HLTENN006 - Apply principles of wound management

Running head: WOUND MANAGEMENT
WOUND MANAGEMENT
Name of the Student:
Name of the University:
Author Note:

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Principle diagnosis of patient
In the case study, the patient Mr. David Pearson who is a 57 year old male, is
suffering from a medical condition. He comes from England and is a retired merchant navy
person by profession. The patient Mr. Pearson has a wife and four sons, with whom he
migrated to Australia in the year 19687. The medical history of the patient shows that Mr.
Pearson has been suffering from osteoarthritis for the last 10 years. This condition kept on
elevating because of his job as an engineer. The case also shows that the patient has been
suffering from problems of hypertension which had been diagnosed about six years ago. The
current medical problem is the problem of weight gain that had resulted in the increase of risk
of the person of getting diabetes. However the current condition of the patient shows that the
cognitive orientation of the patient is proper and he is properly oriented to the place and to
the time.
The medical condition of the patient as is reported that shows that he is suffering from
hypertension. The patient also mentions that he is suffering from pain in his right hip and
knee while he is at rest as well as when in motion. The pain scale shows that when at rest the
pain is at 6-7 and when mobile, the pain scale reads 8. The patient, Mr Pearson also reports
that while he is trying to cover long distances, he runs out of breath and often it becomes
difficult for him to breathe at night which makes him sit up at night. The patient loves to eat
food, however there is a concern of his gain in weight and high risk of diabetes, therefore
there is a chance that this does not affect him. The patient also reports that he has an alcohol
problem which is making him worse. The patient eliminates about 12 times a day, because of
which he also has to get up twice in the night. Most of the time he also suffers from
conditions of constipation, therefore often requires the use of laxative about once a week. The
patient often faces problems to sleep at night. This also because he has to get up at night

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several times for going to the toilet. Sometimes he also had bouts of breathlessness along
with the occurrence of osteoarthritis pain.
Evaluation of the wound management
The evaluation of the wound management status of the patient shows the following:
Wound bed status (include colour/s) – The wound bed status shows bruising of the leg
that is ecchymosis, which is followed by the surgery. The color of the wound bed shows blue
to deep red. There is inflammation in the first stage of the wound bed, this is followed by
proliferation and the final one is the maturation of the wound (Matatov et al., 2013).
Wound measurements – The wound measurement shows that the incision is about 25
centimeter.
Condition of surrounding skin (ie intact, breaking down) –The condition around the
wound shows that the skin is intact since the wound have been stitched after the surgery.
However there is necrosis of the soft tissues in some places (Rosenberg et al., 2014).
Wound exudate (colour, consistency, odour) –The wound exudate is clearless to pale
in color with a thick consistency, which a pungent odour.
Frequency of dressing change- The dressing change is done twice a day, once in the
morning and once in the night.
Wound management
Wound management can be defined as a process that helps in reducing infection and
promoting wound healing. For patients like David Pearson who have chronic wounds, proper
education about wound management is important to promote wound healing. The primary
aim of wound care or wound management is to prevent the contamination from happening in
the area of wound and to properly clean the infected wound for any kind of surgical closure

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or the healing of the second intension. For the treatment of the wounds, an aseptic technique
is required for the treatment of the wounds which uses the things like sterile gloves,
instruments, and bandage materials. It must also be kept in mind that the process of wound
healing occurs in a moister and wet condition. Proper wound healing is also dependent on
understanding of the complex physiological process of wound healing. Wound healing is a
three stage process which involves the inflammatory phase, proliferative phase and the
remodelling phase. Nurses caring for patient with chronic wounds can employ various steps
to ensure the wound healing physiology is optimised. The wound healing process is also
optimized by ensuring that the wound bed is moist and vascularised. Proper wound dressing
is also vital as they play a role in eliminating dead space and controlling exudates (Gonzalez
et al., 2016). Fluid management and taking precautions to prevent bacterial overgrowth also
crucial for recovery of patients like David.
Apart from evaluation of wound status and implementation of appropriate wound
management techniques, the pace of wound healing is also dependent on client factors like
age, presence of other chronic health condition and type of wound healing. Other factors
influencing wound healing includes social factors, physical factors, nutritional factors and
lifestyle factors (Khalil et al., 2015). In case of Mr. David Pearson, ageing can also be a
factor influencing wound healing as he is 57 years old. This can be said because many age
related changes has detrimental impact on wound healing process. As people get older, skin
elasticity is reduced, collagen replacement is delayed thus hindering wound development.
Certain age related diseases like diabetes and cardiovascular disease are also detrimental to
the wound healing process. Mr. David has gained weight, developed hypertension and is at
high risk of diabetes, his quality of life is likely to be impaired. His physical illnesses needs
to be taken seriously as diabetes, hypertension and obesity negatively influence joint
replacement outcome and such patients are most likely to suffer from complications in the

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long run. Controlling blood pressure of David will be vital for preventing complications in
patient (Rodriguez-Merchan 2015). Gould et al. (2015) argues that wound healing is a
chronic process with overlapping phases like inflammation, proliferation, angiogenesis and
wound contraction; and aging is a condition associated with alterations in wound healing.
Hence, physical conditions like ageing and obesity may have effect on recovery of David and
additional care will be needed to promote recovery of David. Focussing on dietary intake and
nutritional aspect will also be vital.
The expectation of the healing process depends on the location of the wound, as well
as the age and chronic health condition of the given patient. The physiology of the wound
healing process is also dependent on location and type of wound healing. Wounds in the areas
of decreased vascularity and areas with thickest skin tend to heal very slowly. According to
the given situation, the patient has a condition of chronic health conditions like diabetes.
Presence of this makes the process of wound healing much slower (Webster et al., 2014).
Diabetes makes the wound less susceptible to healing and the wound takes a long time to dry
up. Additionally the patient presented here is an older adult, therefore the age of the person
also becomes an inhibiting factor for wound healing. With the increase of age, the immunity
of the person declines so does the secretion of the coagulating factors therefore the healing
process becomes long enough (Kosins et al., 2013).
Mr. David’s wound is on the knee and it is most likely that as Mr. David has had total
right knee replacement, his wound is mainly a surgical incision wound which would require
primary intention. This involves healing wound without tissue loss (Singh, Young &
McNaught, 2017). However, primary intention can be achieved only when the wound is no
disruption to the local tissue. Hence, from this information, it becomes evident that regular
assessment and careful evaluation of wound management is important. Therefore, to achieve
primary intention, it is necessary to assess wound and find signs of post op complications

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such as release of exudates, colour of wound, nature of surrounding skin and level of pain.
The review of wound of patient revealed that pain level was 3 and haemoserrous fluid was
releasing. As exudate can lead to wound infection and complication, controlling exudates
from Mr. David’s wound will be important. Hence, regular examination of wound and it’s
exudate will be necessary to ensure that there is no trauma to the wound bed and wound
healing is taking place in a normal manner (Greatrex‐White & Moxey, 2015).
The evaluation of wound for Mr. David also suggest lifestyle factors as a risk for
patient as he is overweight and nutrition and physical activity might be an important factor
affect his health. Hence, for optimal health of patient, providing health education on wound
care and lifestyle changes will be important. As he is overweight and is at risk of developing
diabetes, education on nutritional changes will also be important for the patient. Teaching
patient about well balanced meal and active lifestyle will be necessary. For pain
management, pain education has been defined as any planned activities which are designed in
order to improve the health behaviour of the patient along with the improvement of the health
status of the patient (Stevens et al., 2014). This activity of pain management helps the patient
to facilitate the knowledge of the patient in order to help them to interpret their pain and help
them get directed towards an effective along with the ongoing self-management. In order to
bring about the understanding of the complexities of pain and understand the importance of
self-determination as well as sustainable self –management, it is important to develop skills
that are facilitatory in nature (Itatsu et al., 2014). The expectation of the healing process is to
promote wound healing at the expected time and prevent factors like social and physical to
hinder the wound healing process. Kennedy et al. (2017) supports the fact that quality
education is vital to patient engagement and enhanced health care experience. Guidelines on
management of side effects and pain management will be necessary.

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References
Gonzalez, A. C. D. O., Costa, T. F., Andrade, Z. D. A., & Medrado, A. R. A. P. (2016).
Wound healing-A literature review. Anais brasileiros de dermatologia, 91(5), 614-
620.
Gould, L., Abadir, P., Brem, H., Carter, M., Conner-Kerr, T., Davidson, J., DiPietro, L.,
Falanga, V., Fife, C., Gardner, S., Grice, E., Harmon, J., Hazzard, W. R., High, K. P.,
Houghton, P., Jacobson, N., Kirsner, R. S., Kovacs, E. J., Margolis, D., McFarland
Horne, F., Reed, M. J., Sullivan, D. H., Thom, S., Tomic-Canic, M., Walston, J.,
Whitney, J., Williams, J., Zieman, S., … Schmader, K. (2015). Chronic wound repair
and healing in older adults: current status and future research. Wound repair and
regeneration : official publication of the Wound Healing Society [and] the European
Tissue Repair Society, 23(1), 1-13.
Greatrex‐White, S., & Moxey, H. (2015). Wound assessment tools and nurses' needs: an
evaluation study. International wound journal, 12(3), 293-301.
Kennedy, D., Wainwright, A., Pereira, L., Robarts, S., Dickson, P., Christian, J., & Webster,
F. (2017). A qualitative study of patient education needs for hip and knee
replacement. BMC musculoskeletal disorders, 18(1), 413.
Khalil, H., Cullen, M., Chambers, H., Carroll, M., & Walker, J. (2015). Elements affecting
wound healing time: an evidence based analysis. Wound Repair and
Regeneration, 23(4), 550-556.
Kosins, A. M., Scholz, T., Cetinkaya, M., & Evans, G. R. (2013). Evidence-based value of
subcutaneous surgical wound drainage: the largest systematic review and meta-
analysis. Plastic and reconstructive surgery, 132(2), 443-450.

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Matatov, T., Reddy, K. N., Doucet, L. D., Zhao, C. X., & Zhang, W. W. (2013). Experience
with a new negative pressure incision management system in prevention of groin
wound infection in vascular surgery patients. Journal of vascular surgery, 57(3), 791-
795.
Rodriguez-Merchan, E. C. (2015). Outcome of total knee arthroplasty in obese
patients. Journal of Orthopaedic Surgery, 23(1), 107-110.
Rosenberg, L., Krieger, Y., Bogdanov-Berezovski, A., Silberstein, E., Shoham, Y., & Singer,
A. J. (2014). A novel rapid and selective enzymatic debridement agent for burn
wound management: a multi-center RCT. Burns, 40(3), 466-474.
Singh, S., Young, A., & McNaught, C. E. (2017). The physiology of wound healing. Surgery
(Oxford), 35(9), 473-477.
Webster, J., Scuffham, P., Stankiewicz, M., & Chaboyer, W. P. (2014). Negative pressure
wound therapy for skin grafts and surgical wounds healing by primary
intention. Cochrane Database of Systematic Reviews, (10).