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Running head: NURSING CARE PLANNURSING CARE PLANName of the StudentName of the UniversityAuthor Notes
1NURSING CARE PLANIntroductionThis is the case study of an aged resident under clinical placement. Permissionwas obtained from the clinical facility with regards to obtaining information about thepatient. This is the case study Mr. Stephen Jones. He is a 70-year-old individualsuffering from diabetes, which is the reason for his impaired skin integrity and nutritionimbalance problems. He had recently undergone an open cholecystectomy for removalof his gall bladder. Due to his existing condition of diabetes mellitus, he is suffering fromimpaired wound healing. This essay will give a description of the patient and the medical conditionsassociated with him. Along with this descriptions will be given about the clinicalcharacteristics of the wound, treatment aims, wound management plan, among others.Finally, a nursing care plan will be provided in a prescribed format.Diabetes is generally associated with impaired wound healing (Mirza & Koh,2015). There are various factors that lead to impaired wound healing in diabetes. Theseare impaired production of growth factors, decreased angiogenesis, altered immuneresponse, nutritional imbalance and decrease in the rate of wound contraction(Anderson & Hamm, 2012). Pain and stress are important contributors of delayed wound healing. Pain canresult due to the wound itself or may be caused by some treatments. Patients withimpaired wound healing suffer from nociceptive pain, which is characterized by apersistent ache. This is mainly caused due to tissue damage and is also associated withneuroceptive pain, which is characterized by a stabbing pain sensation. Theneuroceptive pain is caused as a result of nerve damage. Moreover, the psychologicalimpacts associated with delayed wound healing involves depression as well as low selfesteem. The patient in the treatment facility also suffers from poor mental status anddepression related to pain caused due to impaired wound healing. Impact of painassociated with wounds include stress and other negative emotional outcomes like fear,anxiety, depression, among others (Upton, 2012).
2NURSING CARE PLANWound healing is termed as a complex biological process that is involved inrestoring the integrity of tissues. The physiology of wound healing can be divided into 4distinct stages. These are haemostatsis, inflammation, proliferation and tissuemodeling. Haemostasis is linked with exposure of the subendothelial layers of thevessel wall with blood components. Platelets are involved in this process. They adhereto the vessel wall, aggregate and form a haemostatic plug. Along with these thecomplement and coagulation cascades are activated. Activation of prothrombin withinthe tissue leads to formation of thrombin, which in turn cleaves the fibrinogen to formfibrin, which in turn helps in clot formation. The inflammation stage involves themacrophages, neutrophils and lymphocytes. Bradykinin and anaphylatoxins like C3aand C5a increase the permeability of the blood vessels leading to the entry of themonocytes and the neutrophils to the region of the wound. Histamines and leukotrienesare also released from mast cells. Within the wound the neutrophils kill bacteria bysecreting antimicrobial peptides, proteases and generation of reactive oxygen species.Macrophages secrete cytokines and other peptide growth factors. These growth factorsare VEGF, PDGF, bFGF, among others (Barrientos et al., 2014). They enable woundhealing by initiating the synthesis of extracellular matrix, cellular proliferation andangiogenesis. Lymphocytes also produce cytokines and stimulate cytolytic activity. Theproliferation phase is characterized by degradation of the platelet and fibrin matrix,invasion of endothelial cells and fibroblasts. This phase is also characterized by ECMdeposition, re-epithelization and formation of new blood vessels. The remodeling phaseis characterized by ECM turnpver along with significant reduction in cellularity. Scarformation is the ultimate step in the physiology of wound healing (Hämmerle &Giannobile, 2014). The aetiology of impaired wound healing is associated with various factors.These include diabetes, infection, drugs, nutritional problems, tissue necrosis, hypoxia,excessive stress on the wound edges, low temperature or the presence of anotherwound. Impaired wound healing is one of the effects associated with long-termdiabetes. Diabetes causes decreased arterial inflow and sensation, which in turn affectswound healing. Improper control of diabetes can affect wound healing by causingdecrease in cardiac output, impaired phagocytosis by polymorphonuclear leukocytes
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