Wound Care Essay

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Wound Care

Wound

A wound can be defined as, "…the interruption of continuity in a tissue, usually following trauma. Skin is predominantly affected although any tissue, whether nerve, bone or organ, may be wounded" (Definition of a Wound). In order to deal adequately with a wound the professional nurse should have a comprehensive understanding of the process involved in wound -- healing. As one study emphasizes; "All nurses involved in wound management need to understand the wound-healing process, as this should underpin their care plans" (the physiology of wound healing: an emergency response, 2002).

The various methods and ways of dealing with a wound will of course depend on the type of wound and the stage of healing. However, the nurse must be able to identify the stage and type of wound in order to provide the most appropriate and effective treatment procedures. The following discussion will deal not only with the core aspects of wound-healing but also explore some of the treatment processes in dealing with wounds.

2. The anatomy and physiology of wound healing

Wound healing can be defined as "… the physiology by which the body replaces and restores function to damaged tissues" (the physiology of wound healing: an emergency response). There are a number of stages that need to be identified as a requisite to treatment.

2.1. Identifying variables and barriers in wound healing

Identification of the stages and processes of a wound is an essential aspect of treatment. An example of would be the ability to recognize the difference between the inflammatory phase of a wound and the signs of wound infection, in order for the necessary treatment to be applied (the physiology of wound healing: an emergency response, 2002). In other words, the entire physiological process from the initial response to the process of healing and regeneration and complete healing must be understood by the nurse or medical practitioner in order to make correct and timely decisions with regards to treatment. The common phases in the process of wound healing can be briefly summarized as follows.

The inflammatory phase in a wound is the physiological response to an injury. There are a number of physical responses that can be noted in this stage. These include constriction of blood vessels and clotting, as well as the formation of a fibrin mesh forming over the wound which dries to a scab (the physiology of wound healing: an emergency response, 2002). The symptoms and signs of this phase include redness, swelling and pain, but should not be confused with infection. (the physiology of wound healing: an emergency response, 2002).

The "destructive phase 'in the healing process is the stage, in which,

….the body clears away rubbish from the wound in the same way that debris will be cleared away after the fire-fighters have departed. White cells line the walls of blood vessels and migrate into the tissues ready to destroy invading bacteria. (the physiology of wound healing: an emergency response, 2002).

The proliferative phase occurs after about one to three weeks and is the stage of active regeneration and construction of new tissue by the body. This includes the synthesis of collagen and other connective tissue to repair the wound. The edge of the wound draws together during this phase (Phases of Wound Healing).

The final maturation phase takes place when the wound becomes closed (Phases of Wound Healing). In terms of physiology this phase "… involves remodelling of collagen from type III to type I. Cellular activity reduces and the number of blood vessels in the wounded area regress and decrease "(Phases of Wound Healing).

2.2. Barriers to Healing

There are many aspects that prevent or act as obstacles to the healing process in wounds. These can include clinical, socio-psychological, educational as well as organizational factors. Neglect is obviously one of the greatest barriers to the healthy process of healing. The introduction of infection through ineffective treatment can seriously obstruct the healing process. Pain and stress are also barriers to the healing process. As one study notes; "Pain is an accepted feature of chronic wounds. It is known to cause distress to the patient, and, this in turn can delay healing"( Pain-induced stress: a barrier to wound healing).

Lack of education about the healing process can also be a serious obstacle as, without the knowledge needed to implement best practices in the treatment of wounds, complications can occur. Besides a wide range of clinical issues, such as high bacterial infections, there are also socio-psychological issues to consider, such as apathy and depression as well as lack of support. Organizational barriers include aspects such as inconsistent research findings and a lack of standardization of accepted practice (Flanagan).

3. Different Wound Types

There are a wide variety of different types of wounds that can be encountered. Large wounds on the one hand may be extremely serious in terms of blood loss and damage to underlying organs or tissues (Types of Wounds). However, small wounds may be just as serious in that infection may occur in wounds that do not appear to be serious and which are neglected.

In general there are a number of commonly recognized wounds. These include abrasions, incisions, lacerations, punctures, avulsions, and amputations (Types of Wounds). It should however also be noted that many wounds are in fact a combination of these fundamental types (Types of Wounds).

4. Assessment and Treatment

Assessment depends on being able to identify the different stages of the state of the wound. For example, one can determine that the wound is in the proliferative phase of healing by observing that there is a reduction of any bleeding and the wound is pink or red in color (Phases of Wound Healing). Observing color and granulation are indicators of the state of the wound and how it is healing. For instance, "Dark granulation tissue can be indicative of perfusion, ischaemia and/or infection. Epithelial cells finally resurface the wound, a process known as 'epithelialisation'. (Phases of Wound Healing).

4.1. Basic Wound assessment

Assessment and treatment should also take into account other factors, such as any comorbid factors in the health of the patient; for example diabetes or cardiovascular conditions. Allergies should also be observed. Performing a basic wound assessment would therefore mean taking these and other significant variables into account, as well as ascertaining the condition and state of the wound. The assessment of pain and infection in the wound is extremely important. The nurse should therefore assess the wound in terms of the "… type and amount of each respective tissue type present (necrotic, sloughy, granulating) and also the level of pain, infection, exudate and odor present" (Patient Assessment).

5. Wound Dressings

Applying the correct dressing is extremely important in preventing infections and accelerating the healing process; for example to prevent infections such as Staphylococcus aureus, which is known to produce a fibrin-rich biofilm that is "… resistant to the body's natural immune response to foreign bodies" (Wound Care - Types of Dressings).

A few examples of the most appropriate types of dressings for specific types of wounds are as follows. In malodorous wounds the more appropriate dressing would be "Systemic antibiotics only if clinical signs of infection seen. Foam or alginate with activated charcoal. Flagyl Gel with caution"(Wound Care - Types of Dressings). This type of dressing is intended to clear any infection, reduce odor, absorb exudate, and protect. However, in a wound that is yellow necrotic with high exudates, which often result for infections, the following dressing is recommended: "Hydrocolloid with hydrocolloid paste if deep. Hydrogels. Alginates or enzymatic (elase)removal of slough"(Wound Care - Types of Dressings).

Conclusion: Documentation

Wound assessment should be accompanied by accurate and comprehensive documentation. The reason for this is that documentation provides a record and an evaluation of the wound status and it is on… [END OF PREVIEW]

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