Applying Wound Management Principles in a Clinical Environment

This report provides a comprehensive overview of wound management principles within a clinical environment. It begins by defining various wound types, including surgical incisions, arterial ulcers, venous ulcers, mixed ulcers, malignant wounds, neuropathic ulceration wounds, infected wounds, burns, fistulas and sinuses, skin grafts, visceral wounds, discharging wounds, and pressure ulcers. The report then details various wound management techniques such as wound debridement, Doppler assessment, compression therapy, clinical photography, and wound tracing. Furthermore, it touches upon laboratory results related to sterile specimen collection. The report also explores the physiological and biochemical processes of wound healing, factors affecting optimal healing, pain and comfort management, strategies for preventing disease spread, the interdisciplinary team involved in care, and appropriate interventions for wound healing techniques and products. The content includes information about wound dehiscence and provides a thorough understanding of the subject matter.

APPLY PRINCIPLES OF WOUND
MANAGEMENT IN THE CLINICAL
ENVIRONMENT

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
TASK 1............................................................................................................................................1
Question 1 Wound Types............................................................................................................1
Question 2. Wound Management Techniques.............................................................................5
Question 3. Laboratory results.....................................................................................................6
Question 4. Development of contemporary management strategies...........................................7
Question 5. Standards..................................................................................................................7
TASK 2............................................................................................................................................8
1. Define wound dehiscence........................................................................................................8
2. Wound healing physiological and biochemical processes.......................................................8
3. Factors that can affect optimal wound healing........................................................................8
4. Pain and comfort management................................................................................................9
5. Strategies for prevention of disease spreading and minimise cross infection.........................9
6. 4 members of the Interdisciplinary team involved in care strategies for wound healing........9
7. Interventions appropriate for wound healing techniques and products.................................10
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11

INTRODUCTION
Wound management is a term that includes complete spectrum of holistic clinical measures,
interventions, methods in patient care with wounds (Pavletic, ed., 2018). There are various kinds
of wounds that are required to be known by the nurses so that proper treatment of the wounds
can be done in such a manner that complications related to the wound can be avoided. This this
assignment different types of wounds will be discussed, different types of wound management
therapies and questions related to a case study of Sarah Victor who has an abdominal
hysterectomy and was readmitted to the hospital with wound dehiscence.
TASK 1
Question 1 Wound Types
a) Surgical incisions
Define: It is a kind of cut which is made though soft tissue and skin for a procedure or operation.
Causative factors: there are various factors that lead to surgical incisions, but one of them is
requirement of operation for treatment when surgeon makes incision with surgical instrument.
Special nursing considerations: Proper dressing over incision, changing of dressing regularly,
cleaning of surgical incision (Park, Hwang and Yoon, 2017).
Complications: If infection occurs over surgical incisions, it can cause redness of skin, pain,
drain pus, hot on touch.
Treatment method: Prescription of antibiotics to reduce pain and reduce infection chances, Time
to time dressing, specific exercise to heal wounds.
b) Arterial Ulcers
Define: It is a kind of wound cause by poor perfusion to lower extremities. Overlying tissue or
skin are oxygen deprived.
Causative factors: Some of the common factors are: obesity, limited joint mobility, diabetes
mellitus, renal failure etc.
Special nursing considerations: Clean wounds, apply antibiotics or ointments on affected region,
provide special instructions to patients.
Complications: When left untreated it can lead to serious complications like: tissue necrosis,
infection, amputation of affected limb.
Treatment method: provision of various kinds of related therapies such as compression therapy,
increase circulation in affected arterial ulcers part either surgically or medically.
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c) Venous Ulcers
Define: Wounds that are caused by abnormal vein function. Many times, people either inherit or
have a tendency for abnormal veins (Suntar and et.al., 2017).
Causative factors: Most common factors are: blood clots, obesity, injury or ageing or when there
is break in skin.
Special nursing considerations: Focus on promoting healing by applying gauze pads that
moisturized with sterile water, usage of get for promotion of healing.
Complications: infection is one of the main complications associated with it that can result in
pus, fever, swelling, increased pain.
Treatment method: Leg elevation, compress wound, if required surgery by removing unhealthy
tissue.
d) Mixed Ulcers
Define: Result of combination of arterial and venous Ulcers and if not treated properly then it can
either worsen or can reoccur.
Causative factors: Mostly Mixed Ulcers occurs from venous and arterial ulcers that has not be
controlled and in increasing.
Special nursing considerations: Making patients exercise in order to reduce weight and increase
blood flow, monitor diabetes patients blood sugar level.
Complications: Risk of infection that can lead to septicemia or cellulitis, immobility can result in
ulcer worsening (Rosenbaum and et.al., 2018).
Treatment method: reducing weight can reduce this Ulcer, in case of diabetes: blood sugar level
should be reduced and in worse case by surgery affected tissue can be removed.
e) Malignant wounds
Define: It is a kind of cancerous lesion of the skin that might be draining. It can either be an open
area or cavity on skin surface.
Causative factors: Mostly Malignant wounds occurs because of spreading of cancer from skin to
another site or because of primary cancer such as breast cancer that cause Malignant wounds
Special nursing considerations: prevention of infection from the wound from one body part to
another, reducing pain, bleeding and bad odour by doing proper dressing to the wound.
Complications: Poor treatment can increase chances of infection that can result in decreased
quality of life.
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Treatment method: Antibiotics that reduce bacterial infection. These antibiotics can be either
provided from tablets or injections.
f) Neuropathic ulceration wounds
Define: These types of wounds are formed as a result of peripheral neuropathy that typically
happens to diabetes patients.
Causative factors: common factors that cause this wound are: renal failure, surgery, spina bifida
etc.
Special nursing considerations: Dressing of wounds such that wound environment is moist,
cleaning of wounds from time to time.
Complications: Infection from this disease can lead to serios complications such as tissue
necrosis, amputation of affected limb.
Treatment method: Wound is required to be debrided down to healthy, bleeding tissue.
Therapeutic shoes can be suggested to avoid recurrence during treatment finally if still not
treated then surgery (Tsiouris and Tsiouri, 2017Case, 2019).
g) Infected wounds
Define: It is a localized excavation of the skin or tissue that are invaded by pathogenic organisms
surrounding the wounds.
Causative factors: When any skin on body is broken or wound is open, immune system of the
body gets compromised because of which microorganisms enter the skin and cause infection.
Special nursing considerations: proper wound cleaning to reduce bioburden and to reduce
chances of stalled wound healing.
Complications: Most common complication to such wound is stalled wound healing that results
in non-healing wound.
Treatment method: systematic treatment includes provision of oral antibiotics after
microbiological investigation, Antimicrobial dressings.
h) Burns
Define: When tissues or skin is damaged because of overexposure to radiation or sun, heat or
from any other substances causes burn.
Causative factors: There are various factors that causes burn such as: Fire, electric current, hot
metal etc.
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Special nursing considerations: Nursing considerations also depend upon the severity and cause
of the wound but most common symptom is to wash the wound with water and clean it
(Tankersley and Schrobilgen, 2017).
Complications: Bacterial infection, low body temperature, scars, joint or bone problem etc.
Treatment method: Treatment of burns depends upon severity and location of burn.
i) Fistulas and sinuses
Define: Fistula is an abnormal channel that leads between two cavities that may drain fluid
material such as pus or saliva. Sinus has an open end for draining in a blind end.
Causative factors: it is caused by TB sinus, actinomycosis, from surgeries etc.
Special nursing considerations: After surgery dressing, cleaning of wound, apply antibiotics etc.
Complications: heart failure, bleeding, infection, bleeding, irritation many more.
Treatment method: Basic treatment of Fistulas and sinuses includes antibiotics, adequate
excision, drainage, rest and operation.
j) Skin grafts
Define: Surgical process that involves skin removal from ne area and applying it to another part
of body.
Causative factors: due to skin infection, deep burns, large open wounds, skin cancer surgery etc.
Special nursing considerations: Monitor skin grafting continuously, provide medication to
manage pain
Complications: infection, blood clotting, new grafting does not take place.
Treatment method: Provide pain killers to reduce pain, in case of infection or new grafting does
not take place then surgery is done again.
k) Visceral wounds
Define: These wounds are encountered by every surgeon who deals with trauma. These are
injuries to liver, stomach, kidney etc.
Causative factors: it is mainly caused by penetrating mechanism of injury or due to blunt
mechanism (Oryan and Alemzadeh, 2017).
Special nursing considerations: provide medication on time, cleaning of wounds etc.
Complications: superficial wound infection, deep wound infection etc.
Treatment method: Physical examination is done; X-ray is conducted then according to the
wound operation is done.
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l) Discharging wounds
Define: Wounds that contains both blood and blood serum.
Causative factors: liquid discharge from wounds cause this wound.
Special nursing considerations: keeping wound clean and dry, bandage after cleaning the wound,
continuously changing of bandage.
Complications: can cause infection, stalling of wounds.
Treatment method: medications, regular dressing and in worst case surgery.
m) Pressure ulcers
Define: Also known as bed sores. It is a injury to skin or tissue from prolonged pressure on skin.
Causative factors: It happens when a person sit or lie on a same position for too long, as weight
of one’s body against the surface cut off blood supply (Shokri, Kadakia and Ducic, 2019).
Special nursing considerations: Nurses helps in relieving pressure in skin, use negative pressure
wound therapy.
Complications: Complications of this wound is life threatening: can cause skin infection, bone
and joint infection, can cause cancer, sepsis etc.
Treatment method: Treatment depends upon stage of the wound but most common treatment are:
antibiotics and medications, debridement and in last stage surgery is done.
Question 2. Wound Management Techniques
a) Wound debridement
This technique involves removal of necrotic tissue in order to promote wound healing.
There are various methods through which wound debridement can be done:
 Sharp and surgical using scissors and scalpel. It provides rapid results and is highly
selective.
 Autolytic using hydrogels and hydrocolloids, in this rehydration of necrotic tissue is done
(Golchin, Hosseinzadeh and Ardeshirylajimi, 2018).
 Mechanical method such as wound irrigation and hydrotherapy in which rehydration
easily removes surface eschar.
 Enzymatic preparation using bacterial-derived collagenases which helps in promoting
healing.
 Biological method such as maggot therapy. This technique is quite selective but has rapid
healing results.
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b) Doppler assessment
Leg Ulcers can have deleterious effect on overall quality of their live and their wellbeing.
Doppler assessment helps in leg Ulcers treatment of a patient. For this, nurses are first of all
required to conduct a Doppler ultrasound and listen to all kinds of signals that have been
transmitted by Doppler probe. It is a skilled procedure which requires trained nurses who have
taken Doppler assessment training as they would be knowing ways to attend Ulcer patient. For
this patient are required to know Doppler Ultrasound, sphygmomanometer, Cling film in order to
cover ulcer bed and how to apply Ultrasound gel between patient and Doppler probe.
c) Compression therapy
It is a simple and effective kind of therapy to increase overall blood flow activity in lower limbs
through strengthening vein support. It is a kid of wound care that focuses on gently applying
pressure to legs and ankles by wearing specific designed stocking. These stockings help in
stretching out vein walls in order to improve circulations which also helps in eliminating
swelling. This therapy can be used for patients who are suffering from chronic venous diseases.
There are four main types of products that are available for this therapy: carolon stocking, circaid
juxta-lite, farrow wraps and compression stockings.
d) Clinical photography
It is a kind of therapy in which daily clinical condition of patients is recorded and is
further used for diagnosis or for recording condition of a patient during treatment stage. Clinical
photographers mostly work in clinics, wards or theatres. This clinical photography is used for:
patient care, research, medical education etc. It is also used for early diagnosis of a disease so
that effective treatment to be used for the disease can be confirmed (McCaghertyx and Woods,
2018).
e) Wound tracing
It is reliable two-dimensional method which is used for recording wound area which is
quite easy to use and requires no special skills. When this treatment is used in combination with
planimetric area calculation, it increases validity of shadow or pear-shaped wounds without
undermined margins.
Question 3. Laboratory results
Correct process used for sterile specimen collection.
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In order to collect sterile specimen, it is important to use correct recommended technique
including all the precautions related to use of sterile equipment’s.
 Provide patient with appropriate collection instructions in advance that are required to be
followed for specific test and specimen collection.
 Obtain consult of the consent and explain whole procedure to them in order to improve
quality of the specimen.
 Explain all the steps in which specimen will be collected so that if consent has any kind of
doubt then they can clarify it in advance.
 Identify and choose appropriate location for specimen collection and ensure safety and
privacy of the patients (Brennan and Agass, 2016).
 Was hands and wear gloves and apron for collection and ask the consent to wash their hands
as well in order to avoid contamination
 Choose appropriate and required equipment’s such as sterile needles, syringes etc. that are
required to be used for collection of specimens.
 Perform specimen collection and place it within in specimen boxes or bags appropriate for
the procedure.
 Remove gloves, apron and send sample immediately to the lab for storage and testing.
Question 4. Development of contemporary management strategies
Contemporary management technique focuses on the fact how management of a
company establishes their methods or procedures in order to manage company in a more
effective and efficient manner.
Principles of warm moist wound healing
Moist wound healing is a kind of process in which in which a wound environment is
created in order to optimise body’s inherent wound healing abilities. In this process wound is
kept under moist wound healing plaster in order to increase healing process in a better manner. It
is important to know what kind of bandages are required to be used for what kind of wound. Wet
dry bandages are used for necrotic wounds in this saline soaked gauze is used for primary wound
dressing. Warm moist wound healing stimulates healing repair phase.
Question 5. Standards
Significance of NSQHS Standards related to wound management
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NSQHS standards helps in protecting people from any kind of harm in order to improve
their health service provision quality. NSQHS standards for wound management are more
general as compared to other standards. Organizations are required to adapt or develop a proper
wound management system which is based on proper practise guidelines. This system helps in
identifying patient care process after identification of patient’s injury. These standards help in
wound management, pain management, wound dressing etc.
TASK 2
1. Define wound dehiscence
Wound dehiscence is a kind of surgical incision reopening that can occur both either
internally or externally. It is a kind of complication that can occur after surgery and mostly
occurs within two weeks of surgery and mostly occurs in abdominal or cardiothoracic
procedures. According to the case study 12 days ago Sarah has an abdominal hysterectomy but
because of wound dehiscence she was readmitted and has taken a complete course of antibiotics
for her wound infection.
2. Wound healing physiological and biochemical processes
Physiological process of wound healing
Psychological process associated with wound healing is done in four phases. Practitioners
dealing with wound dehiscence are required to be familiar with these stages. In Sarah’s case
practitioners are required to check the current state of Sarah’s wound infection which is sore and
a bit smelly. This helps in addressing issues related to wound dehiscence so that all the issues
related to this can be addressed and would healing process can be enhanced. In Sarah’s case after
examining issues wound dressing is required to be done and vacuum-assisted closure therapy can
be used for dehisced incisions.
Biochemical process of wound healing
This process helps in repairing the damage and enhance process of wound healing. This
tissue also helps in increasing growth of the issues for wound healing. In Sarah’s case This
process can help in increasing tissue growth and Wound dehiscence damage can be repaired.
3. Factors that can affect optimal wound healing
Factors that can affect wound healing
 Stress is one of the main factor that can affect wound healing of Sarah as she does not have
enough sick leaves for recovery.
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 As she lives all alone with her four cats, she won’t be able to take care of herself in terms of
nutrition.
 She won’t be able to take her medications in timely manner as she lives all alone and does
not have enough sick leaves.
 She is quite prone to get infected because of her four cats.
 In her case, Sarah need proper rest so that her wounds can be healed in a proper manner.
Psychosocial impacts Sarah’s wounds on her daily activity: main impacts in her daily life will be
stress and sleep disturbance. In her daily life she will be required to take care of wounds, herself,
her cates as well as will be required to do her daily office work as well
4. Pain and comfort management
For pain management Sarah should be provided with appropriate medications and
antibiotics in order to manage the pain and it is well-controlled. She should taken proper rest so
that her main can be reduced and wounds can be healed properly.
5. Strategies for prevention of disease spreading and minimise cross infection
Infection occurs when any kind of bacteria grow in damaged skin, as in the present case
Sarah is suffering from wound infection hence she has to take precaution so that cross infection
issues or risk can be minimised. In order to minimise that risk, she has to clean her hand with
warm water and soap. This would keep the skin clean which will reduce chances of growth of
bacteria. Environmental hygiene is another strategy that must be known by Sarah, she must sit
and spend time in the places which is clean because microbial bacteria grow with high speed in
the dirty areas. Use of antibiotic stewardship is also great tactic to minimise cross infection
problem in Sarah.
6. 4 members of the Interdisciplinary team involved in care strategies for wound healing
 Practitioner: doctors are the main team members who is responsible for identifying the risk in
Sarah and giving them required antibiotics so that her condition can be improved soon.
 Nurses: They are another member of interdisciplinary team, as nurses have to monitor
condition of patient time to time. They are responsible for checking their heart bits, blood
pressure and giving them medicines timely. This helps the care user in getting recover from
her illness soon.
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 Pharmacist: individual is another important person in the interdisciplinary team as person is
responsible for analysing current medical condition of patient and providing them drug which
are prescribed by medical professional.
 Clinical psychologist: They are the specialist professionals those who works to minimise
emotional distress of patients. As Sarah is suffering from wound infection and she does not
have sufficient sick leaves. She is in stress of affording her entire treatment if she takes leave
from office due to her illness. In this condition psychologists plays the role of guide, they
reduce psychological stress of person by promoting emotional wellbeing.
7. Interventions appropriate for wound healing techniques and products.
Wet- to- dry dressing intervention is the best technique of wound management. It is known
as debridement method in which doctors perform gauze dressing. Devitalized tissues are
removed that helps in speedy recovery of skin. This is cost effective method to get treatment for
this issue. People those who have low pain tolerance can use this intervention technique for
wound management. This is applicable to infected and non infected both kind of wound
infection.
CONCLUSION
From the above assignment it has been summarized that there are various kinds of
wounds and kind of wound has its own complications, nursing care, treatment. It is important for
nurses to know each kind of wounds, complications related to it so that proper and effective
treatment for the wound can be provided to the patients. It has also been concluded that there are
various kinds of standards that helps in wound management that can be used by care homers or
nurses for patient care.
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