Post-operative Wound Dehiscence: Risk Factors, Assessment, and Nursing Priorities

This essay discusses the problem of post-operative wound dehiscence, including its risk factors, pathophysiology, early assessment, nursing priorities, and care plan. The case of a patient with risk factors for wound dehiscence is also presented. The essay emphasizes the importance of proper assessment, pain management, infection control, and diabetes management in preventing and managing post-operative wound dehiscence.

Running Head: WOUND DEHISCENCE 0
Post-operative wound dehiscence
Essay

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Wound dehiscence
Wound dehiscence is the most mutual problem that may occur after the surgical
procedure of a specific body portion, counting the breaking of the stitches applied to settle the
wound quickly. This condition is a serious problem of whole knee arthroplasty (Shanmugam, et
al., 2015). Many risk facets are there for wound dehiscence totalling the intraoperative, aspects
of post-operative period and patient- specific. The Intra operative facets including the location of
the cut; the developments of big crosswise established skin lappets, which have minor blood
amount; and deprived managing soft tissue near the cut. Similarly, numerous features are liable
for unproductive wound curing, for instance age, the peripheral vascular ailment, contamination,
heaviness, smoking, insufficient nutrition, enlarged force or pressure applied to ends of the post-
operative wound (Chen, Lee, Huang, Hsieh, & Tsai, 2015). In this specific essay the case of a
patient will be discussed. Risk aspects, pathophysiology, early assessment, nursing urgencies,
and care design will also be mentioned.
In case of John certain of the risk aspects linked with the wound dehiscence are his
increased body weight, age, and additional illnesses like diabetes. Human knees are the major
joints in body which comprise manifold cartilage tissues that function in protecting the bones.
Situation like tedious gestures, misuse and being overheavy can affect the defensive cartilage at
the linking point of the kneecap, shin-bone, and the thighbone. Deprived of these vital cartilages
the bones initiate rubbing together, which outcomes in discomfort and swelling (Black, et al.,
2015).
The two chief components of primary assessment in case of John are assessment of pain
and infection. Afterward the operation the diseased person might feel aching, which needs be

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evaluated. The registered nurse must inspect the pain by applying different surveys and rating
scale tools. As aching or pain is the central problems that arise even beforehand the surgeries, it
can deliver the valuable medical info and it is the accountability of registered nurses to apply this
data to support the diseased person and reduce their problem (Bhandari, 2017). A rating scale
tool can be used to pain assessment by marking 0 to 10 grades. Zero means, there is no aching, 1-
3 displays that the diseased person is having minute pain, 4-6 indicates there is a modest pain, 7-
10 illustrates that the patient is having extreme pain (Kingsnorth, et al., 2015). This particular
assessment is essential as it deliver great info about the attainment of the surgical operations and
what action should be delivered in John’s case. Additional component of valuation in John’s
situation is investigating any contamination. Contamination is the possible difficulty in any kind
of operating procedure, encompassing the replacement of entire knee. Wound contamination
sometimes happens as the outcomes of the wound dehiscence (Bhandari, 2017). The specific
implant might misplace its connection to the particular bone. Bacteria is recognised as the most
mutual cause of contaminations in the medical procedure, and it might progress and cause
numerous other problems, in John’s case there is great probabilities of contamination as he had
type two diabetes. The registered nurses can achieve blood examinations for any contagions a
measure for any indications like determined fever, trembling chills, augmented redness,
inflammation of knee wound, knee wound drainage, and knee pain worsening (Sandy‐Hodgetts,
Carville, & Leslie, 2015).
The two essential nursing priorities in Mr John Grant’s case are the dehiscence occurs
after surgery and poor management of diabetes. The Post-operative wound dehiscence is the
spiteful occurrence which might happen after any kind of surgical process. Usually the two
flanks of the clinical wound are destined collectively with the support of stitches, which allow

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the patient’s skin to settle back more speedily. Though in some circumstances, a portion or
whole wound can detached, results in partial or widespread wound dehiscence, this designates
that the dual edges of the post-operative wound or surgical areas are detached (Sandy‐Hodgetts,
Carville, & Leslie, 2015). In John Grant’s case it is the chief problem that might arise. As
mentioned in the John’s case study he is a working individual and accomplishes his daily life
works. However currently he is concerned about that routine work as his daughter will have top
this work. John after the discharge might try to support her in café, which can grow wound
dehiscence issues. Additional priority of upkeep in John’s is the managing of his additional
difficulties like diabetes type 2. As mentioned in the case scenario the diseased person had
angina, diabetes type 2, hypertension, GORD, and hyperlipidaemia, it is problematic for him to
handle his post-operative wound issue. It has been recognized that some diabetic individuals tend
to have weaker immunity linked to other individuals; they are more probable to grow
contamination problems. This might fallouts in John’s wound to develop contagious and
worsening condition. Increased BGL is the symbol of diabetes type 2, and it is expected to cause
medical difficulties by its opposite effects on numerous organs and patient’s body processes
(Breen, Ryan, Gibney, & O'Shea, 2015). It might likewise delay the wound healing process in
Mr John Grant’s case, and sort him more probable to develop wound dehiscence issue and knee
replacement failure.
The major nursing priority John’s situation is the post-operative wound dehiscence. The
Nursing care plan for this patient will comprise valuation, setting aims, application of the care
strategy, and assess result. Nurses must evaluate John’s wound in addition to the conditions
associated with environment and system. They should also recognize the threats and any
contributing aspects that might disturb integrity of skin and wound curative procedure. The

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wellbeing objectives for Mr John Grant must be set earlier providing the nursing interventions.
Pain linked with the transplantation of knee joint will be abridged, his post-operative wound will
remain safe from contaminations, his vital sign will also be steadied and Diabetes associated
problems will be managed. Mr John is provided with atmosphere safe from infection, educated
about the habits to defend the wound from any type of viral or bacterial infection and other
bodily movement that may results in wound dehiscence. The favourable therapeutic alliance has
been built with the diseased person. The patient is also well educated related to the heslthy diet in
to settle the post-operative wound quickly. Metformin drug is delivered according the doctor’s
prescription to deal with his diabetes issue (Chatterjee, Khunti, & Davies, 2017). Cleaning and
debridement of post-operative wound has been completed which included elimination of debris
and the necrotic or sluggish tissues if not manageable. The exclusion of necrotic tissues may
assist in dropping the microbial burden in the administration of the postoperative dehiscence.
The apparent contaminations have been cured and the wound moisture that might cause the
infections is balanced with maintaining the adequate hydration (Meyer, et al., 2016).
The suitable wound dressing has been applied to retain the safe and fast curing. The
diseased person is also suggested not to put any stress on the post-operative wound, and certain
likely indicators of the dehiscence such as unexpected pain near wound location, tachycardia,
irregular or serous drainage excreted from the wound, wound opening, changes in the wound
relief, and noticeable viscera at the surface of skin. A Wound therapy associated with Negative
pressure has been used in Mr John’s case. There are different supportive investigation supports
the use of this method in monitoring the skin flora contact accompanied by the dressing.
Afterward the effective application of different intervention evolution of patient’s outcome has
been completed. The wound sustainability is confirmed and his body sign are also steadied. The

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BGL levels are preserved or balanced, the post-operative wound is safe from infections.
Additional condition such as depression is abridged, and the diseased person is helped with
assessment procedure after developing a healthy alliance with him. Certain of the objectives that
are not encountered and require additional efforts are his hyperlipidaemia, and GORD, these
issues need additional drug management with the support of doctor and other team associates.
In my opinion the selected post-operative wellbeing concern in case of John Grant is
post-operative wound dehiscence as it can slow-down the curative procedure, and the older
individuals like him it is problematic to settle the wound because of the impaired immunity. This
specific controlling care strategy to manage the concern assisted me to comprehend how to be
attentive and stick to the health plan already set for John. It also helped me to gain enough
information about the approaches to eliminate the wound contamination.
Bilateral knee osteoarthritis is recognised as one of the mutual forms of the osteoarthritis,
which impacts mobility of the patient and decrease their capability to do everyday life tasks. This
wellbeing issue occurs when the defensive cartilage tissues of bones gets impaired. Two leading
component of early post-operative valuation in John’s scenario are pain and contamination
assessment, and two priorities of nurses are poor management of diabetes and post-operative
wound dehiscence. A comprehensive upkeep plan deal with the main significance of care
comprises, assessment of wound, setting objectives to settle wound, applying the management
methods like using metformin, wound dressing and patient instructions, and assessing the result.
This managing care plan delivers enough info about the curative approaches.

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References
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