Wound Management: Assessment, Evaluation, Healing, Factors, and Pain Management

This document provides an overview of wound management principles, evaluation of each type of wound, wound healing processes, factors that may impact wound healing, management for each of the wounds, health education for the patient, and pain management of the wounds. It also includes information on holistic assessment of the patient, types of wounds, investigations for wound assessment, and health education for the patient.

Wound management
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1.Holistic assessment of the patient.
a) Presenting problems
The patient presents with a poor oral intake. There is also pain that is located in his wounds
of the diabetic foot and an arterial artery.
b) Past medical history
The patient has been diagnosed with chronic obstructive pulmonary disease. The patient also
reports being having postural hypotension, type 2 diabetes mellitus, gastroesophageal reflux
disease which is managed accordingly. The patient also has an ethanol addiction.
c) Social history
He lives in his retirement home village alone. His wife passed away one year ago.
d) Nutrition and elimination
The patient has a poor oral intake and mostly takes soft drinks. The patient has stool
incontinence as evidenced by a pad in situ.
e) Medications
The patient is on furosemide 20mg which he takes orally twice a day, Endone 10mg thrice a
day, Hydromorphone 2mg twice a day, Telmisartan 40mg twice a day, Ventolin 4 puffs thrice
a day, Esomeprazole 20mg daily, warfarin 2mg daily and Lantus 20 units when necessary.
f) Cognitive function
The patient is confused at times.
Types of wounds
A) A diabetic ulcer is an open sore that occurs as a complication of diabetes mellitus and
mostly occurs in the lower extremities (Yazdanpanah, Nasiri, & Adarvishi, 2015). It
can be also due to compromised circulation, trauma, friction or pressure to toes.
B) A pressure ulcer is an injury to the skin and the tissues underlying that occur due to
prolonged pressure on the skin. (Bhattacharya, & Mishra, 2015)
C) An arterial ulcer comes about when there is poor circulation to the lower extremities
leading to poor perfusion causing an open wound.

D) A burn is an injury to the skin and other tissues of the body. They can be caused by
electricity, chemicals or even radiation.
Investigations for wound assessment
a) Complete blood count to check for elevated white blood cell count that indicates the
presence of an infection.
b) A biopsy can be taken in the case of an arterial ulcer to check for malignancy.
Wound management principles
Cleaning and dressing using the right dressing material should be done on a regular basis.
The treatment of the underlying cause of the wound like chronic illnesses like diabetes and
hypertension or even controlling.
Pain management should be key prior to cleaning.
2. Evaluation of each type of wound
Pressure ulcer. Being a stage three type of wound, there is a full thickness loss of skin. The
bone below is not be exposed through the fat will be seen. The skin surrounding the sore is
intact. There is a 30% tissue granulation.
An arterial ulcer that is infected. The wound has a smelly odor. It has a well-defined margin.
The surrounding of the wound is pale and shiny. There is no hair and the wound is not
bleeding. Arteriography or arterial Doppler studies can be done for further assessment.
Burns wound. There are blisters on evaluation and is irregular in the pattern. The skin is red
in color. The skin surrounding the wound is intact and there is no bleeding of the wound
noted and no odour was noted.
The diabetic foot ulcer that looks infected with an odour, measures about 2-3 centimeters and
is green in color.
3. Wound healing processes
Pressure sore. The healing rate is different for each type of sore. For the third stage of the
pressure sore, it heals by forming a scar. Since the patient has a poor oral intake, the healing

process might take a little bit longer. There are three phases of the healing process of this
wound. Inflammation takes place within the first five days, phagocytosis occurs and the
stimulation of the growth factor. Proliferation phase enters that entails the formation of a new
blood vessel, collagen synthesis, and epithelialization. Maturation phase occurs after four
weeks to around two years that improves the tensile strength.
For an arterial ulcer, the wound does not completely heal. The measure is taken into
consideration to increase the circulation to the affected limb like conservative debridement,
pain management and use of occlusive dressing.
Diabetic foot ulcer heals like other wounds but may include surgical debridement to remove
the dead tissues thus promoting healing. Amputation can also be an option when there is
delayed seek for health services by the patient. It helps to prevent further damage to the
limbs.
Basically, healing occurs with proper management of the specific wounds following the
guidelines laid down for each.
Factors that may impact wound healing
Failure to clean and dress the wounds on a regular basis will increase the chances of
infection.
Presence of chronic conditions like diabetes and hypertension may hinder healing if not
controlled well through the administration of medications that are prescribed by the doctor.
Nutrition can also be a hindrance. A patient with wounds is supposed to take meals with high
protein content to promote healing. If the patients fail to eat a balanced diet healing might
take a long time. Failure to take plenty of water may also impact healing because we want to
achieve a high blood circulation in the body especially for patients with an arterial ulcer.
Wound healing process always takes place faster in individuals with younger age. It tends to
be slow in elderly patients.
4. Management for each of the wounds

Pressure ulcer. This wound should be cleaned every day with a sterile technique using normal
saline to prevent infection occurrence. Turning off the patient two-hourly is advised to avoid
pressure on one side for a long time. The care provider should also ensure that support to the
patient is provided like using pillows for support and even putting them between legs. The
supine position should be avoided in this case. High hygiene is also recommended. Pain
medication should be given before doing wound dressing
For the diabetic foot, management includes the control of blood sugar levels. Cleansing of the
wound daily using a sterile technique. The skin surrounding the wound should be kept clean
and moist through the application of body lotion or any oil. Pain medication can be
administered prior to the dressing of the wound. The patient is to avoid walking barefoot to
avoid the collection of pathogens. Supporting the leg affected using pillows to improve
circulation the limb and avoid edema.
The management of the infected arterial ulcer includes the administration of antibiotics as
prescribed by the physician (Lipsky, et.al, 2016). A wet zinc oxide bandage is applied to the
foot affected. Pain management should be included in the nursing interventions. When
cleansing and dressing the wound the use of occlusive dressings will help to manage and
prevent further infection. Always maintain a moist environment for the patient. Inspection of
the skin for open areas that could later progress to skin breakdown. Wash the skin
surrounding the wound carefully with soap and warm water and use a moisturizer on the skin.
The burns wound will be managed by applying antibiotics ointments and cleaning the wound
to remove the dead skin. Change of the dressing is also recommended.
5. Health education for the patient
Encourage the patient to take food that is rich in calories and proteins. Intake monitoring can
be done by the caregiver.
The patient should take a lot of fluids to prevent constipation that will increase the pain in the
anal region.
Foods that are rich in roughage should also be encouraged to prevent constipation.
The patient should moisturize his feet but not in the wound after bathing with warm water
due to the diabetic ulcer. The patients should also cut their nails very carefully especially the
edges.

The patient should also ensure that his blood sugars are always under control. Avoidance of
foods that will raise the blood sugars. Small frequent meals should be taken by the patient
too.
He should avoid walking around barefoot. To always ensure that he has sandals on for this
could bring injuries to the lower extremities.
6. Pain management of the wounds
Ibuprofen is a non-steroidal anti-inflammatory agent used in managing mild to moderate pain
(Day, & Graham, 2015). It is also a non-opioid pain reliever that is orally taken. The dosage
for this drug is 400mg that is taken three times in a day eight hours apart. The pain
medication must always be prescribed by a doctor before it is given to the patient.
Medications are used to make the patient comfortable during their stay in the hospital and
also to enhance healing because some patients may develop a psychological pain that will be
difficult to manage. The patient should also be informed of the pain that comes with these
types of wounds. Patients should also say whenever they are in pain and pain medications
given. Although not all the time the patient cries out means administration of drugs. They
should also be told about the timing of medication (Hume, & Tomsik, 2014). Other non-
pharmacological ways of relieving pain should be taught to patients like diversional therapy,
for example, watching television or listening to music. This will help high dependency on
pain medications.

Bibliography
Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: current understanding and newer
modalities of treatment. Indian journal of plastic surgery: official publication of the
Association of Plastic Surgeons of India, 48(1), 4.
Bryant, R., & Nix, D. (2015). Acute and chronic wounds: current management concepts.
Elsevier Health Sciences.
Day, R. O., & Graham, G. G. (2015). Non-steroidal anti-inflammatory drugs. Encyclopedia
of Inflammatory Diseases, 1-9.
Hinchliffe, R. J., Brownrigg, J. R. W., Apelqvist, J., Boyko, E. J., Fitridge, R., Mills, J. L., ...
& International Working Group on the Diabetic Foot (IWGDF). (2016). IWGDF
guidance on the diagnosis, prognosis, and management of peripheral artery disease in
patients with foot ulcers in diabetes. Diabetes/metabolism research and reviews, 32,
37-44.
Hume, K., & Tomsik, E. (2014). Enhancing patient education and medication reconciliation
strategies to reduce readmission rates. Hospital Pharmacy, 49(2), 112-114.
Lipsky, B. A., Aragón‐Sánchez, J., Diggle, M., Embil, J., Kono, S., Lavery, L., ... &
International Working Group on the Diabetic Foot (IWGDF). (2016). IWGDF
guidance on the diagnosis and management of foot infections in persons with
diabetes. Diabetes/metabolism research and reviews, 32, 45-74.
Lipsky, B. A., Aragón‐Sánchez, J., Diggle, M., Embil, J., Kono, S., Lavery, L., ... &
International Working Group on the Diabetic Foot (IWGDF). (2016). IWGDF
guidance on the diagnosis and management of foot infections in persons with
diabetes. Diabetes/metabolism research and reviews, 32, 45-74.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management
of diabetic foot ulcer. World journal of diabetes, 6(1), 37.