Wound Management Plan for Osteoarthritis Patient with Total Knee Replacement

This article discusses the wound management plan for an osteoarthritis patient with total knee replacement. It covers wound bed status, frequency of dressing, wound measurement, wound exudate, and condition of surrounding skin. It also explains pain management and the expectation of the healing process. The potential impacts of the wound are also discussed.

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WOUND MANAGEMENT PLAN
1. PRINCIPLE DIAGNOSIS OF THE PATIENT
David Pearson main reason for visiting the hospital to seek help is osteoarthritis. This has
been giving him trouble for the past 10 years. He developed hypertension 6 years ago and
experiences breathing difficulties during the night which is relieved when he sits up. He also
has polyuria, he goes to the toilet 12 times a day and twice during the night which affects
his sleep. The main reason for admission to the hospital is due to osteoarthritis and total
knee replacement has to be performed as an intervention (Rönn, et.al, 2011). A prosthetic
knee is inserted and cement applied.
2. EVALUATION OF WOUND MANAGEMENT PLAN
WOUND BED STATUS
Wound beds assessments involve checking granulation tissue which is red and fibrin sloughs
which are yellow. Granulation is pink in color if it is healthy. Dark red granulation indicates
danger, bleeding occurs on contact and indicate the presence of wound infection (Lozano-
Platonoff, Mejía-Mendoza, Ibáñez-Doria, & Contreras-Ruiz, 2015). The level of Leucocyte at
wound bed rises after 2-3 days especially macrophages. Macrophages aid a lot in cleansing
the wound.
FREQUENCY OF DRESSING
The dressing should be left in place unchanged for 12-14 days after surgery when the
sutures are removed. It should not be altered for up to a week after the placement done in
theatres unless the dressing has moved out of place, leaking or has become saturated fully.
When the surrounding skin becomes inflamed or discharges noticed, the dressing can also
be considered for change. Pain and odor may also be considered and assessed for before
changing the wound dressing.
WOUND MEASUREMENT
A centimeter ruler is used to measure the length of the wound (Shetty, Sreekar, Lamba, &
Gupta, 2012). This has to be done on a regularly in order to find out the size of the wound
as well as to know how it is progressing, that is, if it is healing or deteriorating.
Measurement is done in such a way that the open wound edge to open wound age at
longest point is measured. It is done from head to toe and a 7cm ruler to measure the width
of the wound.
WOUND EXUDATE
Wound exudate is produced by the body in response to tissue damage. Exudate that is thick
or milky liquid and may change to brown or yellow indicates an underlying infection that

has to be treated promptly with antibiotics. Exudate facilitates healing since it consists of
proteins and plenty of nutrients, growth factors and enzymes. During the inflammatory
phase of healing, exudates increases. Exudates bathe the wound with nutrients and clean
wound surface. Wounds should always be moist to prevent skin breakdown (Gray, et.al,
2011).
CONDITION OF SURROUNDING SKIN
It can be done by checking the temperature, color, and shape of the surrounding skin.
Increased Temperature of the surrounding skin is an indicator of whether an active infection is
present or Not. Check if there is normal blood flow in surrounding skin, check for dryness or
cracking of surrounding skin. Also, check for skin turgor for any sign of dehydration. Check
moisture level because moisture –associated skin damage is important in preventing further
skin breakdown. Using liquid dressing because it helps protect surrounding skin from moisture
while adhesives reduce friction forces. Surrounding skin breakdown can delay healing and can
worsen wound.
3.
a) EXPLANATION OF WOUND MANAGEMENT
Wound care involves the cleaning of the wound, dressing, stitch removal and infection
control. It is done after sutures have been removed, usually 12-14 days after theater.
However, it can be initiated if the dressing becomes soiled or wet to minimize infections.
Signs of infection, for example, redness, swelling, pain around the knee, increased
temperature and leakage from the wound should be monitored. Infections may be
prevented by use of antibiotics but in cases where symptoms persist, a physician should be
consulted.
b) PAIN MANAGEMENT
Pain can be managed by use of drugs such as morphine 10mg 4 hourly (Rastogi, & Meek,
2013) which should be taken as prescribed and instructed by the surgeon. The patient also
has to be taught in various ways which may help alleviate the pain. This may include
teaching the patient to get involved in activities which will keep his brain busy so as not to
concentrate on the pain. The legs to be elevated and cold ice to be applied after exercise
like walking.
c) EXPECTATION OF HEALING PROCESS
Wound healing process is the process that involves the repair of an injured part of the body.
It involves the replacement of an injured tissue by connective tissue. A scar forms when
healing has occurred. Wound healing process comprises three phases: Vascular response,
bleeding results when the dermis is injured because blood vessels are damaged. The

damaged end of blood vessels constricts to reduce blood loss. Clotting is initiated when
blood get exposed to the air, which is facilitated by aggregation (Young, & McNaught, 2011).
The second stage is inflammatory response where inflammatory mediators such as
prostaglandin and histamine are produced by mast cells which are initiated by activation of
clotting factors and tissue damage. Wound exudate is produced as a result. At the
proliferation stage, the wound is filled with new connective tissue and the size of the wound
reduces due to coupling up of the physiological process of granulation, contraction,
epithelialization, and maturation. It starts three weeks after injury in healthy people and can
last for many months. A lot of factors can also contribute to delayed wound healing and the
general health of an individual will influence the ability of healing in different ways. Factors
resulting in lower tissue perfusion causes reduced blood flow to tissues leading to delayed
healing. As people age, their skin elasticity reduces due to wearing out elastic tissue and
collagen fibers in outer dermal layer also reduce
d) POTENTIAL IMPACTS OF WOUND DISCUSSED
Arthritis of the knee not only affects a person physically but also emotionally and socially.
Activities of daily living such as walking, climbing stairs, doing stairs will be hard for even 6
weeks, and self-care activities such as bathing and dressing are compromised. Dislocation of
a knee happens in some cases, getting up and down of the floor is limited and someone
needs to be careful, use the help of a chair to stand. Since washing and dressing
compromised, one shouldn't bathe unless the wound is fully healed, the patient should sit
on the side of the bed or chair when getting dressed. Close monitoring, therefore, should
be implemented for such a person.

References
Gray, M., Black, J. M., Baharestani, M. M., Bliss, D. Z., Colwell, J. C., Goldberg, M., ... & Ratliff, C.
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Lozano-Platonoff, A., Mejía-Mendoza, M. D. F., Ibáñez-Doria, M., & Contreras-Ruiz, J. (2015).
Assessment: cornerstone in wound management. Journal of the American College of
Surgeons, 221(2), 611-620.
Rastogi, R., & Meek, B. D. (2013). Management of chronic pain in elderly, frail patients: finding a
suitable, personalized method of control. Clinical interventions in aging, 8, 37.
Rönn, K., Reischl, N., Gautier, E., & Jacobi, M. (2011). Current surgical treatment of knee
osteoarthritis. Arthritis, 2011.
Shetty, R., Sreekar, H., Lamba, S., & Gupta, A. K. (2012). A novel and accurate technique of
photographic wound measurement. Indian journal of plastic surgery: official publication
of the Association of Plastic Surgeons of India, 45(2), 425.
Young, A., & McNaught, C. E. (2011). The physiology of wound healing. Surgery (Oxford), 29(10),
475-479.