HLTENN006: Wound Management Plan for David Pearson

This wound management plan addresses the care of a patient, David Pearson, who underwent a total knee replacement due to osteoarthritis. The plan begins by outlining the patient's principal diagnosis, including his presenting problem of osteoarthritis, history of hypertension, breathing difficulties, and polyuria. It then proceeds to evaluate the wound management plan, covering wound bed status, frequency of dressing changes, wound measurement techniques, assessment of wound exudate, and the condition of the surrounding skin. The plan details the wound management, pain management strategies, and expectations for the healing process, including the three phases of wound healing: vascular response, inflammatory response, and proliferation and maturation. The potential impacts of the wound, particularly the effects of knee arthritis on the patient's quality of life, are also discussed. Finally, it provides recommendations for ongoing care, including medication adherence, regular movement, and exercises. The report is supported by references to relevant medical literature.

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WOUND MANAGEMENT PLAN
1. PRINCIPLE DIAGNOSIS OF THE PATIENT
The main problem which made David Pearson to seek for help from the hospital is
osteoarthritis which has troubled him for the past 10 years, he has history of hypertension
which developed 6years ago, he also has breathing difficulties at night which is relieved
when he sits up, he has polyuria, he goes to the toilet 12 times a day and twice during the
night which disturbs his night sleep. The main reason for admission to the hospital is
because of osteoarthritis which its intervention is total knee replacement (Caplan, & Kader,
2014).
2. EVALUATION OF WOUND MANAGEMENT PLAN
WOUND BED STATUS
Wound beds can be assessed for presence of granulation tissue which is red, fibrin sloughs
which is yellow .Dark red granulation is danger sing, it bleeds on contact and indicate the
presence of wound infection (Lozano-Platonoff, Mejía-Mendoza, Ibáñez-Doria, & Contreras-
Ruiz, 2015). Health granulation is pink in color. Leucocyte level increases at wound bed after
2-3 days specifically macrophages, macrophages help cleanse the wound. (Percival, Hill,
Williams, Hooper, Thomas, & Costerton, 2012).
FREQUENCY OF DRESSING
change of dressing is not done until sutures are removed 12-14 days following surgery.
Dressing should remain in place up to seven days from placement in theatres unless
dressing has moved out of place, it is fully saturated, if dressing is leaking, if there is
increase in pain or odor, increased discharge or foul smelling and if the surrounding skin has
become red or swollen
WOUND MEASUREMENT
A centimeter ruler is used to measure the length of the wound (Shetty, Sreekar, Lamba, &
Gupta, 2012). It should be done regularly so that wound size is determined and its progress
measured to show if its healing or deteriorating. Measurement is taken from open wound
edge to open wound age at longest point, the direction of the wound is from head to toe,
use a 7cm ruler to measure the width of the wound.
WOUND EXUDATE
Wound exudate is produced by the body in response to tissue damage. Wounds should
always be moist to prevent skin breakdown. Exudate that is milky or thick liquid that may
turn to yellow or brown is an indicator of infection which should be treated promptly by use
of antibiotics. Exudate contains proteins and variety of nutrients, growth factors and
enzymes which facilitates healing (Sherman, & Barkley, 2011). Exudate increases mostly

during inflammatory phase of healing, it help bathe the wound with nutrients and also
cleans wound surface
CONDITION OF SURROUNDING SKIN
It can be done by checking temperature, color and shape of surrounding skin. Increased
Temperature of the surrounding skin is an indicator whether 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
(Voegeli, 2013). 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 which include wound dressing, removal of stitches and control of infection,
changing dressing is not done until sutures are removed at 12-14days but unless the
dressing is wet or soiled, this reduce chances of infection, signs of infection should be
monitored for example swelling , pain around the knee, redness , increased heat and
leakage from the wound. Antibiotics should be taken to curb infection but in case of those
signs the patient should contact physician immediately
b) PAIN MANAGEMENT
Replacements are often done to reduce caused by arthritis, Pain medications such as
morphine 10mg 4 hourly should be taken as prescribed and instructed by the surgeon,
patient legs to be raised and cold to be applied after activities such as exercise or walking,
patient to keep taking medications gradually rather than stop taking them suddenly
c) EXPECTATION OF HEALING PROCESS
Wound healing process is the process of repair that follows injury to skin, wound healing
process involved repair of injured tissue where it is replaced by connective tissue and forms
scar on fully healing. Wound healing process involves three phase: vascular response, injury
to the dermis causes bleeding because blood vessels are damaged, damaged end of blood
vessels constrict to minimize blood loss, the exposure of blood to air initiates the clotting
process which is facilitated by aggregation . Inflammatory response is another stage where
inflammatory mediators such as prostaglandin and histamine are produced by mast cells
stimulated by activation of clotting factors and tissue damage in turn wound exudate is
produced. At proliferation stage wound is filled with new connective tissue, wound size
decreases because of combination of physiological process of granulation, contraction and

epithelialization and maturation. In health individuals it begins at 3 weeks after injury and
can last for months. Many factors can also contribute to delayed wound healing, general
health of and individual will influence the ability of healing in different ways. Conditions
resulting in reduced tissue perfusion cause reduced blood flow to tissues hence delayed
healing. As people age, there skin elasticity reduces due to wearing out elastic tissue and
collagen fibers in outer dermal layer also reduces
d) POTENTIAL IMPACTS OF WOUND DISCUSSED
Arthritis of the knee in particular affects the quality of life the individual physically but also
emotionally and socially (Neogi, 2013). Arthritis of the knee compromise activities of life
such as walking, climbing stairs, doing stairs will be hard for even 6 weeks, and self-care
activities such as bathing and dressing is compromised. Dislocation of a knee can happen in
some cases, getting up and down of the floor is limited and someone need 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, patient should sit on the side of the bed or chair when
getting dressed
4. EVALUATION OF WOULD MANAGEMENT
Dressing should not be changed unless dressing are soiled then it should be changed to
avoid infection, patient to keep medications until the pain is fully gone, if further medication
is needed doctor should be seen, swelling is normal, patient need to move regularly .
Stocking helps reduce swelling, patient to keep wearing them day and night, exercises are
important by physiotherapist or can be done at home. After 6 weeks patient to try all
domestic tasks, dancing, speed walking and cycling

References
Caplan, N., & Kader, D. F. (2014). A comparison of four models of total knee-replacement
prostheses. In Classic Papers in Orthopaedics (pp. 169-171). Springer, London.
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.
Neogi, T. (2013). The epidemiology and impact of pain in osteoarthritis. Osteoarthritis and
Cartilage, 21(9), 1145-1153.
Percival, S. L., Hill, K. E., Williams, D. W., Hooper, S. J., Thomas, D. W., & Costerton, J. W. (2012).
A review of the scientific evidence for biofilms in wounds. Wound repair and
regeneration, 20(5), 647-657.
Sherman, A. R., & Barkley, M. (2011). Nutrition and wound healing. Journal of wound
care, 20(8), 357-367.
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.
Voegeli, D. (2013). Moisture-associated skin damage: an overview for community
nurses. British journal of community nursing, 18(1), 6-12.