Thinking about Wound Management - Essay Example

Academic Essay Critically Analysis and Thinking about Wound Management Customer’s Name Customer’s Grade Course Customer tutor’s Name 8th April, 2011 Introduction A wound is any injury that is caused by physical means that in most cases result in the disruption of normal growth continuity of body tissues and structures. Wound physiology is normally divided into three phases; defensive, proliferative and maturation. Each phase normally occurs without impediment in order for a wound to heal. The defensive phase occurs from the time of injury to three days. It is characterized by inflammation. A clotting cascade is initiated to protect the wound from bacterial attack. Vasodilatation facilitates the removal of the debris and deliverance of nutrients to the injured tissues (Santoro 2005). Proliferation lasts from the second day of injury until the area is healed. Maturation is the phase that comes last in the healing process and involves scar remodeling after wound closure and may take several years (Enoch 2004). The diversity of wounds and wound care products creates a great deal of complications in the selection of dressing material. This implies that many wounds have several options of dressing that are effective and reliable. Wound characteristics have to be matched with dressing features.Some wounds need absorptive dressing while others need debridement dressing. Dressings fall into a variety of categories that include gauze, hydrocolloids, transparent film and foam among others (Bredow 2006).hydrocolloids are most suitable for Mr. Owen’s wound. They e composed of adhesives that turn into gel when exudate is absorbed. Several factors affect the healing of wounds. These include tissue perfusion and oxygenation, presence or absence of infection, nutrition, medications, underlying disease, mobility and sensation and age. Circulation and adequate oxygen circulation delivers nutrients to wounds for healing and gaseous exchange. All wounds are said to be contaminated but not necessarily infected. Therefore, bacteria compete for nutrients, prolonging the inflammatory stage and delays collagen synthesis (Dealey 1999). Wounds range from simple to complex, acute to chronic. Mr. Owen’s case is very chronic because it has led to the development of various consequences such as ulcers and hypertension. Each of these has characteristic features that make caring for it a clinical challenge. The role of the nurse is to support and facilitate nature’s path through choices that promote healing and prevent further complications. In the case provided, Mr. Owen is suffering from venous ulcer that resulted in the wound he had. Basic reasons for this include the fat that his wound was not clinically attended to. They normally occur just above the ankle. Wound Assessment Wound assessment is the first stage in managing wounds and many believe that a holistic approach is the best in cases that involve patients with wounds (Emerson 2007). This is the vital stage that Mr. Owen skipped and could be the main reason for his suffering. It is through assessment that clinical attendants decide on the treatment. Wound assessment takes three simple procedures. . Source: http://www.coloplast.com/WoundAndSkinCare/Topics/WoundManagement/WoundAssessment/Pages/WoundAssessment.aspx Then the second involves treating the underlying pathology. The last stage is the reassessment of the wound to examine the impact of the treatment. If the wound is treated, continue the treatment. If it is not healed, then the treatment is adjusted. In evaluating treatment, comprehensive assessment has to be done for crucial planning. Wound assessment involves many parameters but the following indices should be included in documenting assessment reports: the size, extent of tissue involvement, the presence of tracts, anatomic location, presence of foreign bodies, and the condition of surrounding skin. Photography is used in many cases for documenting the assessment of wounds. Photography includes the measurement scale and date. The photograph of the wound is taken from the same distance each time to properly frame and scale the wound. The surrounding skin and the wound bed are also examined so as to select the suitable dressing for the wound. When assessing and giving a report of the wound, one has to note the wound location, characteristics of the wound, odour and exudate, the conditions of the surrounding skin, clinical signs of local infection, wound pain including the location of the pain, pain duration and pain intensity. Wound Management After assessment and eventual treatment has been done, the patient and the nurse have to find strategies of managing the wound. The management of open wounds is a major challenge. The first step towards the management of open wounds is determined by the patient’s condition and the wound’s underlying etiology of the wound (Irion 2009). The next step is local wound care. Wound management priorities include reducing or eliminating causative factors. These factors include pressure, friction and moisture. Wound management also includes providing systematic support for healing. This support may be through blood, oxygen, fluid, nutrition or administration of antibiotics. Another strategy is the application of appropriate typical therapy. Therapy may include elimination of infection and provision of thermal insulation (Irion 2009). In the management phase treatment depends on the type, cause and depth of the wound. The nurse or medical attendant should also find out if other structures beyond the skin are involved. The treatment of recent lacerations involves examination, cleaning, and closing of the wound. Minor wounds like bruises will always heal on their own. Other types of wounds such as abrasions just require the wound to be kept clean with soap and water. The opening of the puncture wound is left open to allow for bacteria to be removed from inside. The principles of wound management are essential in managing the continuity of wound healing. They include assessment, haemostasis, analgesia, skin preparation and wound toilet, closure, dressing and infection prevention (Gorgia 1995). Bio-psycho-social Approach The bio-psycho-social component in wound management, assessment and treatment outlines that health effects of wounds affect and are affected by biological (bio), psychological (psycho) and social factors. The bio-psycho-social model of wound management implies that treatment requires that the health care team addresses biological, psychological as well as social influences upon a patients functioning. Patients suffering from wounds need to be taken care of in all these dimensions. These needs are the major contribution to the healing process. By so doing, there could be a clear understanding of how to administer treatment as well as other assessment procedures. The psychological component of the bio-psycho-social model seeks for potential psychological causes of a health problem such as self-control, emotional turmoil as well as negative thinking. The nurse had to determine the causes of the continuous illness that Mr. Owen is suffering from. The wound might have grown worse because of the psychological problems he was going through as a result of loss of hope of healing. Many times patients get worse because of the conditions that they view as incurable. The wound could be better if Mr. Owen got someone to explain some issues that may lead to the recovery from the condition. These factors may include socioeconomic status, culture, poverty, technology, religion among other factors. These factors directly influence human health both positively as well as negatively. All a patient needs is comfort even when the normal status is not very good (McGonogle 2009). Cultural Perspectives Many times we have formed a culture of our own where we heal ourselves in case of injuries. Most of the time, many people treat all injuries as minor injuries. This then results in very serious and chronic conditions that are complicated in nature. We seek to find a short cut of getting healed simply because there is much to do other than visiting specialists. These cultures have resulted into complications that everyone is afraid of (Bredow 2006). Mr. Owen belongs to the aged. He is retired and as the study shows, he is sixty eight. Being in the old age group could be a contributing factor to the development of the ulcer in the wound. It can be physiologically concluded that the old age group are very vulnerable to opportunistic infections especially if a wound is already in place (Gorgia 1995). As much as the body heals itself, it has to be supplied with the correct material that will help in generating the desired hormones that help in the healing of such wounds. Mr. Owen is a man. He is probably in a good position to heal because physiologically men are said to heal faster than women. Mr. Owen can be seen to man who is not so high in the economic ladder. This is evident because, before he retired, he worked as an office worker. Later he is caught up in a flood cleanup which led to his injury and resulting wound. His level of education is not that high because I believe he lacked medical literacy (Bredow 2006). He should have gone to hospital before he treated himself. We cannot really say that Owen was careless and therefore deserved the wound but generally, he should have managed the wound better before it became an ulcer. But he kept treating himself until it was out of control. Chronic wounds are said to occur in individuals but most frequently among the elderly and those that are chronically ill. With the ageing population, as well as the increasing prevalence of chronic disease, wound care will now be inevitably a significant factor in health systems. Therefore, the essentials needed for wound healing include nutrition. Without adequate nutrition, healing may be impaired and even prolonged (Gorgia 1995). Nutritional supplementation helps in speeding up the healing process of wounds. Therefore nutritional status which goes hand in hand with socioeconomic status is very important. Privacy, in wound physiology may be a term to describe the confidentiality involved after diagnosis (Barbul 2002). It is usually a tradition for doctors to keep diagnosis results. It helps the patients in the psychological healing domain. Wounds range from simple to complex, acute to chronic. Mr. Owen’s case is very chronic because it has led to the development of various consequences such as ulcers and hypertension. In evaluating treatment, comprehensive assessment has to be done for crucial planning. Patients suffering from wounds need to be taken care of in all these dimensions. These needs are the major contribution to the healing process (Gorgia 1995). Conclusion Wound physiology has been seen to be a very critical topic of discussion. Wound physiology is normally divided into three phases; defensive, proliferative and maturation. Each phase normally occurs without impediment in order for a wound to heal. The defensive phase occurs from the time of injury to three days. It is characterized by inflammation. A clotting cascade is initiated to protect the wound from bacterial attack. Vasodilatation facilitates the removal of the debris and deliverance of nutrients to the injured tissues. Proliferation lasts from the second day of injury until the area is healed. Maturation is the phase that comes last in the healing process and involves scar remodeling after wound closure and may take several years. References Carol, Dealey and Janice Cameron, 2008. Wound management. Blackwell. Carrie, Sussman and Barbara, Jensen 2007. Wound care: a collaborative practice manual. Lippincott Williams & Wilkins publishers. Dealey C. (1999). The care of wounds: A guide for nurses. Oxford ; Malden, Mass. Blackwell Science. Electronic book. Dee McGonigle and Kathleen Garver 2009. Nursing informatics and the foundation of knowledge. Jones and Bartlett Publishers. DiPietro L.A. and Burns A.L., Eds. 2003. Wound Healing: Methods and Protocols. Methods in Molecular Medicine. Totowa, N.J. Humana Press. Electronic book. Glenn Irion, 2009. Comprehensive Wound Management. SLACK Inc. 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