Principles of Wound Management in the Clinical Environment

This document discusses the principles of wound management in the clinical environment. It covers topics such as the pathophysiology of wounds, treatment options for different types of wounds like burns, ulcers, and infections, and the healthcare professionals involved in wound care. It also provides information on strategies for wound care and the importance of preventing wound infections. The document includes references to relevant books and journals.

HLTENN006 Apply principles of wound
management in the clinical environment

Contents
Scenario 1....................................................................................................................................................2
Scenario 2....................................................................................................................................................6
Scenario 3....................................................................................................................................................7
References...................................................................................................................................................8

Scenario 1
1) Mentioning the source of E. coli pathogen
 Infectious agent: Considering the scenario infectious agent have been traces of feces of
which were present of nurse’s hand and its coming in the contact with the wound of
another client.
 Reservoir: The reservoir to this infectious agent was Mary Gordon who has been
suffering from gastrointestinal infection.
 Portal of exit: Portal of exit for E coli is through gastrointestinal tract or can be through
food and environment.
 Mode of transmission: Considering this scenario the mode of transmission has been
infections germs which has been carried by nurses and its contact with other client.
 Susceptible host and immunity: the response of susceptible host in E. coli have been
categorised onto two grounds initial is the degree of inflammation in the kidney which
relates to intensity of infection and second is the resolution is spontaneous in some cases
considering the immunity.
2) Explanation of ways through which this cross infection could be avoided.
 The primary approach through which this cross contamination could have been avoided if
nurse had followed proper hand hygiene. The nurses are recommended to wash their
hands with institutionally provided soap and warm water and further rinsing the same
with disposable towel (Armstrong, Eidt and Berman, 2019). This approach has been
successful in prevention of occurrence of situations of cross contamination.
 The another approach to prevent cross contamination is following the Aseptic technique
which focuses on sterilizing of medical equipment so to prevent spreading of
microorganisms.
3) The physiological impact of possessing an acute wound generally results in stress,
negative mood of an individual, social distancing and disturbances in the sleeping pattern.
The reason behind such physiological can be the pain which has been suffered by an
individual or inability to move and perform routine tasks.
4) The standards of health and quality of health services which has been laid down by the
Australian government attempts to protect public from the harm and simultaneously
making sure that better quality of health services is offered. The standard 3 of NHQHS
states that healthcare services providers have to implement systems that prevent and cope
with infections relating to healthcare (National Safety and Quality Health Service
Standards, 2012). These standards have laid down some of the criteria such as adequate
governance, infection prevention and control strategies, communication and most
importantly sterilization.
5) Dressing options:

Wound Type Dressing options Review times
Dry necrotic wound Moisture retention eg hydrocolloid,
semi permeable
3-4 days
Slough - covered wounds Hydrocolloid Every 2-3 days
Infected wound Hydrogels Dressing to be changed
every 1 to 3 days
Graze, abrasions - clean Cloth dressings Every day
Graze, abrasions - soiled Cloth dressings Every day
Puncture wounds or bites Open or dry dressings Every 2-3 days
Laceration - suturedLacerations Cloth dressings Every 1-2 days
Burn-minor Burns Films (both as primary and secondary
dressing)
Every 1-2 days
Burn-major or requiring admission eg
special areasBurns
Alginate dressings with lots of fluid Every two days
Chronic wounds eg ulcers, PEG sites etc Collagen wound dressings Every two days

Dressing types Example
s
Advantages Disadvantages Indication
s
Contraindicatio
ns
Semi-permeable -
thin, adhesive,
transparent
polyurethrane film
OpSite,
Tegader
m
Some
moisture
evaporation,
Reduces
pain. Barrier
to external
contaminatio
n. Allows
inspection.
Exudate may
pool, may be
traumatic to
remove.
Superficial
wounds.As
a
secondary
dressing.
Highly exudative
wounds.
Non adherent Moist
(Tulle Gras
Dressing) - Gauze
impregnated with
paraffin or similar.
May be impregnated
with antiseptics or
antibiotics
Tullegras Soothes and
protects the
wound and
minimizes
changes of
infection
Requires a
coating of
secondary
dressing as
well
Wound and
brazes
allergy
Non adherent Dry
Thin perforated
plastic film coating
attached to absorbent
pad
Tricose Supports in
absorbing
light exudate
Less suitability
in high exudate
Moderate
exudate
wounds
Dry wounds
Fixation
SheetPorous
polyester fabric with
adhesive backing
Mefix Can be
applied
directly on
wound
Require
numerous
countermeasur
es
Wound
which does
not require
frequent
reviewing
Allergy based
infections

Calcium
AlginateNatural
polysaccharide from
seaweed
Kaltostat Reduction in
pain.
Requires
secondary
dressing
Haemostasi
s
Dry wounds
Foam
DressingsPolyuretha
ne foam dressing
with adhesive layer
incorporated
Allevgn Faster
healing
Suitability for
wounds require
moisture
Light to
heavy
wounds
Very dry
sloughly
Hydrocolloid
Dressings
Polyurethane film
coated with adhesive
mass
Duo
derm
Comfortable
and suitable
for all skin
types
Limited
suitability
Heavily infected
wounds
Paper adhesive tapes
Adhesive tape may
be applied directly to
healing laceration
3M Prevents
local skin
tension
Poor reliability
when it comes
to their
adhesive
properties
Low
tension
wounds
Burns and deep
wounds

Scenario 2
1) The burn injuries are normally categorized on to three grounds i.e. first degree, second
degree and third degree. The division is basically carried out on the basis of severity of
degree to the individual. Considering John who have been suffering from 3rd degree burns
will be treated with utmost care considering the intensity of the burns. There will be
delivery of fluid and pain medication and precautions will be taken to further avoid any
infections. Maintaining dressings that are biosynthetic through administering of topical
agents such as silver sulfadiazine. This will assist in right healing of the burn injury.
2) The psychological impacts of 3rd degree burns typically results in sadness due to physical
appearance, anger, pain and stress about the future. Physical impact can be numbness due
to damage to the nerves, breathing problems and bone and joint problems ( Vowden and
Vowden, 2017). The probable long term effect of such injury on john will be PTSD (Post
traumatic stress disorder) which may be through intrusive memories of the event,
avoiding people and destructive behavior.
3) Below listing 6 members of the multidisciplinary team who will be responsible to look
after John and discharge planning.
 Burns Consultant
 Nurses
 Junior Doctors
 Anesthetists
 Physiotherapist
 Psychologists
4) To collect a wound swab specimen there will be a requirement of unsterile gloves,
syringes prefilled with sodium chloride, sterile swab container, wound dressing and
sterile gauze pads. The collection of wound swab will be helpful in identifying the
infections and bacteria carried by the person. Higher understanding of the wound will be
helpful in garnering the most effective therapy.
5) It is not advisable to clean the wound before taking a specimen. The justification for the
same that wound before cleaning will be helpful in identifying the bacteria and infections
present and helpful in identifying the best suited therapy.
6) All these signs indicate that John is suffering from wound infection. Determining the
results of the specimen can determine the actual cause or type of infection. It is very
important to prevent the wound infection in burn patient as it is still the biggest cause of
mortality. It is important to prevent infection for the brunt patients as it increases the
changes of their speedy recovery and at the same time enhances the mortality and morbid
rates (Mickelson, Mans and Colopy, 2016).
7) John successfully went through debriding therapy, the level of fluids is normal and is
now suffering from a wound infection which is to be corrected only results of microscopy
are availed.

Scenario 3
1) The pathophysiology of diabetes is generally relating to the level of insulin present in the
body of a human being and its capacity to utilize the same (Francesko, Petkova and
Tzanov, 2018). On the other the arterial ulcers are formed with reduced blood flow and
perfusion of the subsequent tissue.
2) There are two approaches through which ulcers can be diagnosed. The initial approach is
endoscopy in which a tube is inserted down the throat to observe esophagus, stomach and
duodenum. Another approach can be X-ray test which can be performed to conduct a
diagnosis of the ulcers for an individual.
3) Below listing are the approach which can used to treat Diabetic, Venous and Arterial
ulcers
 Revascularization is a surgical approach which can be considered to treat ulcers.
It is useful in restoring the normal blood flow the affected areas.
 There are various non-surgical methods as well to deal with the arterial ulcers
such as exercises, maintaining proper blood pressure and avoiding too much stress
on the body.
4) Listing 4 healthcare professionals who would look after Cathy who is suffering from a
non-healing diabetic ulcer
 Diabetologist
 General practitioner
 Radiologist
 Vascular surgeons
5) Listing 2 would care strategies which are to be discussed with Cathy and her family
 The initial strategy will be opting for an antibiotic therapy this will be helpful in
determining whether the business is responding the medications if not a specimen
will be taken for further examination.
 Second approach is tissue debridement, if the wound is still not responding to the
procedures then there may be further requirements of alternating the treatment
plan.
6) Slough is referred to a devitalized host tissue which may be in cream, yellow or tan
appearance. This accumulated layer on a wound tend to hamper the healing process and
this needs to be removed. There are few approach to deal with slough such as
debridement, anti-biofilm agents and antimicrobials topical or systematic. The scope is
higher as there are increasing number of people suffering from non-healing diabetic
ulcer.

References
Books and Journal
Armstrong, D.G., Eidt, J.F. and Berman, R.S., 2019. Clinical assessment of chronic wounds.
Vowden, K. and Vowden, P., 2017. Wound dressings: principles and practice. Surgery
(Oxford), 35(9), pp.489-494.
Mickelson, M.A., Mans, C. and Colopy, S.A., 2016. Principles of wound management and
wound healing in exotic pets. Veterinary Clinics: Exotic Animal Practice, 19(1), pp.33-53.
Francesko, A., Petkova, P. and Tzanov, T., 2018. Hydrogel dressings for advanced wound
management. Current medicinal chemistry, 25(41), pp.5782-5797.
Online
National Safety and Quality Health Service Standards. 2012. [Online]. Available through: <
https://www.safetyandquality.gov.au/sites/default/files/migrated/NSQHS-Standards-Sept-
2012.pdf >.
(Armstrong, Eidt and Berman, 2019)( Vowden and Vowden, 2017) (Mickelson, Mans and
Colopy, 2016)( Francesko, Petkova and Tzanov, 2018)