Holmesglen HLTENN006: Wound Management Plan - Noel Frost Case Study

This document presents a comprehensive wound management plan for Mr. Noel Frost, a 65-year-old patient who underwent a total knee replacement and developed a post-operative wound infection. The plan details the patient's medical history, social background, and current condition, including the type of wound, dressings used, and relevant medical information. It outlines the wound assessment process, including location, dimensions, appearance, exudate, and odor. The plan also addresses the patient's mobility, diet, and elimination needs. The assignment adheres to the guidelines of HLTENN006, applying the principles of wound management in a clinical environment. The case study includes an essay that addresses the patient's presenting problem, other medical conditions (osteoarthritis, hypertension, and Type 1 diabetes), and the reason for admission. The project incorporates a detailed wound management chart, including wound care assessment, nurse reviews, and swab results. The document also reflects on the importance of understanding wound aetiology, the physiology of wound healing, and the factors influencing the healing process. This assignment provides a thorough understanding of wound management, from initial assessment to ongoing care and treatment.

Wound Management Plan 1
Reason for this admission : The patient has undergone total knee replecament and
is suffering frompost operative wound infection
Name of patient: Mr. Noel Frost
Age: 65 years
Social History: Has a wife and two daughthers (married) and 5 grandchidren.
Occupation: Retired civil engineer who has been working a senior lecturer
Cognition: correct orientation to time and place
Principle diagnosis: osteoasrthritis
Medical History: osteoarthritis, hypertension, , Type 1 diabetes
Type of Wounds: wound in knee
Dressings: At right knee with crepe bandage, kept intact
Diet: through IV in the wrist
Elimination: 12 times a day
Mobility (pre-admission): 2 wheel-walker (around the house), crutches & WC
(outside house)
 ADLs: Top half (100% independent)
Lower half (70% independent)
FOR OFFICIAL USE ONLY Holmesglen: fd/nursing æOct-2018 Delivery & 2\HLTENN006 - Apply principles of wound management\New Assessment 201 Mssessment Task 1-
Simple Wound\Wound Management chart.d00(

(5 z
z
WOUND CARE ASSESSMENT &
PLAN
Only One (1) Wound Per Form —
Circle or tick responses as appropriate
Legend for Wound Stages Location (circle site on
Stage Skin Integrity Appearance Exudate
Intact/Non Blanchable Erythema or Discolouratjon None
2 Superficial Loss Erythema, hot, painful or
oedematous Low / Mod
3 Loss of B/c tissue wit) cavity Sloughy, Necrotic, Red Low / Mod i High
4 Loss of s/c tissue with cavity, Red
Sloughy, Necrotic,
involving bone, muscle or tendon
Low / Mod / High
Unstageable Loss of tissue with cavitv,
unab'e to view base of wauhd Slough, Necrotic, Red Low / Mod i High
Suspected
Deep [6)
Intact but suspected to have
deep tissue involvement
Intact, Discoloured or blood
filled blister None
WOUND TYPE:Pressure injurya Burn Arterial ulcer
Venous ulcerMalignant Haematoma Diabetic ulcer
LacerationAbrasion Surgical Incision
BlistersSkin Tear a Omer
Date: Time: Date: Time: Time:
Dimensions: 4incles
10 inches Widdi
Depth
Length
cm
cm cm
cm
cm
cm
Stage:
Photograph:
Consent obtained Yes / No
Photograph Yes / No Photograph Yes No Photograph
Wound Swabs: Wound Swab Yes / No Wound Swab Yes / No Wound Swab
Results of swabs:
Nurse Review: Nurse Review Yes / No I Nurse Review No Nurse Review
Duration of Wound:
mths = Months
< 3 mths / 3-6 mths /
6-12 mths / 12+ mfrs
< 3 mths f 3-6 /
6-12 mths / 12+ mths
< 3 mths / 3-6 mths /
6-12 mths / 12+ mths
baldate: Amount:
Type:
a Nil a Mod Q
Heavy
a Low a
Mod Heavy Low a
Mod Heavy
Serous Purulent
Haemoserous
C) Serous a Purulent
Haemoserous
a Serous Pun.]lent C.I
Haemoserous
Drains Insitu
Odour: Q Offensive NÉE I C) Offensive Nil Offensive Nil
Colour of Wound and
Surrounds
colour a Pink
epitheiisation Cl Red -
granulating
Yellow - slough
Green - infectious
Black -necrosis
Colour (Tick)
Pink - epithetisation
Red granulating
Yellow -
slough Green
- infectious
aack -
necrosis
Colour (Tick)
Pink - epitheiisation
a Red - granulating
Yellow - slough
Green - infectious
Black -necrosis
Surrounding skin: Healthy
fragile O Macerated
Inflamed Q Discoioured
Other
Heatthy Dry/Scaly
Fragile Q Macerated
Inflamed Discoloured
Other
Healthy C] Dry/Scaly Fragile
Macerated inflamed
Discotoured
Cl Other
Suture Line: jaggered Q Clips / Sutures insitu Clips / Sutures insitu a Clips / Sutures insitu
Present on admission:
Comments:
Pain on dressing change
Severity Score (Score 1-
10): 3
RN Printed Name:
RN Signature:
Intermittent Intermittent

Right knee
Crepe bandage
Aquacell or tegaderm
Pearson
David
Male
Twice a day
Saline,
Ringer’s solution
Hydrogen peroxide