the case of Mr. Wong.. The learning processes in doing this paper entail patience and long study since this is a complex medical problem requiring specialized care and treatment. By researching and undertaking this assignment, I have learned the rigorous nursing care needed for patient like Mr. Wong. The information and the learning gathered will be very useful in the future when dealing with cases such as this. In conclusion, it was found that in wound healing, an assessment of the whole patient’s case including all possible contributing factors carefully conducted to come up with an efficient management plan should be conceptualized and developed. It is important that the patient will cooperate with this plan for it to be a success. For the nurse to be efficient, several skills has to be possessed like understanding of physiotherapy, occupational therapy, diet, dermal care and treatment, social work involvement and efficient nursing care. REFERENCES Background Information. and the History of Advanced Wound Healing. 2007. Tycohealth. Kendall. http://www.tycohealth-ece.com/index.php?option=com_content&task=view&id=57&Itemid=74. Carney, Nancy. 2002. Pressure Sores. Batten Disease Support and Research Association. http://www.bdsra.org/bookstore/Pressure%20Sores.pdf. Gardner, Michelle. Uneventful Process or Complex Medical Problem Requiring Specialized Treatment and Care? Infection Control Today Magazine, March 1, 2002. Virgo Publishing, LLC. http://www.infectioncontroltoday.com/articles/231feat3.html Keast, David & Orsted, Heather. 2000. The Basic Principles of Wound Healing. Ostomy Wound Management, vol. 46, no. 11, p. 16. Pilonidal. Wounds. 2007. HMP, vol. 19, no. 11, pp. 299-309. HMP Communications. Wound Healing Center. 2005. Texas: Citizens Medical Center. http://www.citizensmedicalcenter.org/WoundHealing/.s Read More