Case Study: Wound Management Analysis and Treatment

This case study analyzes three scenarios related to wound management. The first case involves a burn injury, focusing on pain assessment using the Visual Analog Scale (VAS), the importance of pain reduction for healing, and the skin healing process with skin grafts. The second case examines a pre...Read More

Running head: WOUND MANAGEMENT
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Wound Management
Student name:
Student ID:
Author’s note:

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Case study 1:
1. Appropriate pain assessment tool.
Burn injuries are often coupled with large amount of pain and discomfort due to loss or damage
of skin, with oedema on a larger scale. A detailed pain management assessment can be
completed on arrival of the patient and then continued within an interval of 1 to 4 hours, through
the course of admission. The re-evaluation of the pain during the outpatient visit and even after
discharge is often carried out. In case of Carol, Visual Analog Scale (VAS) can be used as pain
management tool. VAS, is generally used as outcome for measurement and represented on 100-
mm horizontal line on which Carol’s intensity of pain is represented between two extremities
such as no pain or worst pain.
2. Importance of reduce pain levels in wound patients
The effect created by pain cannot be underestimated. As per Burkhardt et al. (2015), increase in
level of pain can lead to stress. The increasing levels of stress can create psychological trauma on
the patient slowing down the process of healing. A new evidence bases study by Dreifke et al.
(2015), found that cells are often seen to respond differently to pain. however, pain may often
have different use. As observed by Dreifke et al. (2015), reducing the pain sends immune signal
to the body to facilitate the healing capabilities. In similar regards, it can be taken into
consideration effect of stress and pain of wound makes it important for healthcare professionals
to reduce pain during the course of treatment
3. How the skin heals with the assistance of a skin graft
Skin graft is often a requirement of treating burnt skin quickly and without minimum scars. In
order to heal the skin through the use of skin graft the graft is not kept is immobilised for 5 days.

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during the course of immobilization, the blood vessels grow and there is a connection established
between the grafted and burnt skin. 5 days after the surgery, the therapy programs are initiated to
maintain flexibility of the area.
3. Problems while assessing wounds
Failure to assess the level of sensation within the burnt area if any
Reduced mobility as burn was caused on her leg

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Case study 2:
Q1a) Suitable dressing for pressure ulcer
Antibiotic treatment or anti-microbial dressing may be needed in the mentioned case. In case of
John, the pressure ulcer is at high risk of becoming infected. Thus, the use of antimicrobial silver
foam dressing can be termed useful. On the other hand, a combination of foam dressing with
silver alginate can be used for treating the pressure ulcers in John.
Q1b)
A moist wound healing environment is important as contrary to the age old tradition of keeping
the wound dry and formation of scab. The maintenance of moist environment can make the body
focus on the pressure ulcer, rather than simply protecting it and facilitating faster healing of the
wounds. Additionally, in order to break down the scabs, energy is required that could not have
been achieved for timely healing of wounds.
Q1c) John required a primary or secondary dressing, or both
John required both primary and secondary dressing. The primary dressing is used to manage
oozing of fluids and is placed on the wound directly. The primary dressing can be used for
healing the wound while the secondary dressing can be used for holding the primary dressing in
place.
Q2) Risk assessment with tools
The risk for John can be termed as pressure ulcers progressing toward infection pressure ulcer
can lead to formation of sepsis additional risks associated with pressure ulcer include

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osteomyelitis, localized infection, and even cellulitis. In similar regards, it can be stated non-
healing pressure ulcer can hint toward underlying osteomyelitis.
The Braden scale contains items such as friction and shearing, sense perception, nutrition,
mobility, activity and moisture. The mentioned scale helps in understanding the importance of
care and the factors to be considered for providing care for the patients. The second tool is
Norton Scale, composed of 5 items that encompasses mobility, physical condition, activity,
mental condition and even incontinence. The event of mobility can be considered to play no
importance in the mentioned case scenario; however, things can improve and the patient can
improve the condition related to mobility
Factor Effect on wound healing
Age As per Ghannam et al. (2018), aged individuals tend to experience
slow rates of wound healing as compared to the younger
populations. The link between the age and wound healing can be
attributed to the associated comorbidities that comes with age.
The cell turnover decreases with increase in age. In the mentioned
case scenario, John is 82-year-old and may face delayed would
healing due to lower rates of cell turnover
Nutrition Coping with wound and injury often demands a lot of nutritional
requirements. As pointed out by Ghannam et al. (2018), wounds
are often seen to heal in presence of adequate protein levels. In

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addition to that body additionally demands high levels of oxygen
to facilitate the transportation of oxygen as haemoglobin uses iron
to bind and get transferred.
In addition to that vitamin B, C and A are known for their roles in
building collagen and even for epithelialization. However, in the
mentioned case study John is not on a healthy diet schedule
making it extremely difficult to heal the wounds at a faster rate

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Case study 3:
Q1a.
Infectious Agent: In case of Maggie, infectious Agent is the Methicillin-resistant
Staphylococcus aureus (MRSA). It is because of it Maggie is seen to be infected through the
wounds
Susceptible host: A patient with reduced mode of defences. In case of Maggie, it can be easily
stated she was subjected to inflammation of surgical staples due to poor health conditions.
Susceptible host is protected due to the chain of infection being broken.
Portal of exit: The drainage from open wound coupled with sanitization of hands and wearing of
gloves while dressing the wounds can help in treating the wounds.
Reservoir: There are primarily three main reservoirs for MRSA that includes hospital settings
and inanimate objects such as utensils, bed linen and even floors. The second reservoir is the
staff who act as agent of infection transfer coupled with the already infected patients
Mode of transmission: The main areas that causes transfer of MRSA can be termed as the
transmission done through direct contact. Contact with wound, or using items used by the
infected individual
Portal of entry: For MRSA to transfer successfully, it is important to gain suitable host that
includes transmission through direct contact and even through infected objects and person
Q1b) Nosocomial Infections
Hospital acquired infection is often caused due to presence of toxin or infection within the
mentioned healthcare setting (premiersafetyinstitute.org, 2019). There are possible chances that

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may lead to the perception that the hospital is responsible for this infection as it happened in the
hospital itself. However, it should be taken into consideration that MRSA is more pronounced
among individuals with lower levels of immunity. In case of Maggie the immunity level was
relatively low that made her an easy target for MRSA infection.
Q1c. Immune response in regards to infections
The immune system and blood are the primary interventions that initiates response to immune
system. In the initial condition of response is the skin that protects entry of certain germs.
However, in case of MRSA the infection is caused due to open wounds making things difficult
for the skin to act as a first line of defence. Other than that, the innate adaptive immunity is seen
to participate for the protection mechanism against the bacteria. In case an infection is caused,
the white blood cells (WBC), is responsible for identifying the microbe and in response to the
same produce antibodies to fight the possible cause of infection
Q 2. Treating infection with the following factor:
Poor nutrition: Eating foods with proper nutrition can help in increasing the immune power.
However, in the mentioned case study, there is no evidence that the service user is seen to
indulge herself in a healthy life making her delay the process of healing (Vaidya et al. 2015).
Smoking: Excessive of smoking can make the MRSA infection worse (Heather, 2019) Research
based study provided an idea that MRSA exposed to smoke were resistant to killing by species
reactive to oxygen. The chemical is seen to burst the macrophages. In addition to that it was
discovered smoke exposed MRSA are shown to exhibit high resistance of killing by anti-
microbial peptides and thus trigger higher rates of inflammation. Thus, with increase in smoking
incidents the MRSA infection tend to get worse

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Diabetes: Infection is a well-recognised term and can be termed as a barrier to healing and
evidence based studies lead to the fact that MRSA healing time is seen to increase by two fold
with those suffering from diabetes. Diabetes can lead to complications causing ulcers, and
infection. This in return acts as an open source for MRSA infection (Bowling, Jude & Boulton,
2018)
3.
Problem Intervention Rationale Evaluation
Location of
Wound
Left knee Possible cause
inflammation due to
surgical staples
Informing the patient
about her medical
condition so that she
can take careful steps in
being safe from further
infection
Activities of
Daily Living
Decrease or quit
smoking
Excessive of smoking
can make the MRSA
infection worse.
Research based study
provided an idea that
MRSA exposed to
smoke were resistant to
killing by species
Providing the patient
with nicotine chew
tablets and informing
them how smoking can
cause harm

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reactive to oxygen. The
chemical is seen to
burst the macrophages.
In addition to that it was
discovered smoke
exposed MRSA are
shown to exhibit high
resistance of killing by
anti-microbial peptides
and thus trigger higher
rates of inflammation.
Thus, with increase in
smoking incidents the
MRSA infection tend to
get worse
Reduced
Mobility
Knee surgery The surgery can
enhance the events of
mobility and ensure that
she can move freely
Inform the patient about
the possible modes of
exercise
Pain Due to MRSA infection The inflammation is can
distress and pain
making it difficult to
concentrate on daily
Discuss the possible
pain management
strategies

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activities
Referral
Need
Nutritionist To guide a proper diet
plan
Ask what the patient
prefers to eat
General questions
Q1)
“National Safety and Quality Health Service Standards” standard 3 makes special mention of the
ways that can be used to prevent healthcare associated infections. The standard 6 mentions the
importance of maintaining clean setting that in return can reduce the chance of infection
(safetyandquality.gov.au, 2019)
Q2)
Materials used for dressing wounds in the modern times are highly designed with the use of
technology. The technical intervention was further used to maintain just the right level of pH,
moisture level and even gas exchange for healing the wound in proper and fast manner.
However, things were not the same 3 decades ago when primary disinfectant was a mode of
treating wounds. However, with the passage of time modern wound dressing is seen to make use
of plasma polymerisation to fill the wounds (Salge et al. 2017). Plasm polymerisation coating is
found in treating surface wounds within in vitro settings. However, it should be taken into
consideration that the mentioned mode of wound treatment is costly and may not fit the budget
of every patient.

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Reference list
Bowling, F. L., Jude, E. B., & Boulton, A. J. (2018). MRSA and diabetic foot wounds:
contaminating or infecting organisms?. Current diabetes reports, 9(6), 440.
Burkhardt, R., Hämmerle, C. H., Lang, N. P., & Research Group on Oral Soft Tissue Biology &
Wound Healing. (2015). Self‐reported pain perception of patients after mucosal graft harvesting
in the palatal area. Journal of clinical periodontology, 42(3), 281-287.
Dreifke, M. B., Jayasuriya, A. A., & Jayasuriya, A. C. (2015). Current wound healing procedures
and potential care. Materials
Ghannam, S. F., Korayem, H. E., Farghaly, L. M., & Hosny, S. (2018). The effect of chitosan
nanosilver dressing versus mesenchymal stem cells on wound healing. Journal of African
Association of Physiological Sciences, 6(1), 23-31.
Heather Buschman, P. (2019). Cigarette Smoke Makes Superbugs More Aggressive. Retrieved
17 July 2019, from https://health.ucsd.edu/news/releases/Pages/2015-04-02-cigarette-smoke-
makes-superbugs-more-aggressive.aspx
Potter, P. A., Perry, A. G., Stockert, P., Hall, A., & Peterson, V. (2016). Clinical Companion for
Fundamentals of Nursing-E-Book: Just the Facts. Elsevier Health Sciences.
premiersafetyinstitute.org (2019) Healthcare associated infections (HAIs) - Premier Safety
Institute. (2019). Retrieved 17 July 2019, from http://www.premiersafetyinstitute.org/safety-
topics-az/healthcare-associated-infections-hais/hai/
safetyandquality.gov.au (2019) Australia Commission on Safety and Quality in Healthcare.
(2019). Retrieved 17 July 2019, from https://www.safetyandquality.gov.au/

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Salge, T. O., Vera, A., Antons, D., & Cimiotti, J. P. (2017). Fighting MRSA infections in
hospital care: how organizational factors matter. Health services research, 52(3), 959-983.
Vaidya, P., Pawar, G., & Krishnamurthy, N. (2015). Community acquired MRSA infections—
Three recent cases and an overview of CA MRSA infections. Pediatric Infectious Disease, 7(1),
8-12.