Case Study on Chronic Wound Management and Treatment Strategies

This assignment delves into the medical management of pressure injuries, examining their etiology, progression through various stages, and comprehensive treatment methodologies. It identifies risk factors such as immobility and nutritional deficiencies, and explores both non-surgical and surgical treatments including debridement and skin grafts. The study emphasizes early detection and preventive measures to mitigate complications, underlining the importance of patient education and regular monitoring by healthcare professionals.

ASSESSMENT ONE
CASE STUDY (Section
1 & 2)

Table of Contents
SECTION 1 ...................................................................................................................3
A. Define the underlined words (1.1)...................................................................3
B. List and describe the PPE (personal protective equipment)(1.2, 2.5)..............4
C. ..........................................................................................................................4
D. ..........................................................................................................................5
E. Explain complications if she did not elevate her leg (2.4, 2.3).......................5
F. Psychosocial impact of r wound on the main activity she likes to do (2.3).....5
G. Pathological and biochemical processes related development of venous
ulcer(2.2)...............................................................................................................5
H. Impact moist dressings and compression bandaging has on improving healing.
(3.5, 5.1)................................................................................................................6
SECTION 2....................................................................................................................6
A. Nursing Care Plan - wound care management plan (3.1, 3.6, 5.5, 5.7, 6.5)....6
REFERENCES...............................................................................................................8

SECTION 1
A. Define the underlined words (1.1)
 Venous Ulcer: These are the wounds the generally occur due to inappropriate
functioning of venous valves mainly of legs.
 ABPI: Ankle Brachial Pressure Index is a method that is used for
identification of insufficiency of arteries in the limb.
 Doppler Ultrasound: It is a non invasive test that is performed to estimate the
flow of blood within blood vessels through the process of bouncing high
frequency sound waves.
 FBE: It is a common test that is performed to diagnose the presence of
infections in blood.
 Compression bandaging: Compression bandaging refers to the application of
pressure with the help of bandaging in order to control the oedema and reduce
the selling (Klein and et.al., 2013).
 Holistic: It is concerned with the treatment of whole body system.
 Vascular: It is related to vessels especially those who carry blood.
 Medial: It means things that are situated in the middle.
 Haemoserous: It is thin pink coloured watery fluid composed of blood and
serum.
 Purulent: Discharge of puss is known as purulent.
 Exudate: It is the cell mass and fluid that come out from blood vessels during
the time of inflammation.
 Congested: The appearance of thick crowded skin that is dull in look build up
by the combination of dead skin.
 Oedematous: It refers to accumulation of fluid in the tissues and under the
skin in body.
 Distal: It means the wound is situated away from the point of attachment.
 Proximal: It means present to the closest point of origin.
 Colonisation: It is the process of settling over the indigenous species of a
particular area (Knottenbelt, 2013).
 Anaemia: It is the condition of deficiency of red blood cells in the blood.
 Neutrophil: It is a type of white blood cell and act as the first responder of
immune system.

B. List and describe the PPE (personal protective equipment)(1.2, 2.5)
The list of personal protective equipments that can be worn by nurse while
completing the Mrs Rose wound care are:
 Gloves: Gloves act as the barrier between the wound and agents of exposure
and hence help in preventing the infections.
 Apron: Apron can b used in order to prevent the flow of cross contamination
among patients and nurse (Rosenberg and et.al., 2014).
 Hair cap: Hair cap is generally used to prevent the contact of hairs with
wound as it may lead to infections.
C.
I.
The specific order of the wound treatment in case of Mrs. Rose is:
 Vital sign assessment
 Wound assessment
 Assessment of surrounding skin
 Wound swab
 A blood test
 Regulation of Body Mass Index
 Change in lifestyle
 Mobility assessment along with check on nutritional intake (Zelen and et.al.,
2013).
II.
The correct way of application of compression bandage on Mrs Rose's wound
is:
1. Measurement of ankle circumference prior to application of compression
bandage.
2. Cleaning the ulcer by the use of warm normal saline and soaking the dry skin
around ulcer (Matatov and et.al., 2013).
3. Application of hypo-allergic protective cream or aqueous cream over the
wound.
4. Application non adherent dressing ion the ulcer bed. First layer is of
orthopaedic wool and then second layer is composed of light compression
bandage and final layer composed of cohesive extensible bandage.

5. Finally, a gauge padding that cover the moistened dressing.
D.
I.
The factors that can effect wound from healing are: presence of slight
haemoserous and purulent exudate that appears on the top of wound. Along with the
presence of oedematous sections on the proximal and distal end also effect the healing
procedure of wounds (Carlson and et.al., 2013).
II.
As it is mentioned that Mrs Rose is in obese range so the presence of steroids
hinders the formation of blood clots and thus impact the health of wound. Along with
this obesity leads to development of wounds and this create the risk of infection in
them. Along with this she is smoker too and nicotine that is present in the cigarette
reduces the flow of nutrients in the blood and leads to impaired healing procedure
(Basic principles of wound management, 2017).
E. Explain complications if she did not elevate her leg (2.4, 2.3)
Leg elevation is important in the case of venous ulcers as it help in venous
return along with these reduces the pain and swelling in the leg. Thus, in the absence
of elevation of leg the pain and swelling are not able to cure in the effective manner
(Greaves and et.al., 2013).
F. Psychosocial impact of r wound on the main activity she likes to do (2.3)
The main activity of Mrs Rose is that used to go with her friends in the local
bingo club but due to presence of wound she is refrained from going their thus now
she will not be able to visit that place more.
G. Pathological and biochemical processes related development of venous ulcer(2.2)
After getting cut from the trolley the veins in that particular area develop Deep
vein thrombosis, peforator insufficiency, deep vein insufficiency, calf muscle
insufficiency and arteriovenous fistulas leads to the increased pressure in distil veins
of the legs and causes venous hyper tension. Thus leading to the venous ulcers.

H. Impact moist dressings and compression bandaging has on improving healing.(3.5,
5.1)
Moist dressing includes the healing of wound in the moist environment and
leads to autolyzed debridement, drainage nourishment and is minimally invasive and
non invasive that help in reducing the scar formation. The moist environment promote
the release of various growth factors, along with the promotion of immune cells and
help in accelerating the skin cell migration. Compression bandaging help in the
management of the wound and reduce the blood loss from it (Stevens and et.al.,
2014).
Compression stockings helps in applying the pressure to lower leg that further
help in maintaining the appropriate blood flow and help in the reduction of swelling.
SECTION 2
A. Nursing Care Plan - wound care management plan (3.1, 3.6, 5.5, 5.7, 6.5)
Nursing diagnosis-
(risks related to
nursing diagnosis)
Goals Intervention/
Implementations
Evaluation
1 Loss of mobility To
increase
the
mobility
rate.
Taking walk for a short
distance to continue the
process of mobility
(Knottenbelt, 2013).
The mobility rate
come to normal.
2 Risk of infections
To
control
the rate of
infections
.
Proper cleaning of wounds
with the normal saline and
antiseptic solutions.
Wound is
prevented from
Infections.
3 Increase in the
blood pressure
Maintain
the
normal
blood
Maintenance of healthy heart
condition by elevation of leg.
Healthy
condition of
body is
maintained

pressure.
4 Improper healing Fast
healing to
get rid of
further
complicat
ions.
Appropriate moistened
dressing to accelerate the
process of healing (Klein and
et.al., 2013).
Healing is done
at faster rate.
5 Loose dressing Reduce
the flow
of blood
from
veins.
Compression bandaging in
order to minimise the blood
loose.
Blood lose is
prevented.

REFERENCES
Books and journals
Carlson, G. L. and et.al., 2013. Management of the open abdomen: a national study of
clinical outcome and safety of negative pressure wound therapy. Annals of
surgery. 257(6). pp.1154-1159.
Greaves, N. S. and et.al., 2013. The role of skin substitutes in the management of
chronic cutaneous wounds. Wound repair and regeneration. 21(2). pp.194-
210.
Klein, S. and et.al., 2013. Evidence‐based topical management of chronic wounds
according to the TIME principle. JDDG: Journal der Deutschen
Dermatologischen Gesellschaft. 11(9). Pp.819-829.
Knottenbelt, D. C., 2013. Handbook of Equine Wound Management E-Book. Elsevier
Health Sciences.
Matatov, T. and et.al., 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). pp.791-795.
Rosenberg, L. and et.al., 2014. A novel rapid and selective enzymatic debridement
agent for burn wound management: a multi-center RCT. Burns. 40(3). Pp.466-
474.
Stevens, D. L. and et.al., 2014. Practice guidelines for the diagnosis and management
of skin and soft tissue infections: 2014 update by the Infectious Diseases
Society of America. Clinical infectious diseases. 59(2). pp.e10-e52.
Zelen, C. M. and et.al., 2013. A prospective randomised comparative parallel study of
amniotic membrane wound graft in the management of diabetic foot
ulcers. International wound journal. 10(5). pp.502-507.
Online
Basic principles of wound management. 2017. [Online]. Available through
<https://www.uptodate.com/contents/basic-principles-of-wound-
management>. [Accessed on 10th October 2017].