Apply principles of wound management in the clinical environment

all questions in the 3 case studies and general questions.

 

Case Study Scenario 1 – Burn Injury:

Carol Mitchell, aged 64 was admitted to the burns unit after sustaining burns to the front and back of her left lower leg and foot.  Carol had been cooking in her kitchen when she accidentally knocked a saucepan full of hot oil over herself. Carol’s husband drove her to the nearest medical centre where Carol’s burn was treated and then she was transported by ambulance to the hospital for further assessment.

15595171 / Bork / shutterstock.com

In the emergency room, Carol was conscious and in evident distress. Her admission notes were: areas of variable depth of injury over her lower leg and foot; dark pink discoloration with sluggish capillary refill, blistering is evident; an area on her inner left ankle has an area of blotchy red/white with sluggish to absent capillary refill, patient is complaining of pain on her lower leg, but states that her ankle is somewhat pain free.

After consultation with the Burns team, the burns are to be surgically debrided and a small skin graft will be applied to her inner ankle injury.

 

 

Case study 1 - Short answer questions:  word count and referencing stated where required

Read each question carefully and ensure you answer each part.

 

Q1.    The wound healing process commences when any damage to the skin has occurred. Once the skin is impaired and a wound is created the healing process begins. This is a dynamic and complex process. It consists of four stages

Match the stage with the physiological and biochemical processes

  • haemostasis – stage 1
  • inflammation phase – stage 2
  • proliferation or reconstruction phase – stage 3
  • maturation phase – stage 4

 

Stage

physiological and biochemical processes

Stage 3

(proliferation or reconstruction phase)

During this phase tissue is temporarily replaced and the area is cleaned up by macrophages which digest the dead bacteria and debris.  New blood capillaries are developed and granulation tissue (mainly collagen) is laid down. As granulation tissue continues to be laid the epithelium thickens to 4 to 5 layers forming the epidermis. The wound contracts and becomes smaller. This stage can take from 2 to 24 days

Stage 1

(haemostasis)

Process of the wound being closed by clotting. Starts when blood leaks out of the body. The first step is when blood vessels constrict to restrict the blood flow. Next, platelets stick together in order to seal the break in the wall of the blood vessel. Finally, coagulation occurs and reinforces the platelet plug with threads of fibrin which are like a molecular binding agent, this stage happens very quickly

Stage 2

(inflammation)

Vasodilation of surrounding tissues occurs due to the release of histamine and other vasoactive chemicals.  This increases blood flow to the surrounding areas which leads erythema, swelling, heat and pain.  White blood cells descend into the area as a defense response. This phase lasts approximately three days

Stage 4

(maturation phase)

The wound and surrounding tissue is gradually remodeled and the collagen cells laid down are strengthened. This stage can last from 24 days to approximately one year. During this stage the wound is still at risk and should be protected.

 

 

 

Q2a. Skin Assessment – outline the steps of the skin assessment for Carols Burns that would be carried out immediately on admission to the emergency department. (Max 80 words, reference)

Skin assessment: the skin assessment can capture the general burn condition of the patient in emergency department. The steps of skin assessment are as follows:

Careful palpation as well as inspection of the skin

Documentation of the findings

Assessment of color, temperature, mobility, moisture content, lesions, and turgor of the skin

Toenails to be palpated and inspected

The lesions are to be categorized into primary or secondary lesions.

 

Q2b. Part of the assessment (here is a clue for the above question) is burn size, using the burn chart (below), Tick the correct estimate of the size of Carols Burn using the information in the scenario

      Burn percentage 20% approx.

?    Burn percentage 9% approx.

      Burn percentage 27% approx.

      Burn percentage 0.7% approx.

224297740 / stihii / shutterstock.com

Q2c. When a patient suffers a burn injury it is important to classify the wound.

Please provide a description for each of the classifications in the table below.

 

Classification

Description

Superficial

It leaves the deep inside skin layers intact. The superficial wounds are generally caused by the frictional force rubbing against the surface.

Partial thickness

the partial thickness wounds are extended to the first two layers of the skin i. e. epidermis.

Full thickness

it extends the two layers of the skin including dermis and epidermis. It also extends towards subcutaneous tissues containing fat and muscle cells.

 

State which one would most likely apply to Carol’s area of her burn around her inner left ankle

Partial thickness wound.

 

Q2d. When undertaking a wound assessment the main purpose is to optimise the healing process and to produce a baseline status against which the healing process can be measured(max 100words, reference)

Outline four (4) aspects you may consider when conducting a holistic wound assessment.

Please provide a reason for each of your choices. (Max 100words, reference)

Marking of the measurement: measurement is done for the wound assessment. The wounds should be measured in centimetres.

Site of the wounds: location of the wound is the valuable information for assessment.

Examination of the wound: four types of tissues are present in the skin such as epithelial tissues, granulation, eschar, and slough. The tissue type should be distinguished to identify the wound location. The characteristics of the tissues may be changed indicating the progress of the healing.

Examination of surrounding skin: the surrounding skin should be macerated to determine the prolonged exposure of the moisture. This step indicates the type of dressing that should be done.

 

 

 

Q3a. As stated in the case study Carol is complaining of pain

Which of the following strategies may be utilised to provide comfort to Carol? (There is more than one)

?    Provide pain relief

?    Provide distraction therapy

?    Elevate Carol’s foot above heart level

      Ensure bed comfort

      Assess stress / anxiety levels and look at reducing these

      Inform Carol that pain is a normal aspect of a burn and there is not much that can be done to reduce all pain

 

Q3b. Describe an appropriate pain assessment tool

Why it is important to reduce pain levels in patient with woundsx? (Max 100 words, reference)

  • Assessment of the background pain while the patient is at rest. The background pain is caused due to the thermal tissue injury with moderate intensity and long duration.
  • The next step of assessment tool is the procedural pain assessment. It is the intensified pain that can be generated by the debridement of the wounds. The changes of dressing or rehabilitation can relief this kind of pain.
  • The next step of pain that the assessment tool measures is the break through pain. It is unexpected kind of pain caused when the effects of analgesic drugs are exceeded. It can happen while the patient is at rest or during stress.
  • Chronic pain lasts for more than six months. It occurs after complete healing.

The pain level should be reduced to the patients otherwise increased pain may result into the failure of heart.

 

Q4.    It was noted in the case study for Carol that she required “surgical debridement” to her burns

State what surgical wound debridement is and why is it done? (Max 40 words, reference)

Debridement is the procedure by which wounded skins are treated. It may involve the complete cleaning or removal of the hyperkeratotic skin, non-viable, or infected skin tissues along with foreign residual matters or debris by surgery.

It is done for lowering the pain by allowing the healing of the skin.

 

 

Q5.    Describe how the skin heals with the assistance of a skin graft. (Max 100 words, reference)

Skin grafting is done for the healing of the skin by removing one area of the body for repairing the damaged skin tissues or layers. The removed skin part is grafted to some other parts of the body. The skin does not have blood flow with its own sources. Thus, skin grafting can be helpful in healing more quickly by reducing the scars. Skin grafting can be done in the following ways:

  • A flap of the skin containing fat and muscle is to be cut
  • The flap skin remains attached to the original site by one end for carrying blood supply
  • The flap skin is then removed to the new site where it is to be grafted

 

Q6.    When assessing a patients wound discuss 2 common problems / complications you may encounter

Infection: Microbial contamination in the wounded tissues

Osteomyelitis: Spreading of the infection to the surrounding tissues.

 

 

 

Case Study Scenario 2 – Pressure Ulcer:

John James is an 82 year old male who has been a resident in the high care ward of a local aged care facility for the past 2 years.  His mobility has been decreasing since admission and he now requires 2 hourly turns when in bed and is reliant on a hoist and wheelchair. 

John is incontinent of both urine and faeces and has a poor dietary intake.  John’s skin is paper thin and the pressure ulcer on his sacrum, below has increased in diameter by 2cms over the last 2 weeks. 

John was recently transferred into your hospital ward with chronic bronchitis.

417970330 / Elena Kitch / shutterstock.com

 

 

 

Case study 2 - Short answer questions:  word count and referencing stated where required

Read each question carefully and ensure you answer each part.

 

Q1a. You have been asked to attend to the dressing of Johns wound. What would be a suitable dressing to use on Johns wound

Alginate dressing.

 

Q1b. State the goal of this treatment as per Q1a – what are you trying to achieve by maintaining a moist wound environment (max 80 words, reference)

Alginate dressing is done to treat the patients with pressure ulcers by promoting healing of the tissues. With the sloughy wounds alginate can be used in dressing. It provides a moist covering on the wound by preventing dryness and allowing the wound to get healed up quickly. Alginate dressings are biodegradable. For the moist environment of the wounds it is most applicable. These dressings are made from the sea weeds. Alginate can absorb exudates 15 to 20 times of their own weight.

 

Q1c. State whether John required a primary or secondary dressing, or both, and provide a rationale for your choice (max 70 words, reference) 

John is required secondary dressing with non-adherent primary dressing composed of alginate. The secondary dressing is required to hold the primary alginate dressing in place. Otherwise, the primary alginate dressing can do the needful. The primary alginate dressing would interact with the sodium and calcium ions secreted from the wound region in order to determine the intrinsic properties. The secondary dressing to be used to keep the primary dressing in place may be an adhesive Biatain Silicon. It would help in resolving infection.

 

 

 

Q2a. Most infections agents are micro-organisms, these include: – (choose one answer)

      Bacteria, viruses, Soil, protozoa and prions

      Bacteria, Candida, fungi, protozoa and prions

?    Bacteria, viruses, fungi, protozoa and prions

      Bacteria, viruses, fungi, protozoa and dust

 

Q2b. Match the common fungal infections with their major reservoir

Common fungal infection: Candida albicans, Aspergillus organisms

Common fungal infection

Major reservoir

Aspergillus organisms

Soil, dust, mouth, skin, colon, genital tract

Candida albicans

Mouth, skin, colon, genital tract

 

Q2c. Match the common viral infections with their major reservoir

Common viral infection: Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus (HIV), Herpes simplex virus (type I)

Common viral infection

Major reservoir

 

Reservoir

Hepatitis A virus

Faeces

Hepatitis B virus

Blood and body fluids

Hepatitis C virus

Blood

Human immunodeficiency virus (HIV)

Blood, semen, vaginal secretions (also isolated in saliva, tears, urine and breast milk, but not proved to be sources of transmission)

Herpes simplex virus (type I)

 

Lesions of mouth or skin, saliva, genitalia plus herpes zoster (shingles) or viral warts or herpangina (oral ulcers)

 

 

 

Q2d. On the picture below, place an X on each of the areas that pressure sores can develop.

State 4 pressure relieving devices that may be used for John either in hospital or when he goes back to the aged care facility

 

X

X

X

X

X

X

X

X

X

X

 

132726884 / Anna Rassadnikova / shutterstock.com

 

Pressure relieving devices

1. High foam mattress

2. Splint

3. Pillows

4. Heel throughs

 

 

Q3.    Match the Ulcer type with their specific characteristic

Ulcer type:Venous ulcers, Diabetic ulcers, Arterial ulcers, Pressure ulcer:

Ulcer type

Characteristic

Venous ulcers

Caused by ischaemia; related to the presence of arterial occlusive disease; symptoms include pain and tissue loss

Diabetic ulcers

Local losses of epidermis and various levels of dermis and subcutaneous tissue, occurring over or near the malleoli at the distal lower extremities; caused by edema and other sequellae of impaired venous return.

: Arterial ulcers

Caused by trauma or pressure secondary to neuropathy or vascular disease related to diabetes mellitus.

Pressure ulcer

Caused by pressure which destroys soft tissue

 

Q4.    As John is quite elderly and his mobility has decreased, outline 3 risk assessments you can do, and using your research state 2 common risk assessment tools used in Australia (max 80 words, reference)

Risk assessment is necessary for the persons while they are entering into the setting of new care. Risk assessment can quickly identify the changes of the pressure ulcers in the patients. Assessment can minimize the risk factors associated with the pressure ulcer (Achten et al., 2018). The assessment can take care of the patients on daily basis.

Effective assessment tool for Australian patients can be Braden scale.

 

 

 

Q5.    There are four stages of pressure ulcer formation each stage has its noted characteristics.
Match the stage with the presentation.

Stage: Stage 1, stage 2, stage 3, stage 4.

Stage

Presentation

Stage 1

pressure injuries present as shiny or dry shallow ulcers without any bruising present

Stage 4

Pressure injuries are the most severe and represent full-thickness tissue loss with exposed bone, tendon or muscle

Stage 3

pressure injuries present as areas of persistent, non-blanch able redness when compared with the surrounding skin

Stage 2

Pressure injuries represent full-thickness skin loss. Subcutaneous fat may be visible, but bone, tendons or muscle are not exposed.

 

State which stage you think John’s pressure ulcer is at

Stage 2

 

Q6.    When the nurse is assessing Johns wound he/she documents what it looks like using a variety of methods.

Choose from the following words and fill in the blanks with words that match them to the sentences.

Probe, marking pen, wound tracing, a ruler, written consent, Ttransparent acetate grid, clinical wound photography, wound measurement.

Ttransparent acetate grid provides the most accurate and objective means of assessment and

evaluation of wound treatments.

clinical wound photography can be used to provide an accurate measurement of the length and width

of a wound

Assessment of the depth or length of a wound can be performed using a wound measurement

Using a two-dimensional method such as by tracing the margins of the wound can be assessed

using a probe and marking pen.

It is essential that written consent is obtained from the patient/relative or carer

prior to taking photographs

 

Q7.    Johns doctor has ordered a Doppler ultrasound, what does this involve (max 60 words,reference)

The Doppler ultrasound test uses sound waves of high frequency for the measurement of blood flow through veins and arteries. The Doppler is specifically used to supply blood to the arms and legs. The vascular flow or blood flow studies can detect the abnormal blood flow in the arteries or blood vessels.

 

Q8.    Identify and discuss 2 effects on wound healing in regards to complex and challenging wounds(max 100 words, reference)

Factor

Effect on wound healing

Oxygenation

: oxygen has significant role in the process of wound healing. Oxygen is required for the function of killing bacteria or other resistant types of infection. Oxygen can stimulate the creation of new blood vessels by aiding growth factors in the formation new skin.

 

Infection

: infection is the localized defect as well as excavation of skin underlying the soft tissues caused by pathogenic infection. The infectious tissues are surrounded by viable tissues. Infection can trigger the immune responses of the body causing inflammation or tissue damage (Dolete et al., 2018). Infection can slow down the healing process.

 

 

 

Q9.    Many factors affect the wound-healing process. Therefore, wound management strategies must be tailored to meet the individual holistic needs of the patient, their wound and their environment.

Tick the sentence that best outlines the principles of wound management 

      Assess and correct cause of tissue damage

      Assess wound history and characteristics

      Ensure adequate tissue perfusion

      Wound-bed preparation

      Wound cleansing

      Wound-cleansing solutions and techniques

?    All of the above

 

 

 

 

Case Study Scenario 3 – Infected Surgical Wound:

Ms Maggie Malone is an obese 52 year old female, who was admitted to the orthopaedic ward for a total left knee replacement.  Staples were the method of wound closure. 

Ms Malones’ medical history reveals that she is a heavy smoker, smoking at least 30 cigarettes / day and was diagnosed with Diabetes type 2 around 4 years ago, but has not been following a recommended diet.

Day 5 post-op: Maggie is complaining of pain in her left knee, she is febrile 38.7C and an increase in discharge from her wound on her dressings is apparent.  On removal of the wound dressings, the wound appeared reddened and inflamed; staples are insitu; an open 1.3cm gap at the lower end of the wound was obvious and is oozing purulent fluid.  A wound swab is taken and results show a Methicillin-resistant Staphylococcus aureus (MRSA) infection

On reading the surgeons’ instructions: “Antibiotics to be commenced; Wound cavity to be dressed daily with Dressing as per directed by wound specialist

Ms Malone is reviewed by the wound management nurse who documented the following:

“Nursing: Wound to heal by secondary intention. Wound cavity measures 13mm long x 10mm wide and 8mm deep, extending to the subcutaneous tissue layer. Wound bed consists of 100% granulation tissue; is malodorous and is oozing a moderate amount of haemopurulent exudate. Staples to remain insitu until day 10 post-op“

74838715 / jsouthby / shutterstock.com

 

 

Case study 3- Short answer questions:  word count and referencing stated where required

Read each question carefully and ensure you answer each part.

 

Q1a. Maggie’s Husband comes to visit and he has asked you to explain Maggie’s infection, how she got it and how long will she have it for, to be able to explain to Maggie’s husband you need to understand the chain of infection

Listed are the 6 elements required for a disease to be spread (start with infectious agent). Label the following chain of infection diagram with these elements in the correct order.

Beside each element state how it applies to Maggie’s wound

  • Infection Agent - Staphylococcus aureus
  • Susceptible host - Maggie
  • Portal of exit - wound
  • Reservoir – infected tissue, blood stream
  • Mode of transmission – infected tissue
  • Portal of entry - coughing or sneezing

 

95425765/ billdayone/ Shutterstock.com. Modified by TAFE Queensland.

Q1b. Using the above model, it could be suggested that this is a hospital acquired infection (HAI). 

Please provide a brief discussion on how you would explain this to Maggie’s husband. Provide this education as though you were speaking to the client’s husband. (Max 80 words)

the infection has been occurred to Mrs. Maggie by Staphylococcus aureus. The bacteria can be spread directly by the contact with infectious tissues. This is a hospital acquired infection. The uses of contaminated objects can cause this infection to occur. The inhalation may also spread the bacteria. Dispersed coughing or sneezing are also causal factors. The bacteria can spread through blood streams or infected organs. Thus, it seems that Maggie has been infected by one pof the following ways in hospital.

 

Q1c. Tick true or false for the following in regards to the bodies defence mechanisms against wound infections

 

True

False

The body has normal defenses against infection.

?

 

Each organ system has defense mechanisms to protect against exposure of infectious microorganisms.

 

?

Normal flora, body system defenses and inflammation are non-specific defenses that protect against microorganisms, regardless of previous exposure.

?

 

Separate cells and molecules of the immune system don’t help the body resist disease.

?

 

Immune-system responses are either pathogen-specific or non-pathogen-specific defenses. If any of the body's defenses fail, an infection can quickly progress into a serious health problem.

?

 

 

 

 

Q1d. Discuss in terms that you can understand - the immune response in regards to infections. (Max 100 words, reference)

The task of the immune system is to protect the host body against the infection of the pathogens. Immune system thus helps in protecting the body from getting infected. The appropriate immune system requires reciprocal interactions with the infectious agents or pathogens. Thus, innate and adaptive immunities come into question. Immune system increases the blood flow in the local region and sends the cells of the immune system to destroy or attack the bacteria (Brennan, 2017). Antibodies are produced from the immune system to attack bacteria for destroying them. The specific immune system against pathogens involves T lymphocytes and antibody. Antibody-dependent cell-mediated cytotoxicity (ADCC) is formed within the body.

 

Q2.    Standard and Additional precautions – Using the word bank complete the sentences in regards to precautions. (fill in the blanks)

Word bank: Mucosa, airborne, fluids, single, all, contact, suspected, infection, skin, known, droplet, co-horted

Maggie requires both standard and additional precautions, standard precautions are infection

control practices used for co-horted patients, regardless of their known

infection status.

 

Standard Precautions dictate that personal protective equipment (PPE) must be worn when there

is a risk of contact with all, non-intact contact Or contact

 

Infection may be transmitted in various ways. The 3 transmission categories are Mucosa,

fluids and airborne

 

Maggie’s type of transmission is airborne

 

Transmission-Based Precautions are infection control practices used for patients with

Suspected  Or known conditions.

 

As Maggie has MRSA, an infectious condition she would require additional precautions and should

be nursed in a single room or droplet in a room with a patient with

the same infectious condition.

Q3.    As stated in the case study Maggie had a wound specimen taken .The following pictures are 16 steps of collecting a wound swab for micro-culture and sensitivity (M/C/S). Number the steps on the diagrams from 1 to 16 in the correct order.

Who would you discuss the results with when they are sent through to the ward?

................................................................................................................................................................

 

Step:    11

245726332 / Tibanna79 / shutterstock.com

Swab entire wound for 30 sec over clean granulation tissue

Step:    7

308859290 / Henrik Dolle / shutterstock.com

Label specimen immediately to clearly identify patient and specimen

Step:    8

170667929 / Sherry Yates Young / shutterstock.com

Clean the wound to remove normal flora & old drainage

Step:     6

17248321 / Ed Phillips / shutterstock.com

Read pathology request form. Determine specimen to be collected

Step:    10

515115067 / igorstevanovic / shutterstock.com

Return swab to container, taking care not contaminate swab tip 

Step:    9

485769865 / strawberrytiger / shutterstock.com

Place specimen & request slip in biohazard bag & send to laboratory

Step:   

320251289 / Nonlani / shutterstock.com

Hand hygiene

Step:   

235290421 / Meg007 / shutterstock.com

Remove gloves if worn

 

 

Step:    3

320251289 / Nonlani / shutterstock.com

Hand hygiene

Step:   

453278584 / FutureL / shutterstock.com

Moisten tip of swab with sterile water

Step:    4

631750559 / Fuller Photography / shutterstock.com

Gather equipment

Step:     1

317578808 / Monkey Business Images / shutterstock.com

Explain procedure, obtain consent, assess pain, offer analgesia

Step:     5

175257935 / Jeffrey B. Banke / shutterstock.com

Apply PPE if needed

Step:    2

17248318 / Ed Phillips / shutterstock.com

Complete pathology request slip with patient details & details of specimen

Step:   

21608890 / Daleen Loest / shutterstock.com

Await results and follow-up

Step:   

141478696 / racorn / shutterstock.com

Document in Progress Notes

 

 

 

Q4.    What impact will the following issues have on Ms Malones’ wound healing and her activities of daily living? Including psychological impact

Put each of the above issues under a heading and discuss each in detail.  Support each issue with research and a clear rationale (reason) for why it will affect her healing. This question is looking for your ability to problem solve and critically think. (Max 150 words, reference)

Poor nutrition

Poor nutrition can affect the patient suffering from type 2 diabetes. The unproper diet can increase the chances of diabtetes more. The diabetic patients undergoing the knee replacement surgeory have to face severe conditions for this reason. In daily life the patient should take proper diet so that the diabetes remains under control.

 

Smoking

Smoking increases the chances of bronchial infection with poor immune power to the patients suffering from type 2 diabetes. One infection increases the chances of occurrence of other related infections (Cancio et al., 2017). The patient has to suffer from both infection in the wounded site and also bronchial infection. Smoking increases the risks of lunf infection that can become chronic in the other infectious patients.

 

Diabetes

Diabetes increases the chances of infection in the body by lowering the immune system. Diabetes can cause the delay in healing process in the infected tissues. The blood clotting period increases. Thus, the patients has t suffer for longer period of time than expected. Sdiabetes increases the risk factors of many other related diseases.

 

 

 

Q5.    Develop a nursing plan of care for Ms Malone. Your care plan must follow a nursing problem solving approach using the table below 

Give one nursing intervention for each problem stated below i.e. a total of 5nursing interventions that you would put into place to assist Ms Malone with the following problems. (Max 300 words)

Support each intervention with a rationale/reason, evaluation and a reference

 

PROBLEMS:

  • the location of her wound
  • activities of daily living
  • reduced mobility
  • Pain
  • Referral needs – which other health team members both within and outside the hospital environment would be involved in the care of Ms Malone.

Problem

Intervention

Rationale

Evaluation

(including how you would involve the patient?)

Location of Wound

Primary dressing to be done.

The type mof dressing varies with the locations of the wound. For example the wound in the legs or arms require alginate dressing. Thus, primary dressing is solely dependent on the location of wound.

The patient should be undergone primary observation after dressing. Then he/she should be suggested with surgery if required.

Activities of Daily Living

Daily routine of walking, diet plan, and physical activities should be asked to the patient.

Daily excercises, diet plan, walking can reduce the severity of many diseases, especially for the infectious diseases.

Proper diet can minimize the risk factors associated with diabetes. Walking or other physical activities are also helpful in this manner. Thus, the risks of infection is less.

Reduced Mobility

Assessment of the degree of mobility

Reduced mobility can be resulted from a lot of reasons. It may include infections to different body parts.

Reduced mobility should be treated as early as it is diagnosed.

Pain

Type of pain should be assessed. Pain management should be started immediately. 

Pain can be actute or chronic. Acute painj can result in different fatal conditions including failure of heart.

Pain management should be done to relief the pain immediately.

Referral Needs

Park, Hwang, & Yoon, (2017)

Knight et al., 2019

Lindholm & Searle, (2016)

General Questions

Q1.    Refer to the following webpage and identify and provide a brief description regarding the intention of the 2 standards that could relate specifically to wounds and infections (max 60 words)

https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf

Clinical workforce: it is necessary to deliver the high quality with safe health care services for the improvement of the system. The clinical workforce should actively participate in the organizational processes. They need to understand the responsibility in terms of quality and safety.

Health service owners: they have to plan accordingly to integrate the governance for promoting safety of the patients with quality work in the organization (Lipsky et al., 2016). The explicit support is required for the patients and family members.

 

Q2.    Outline the difference between an acute wound and a chronic wound (max 40 words, reference)

Acute wound: it gets progress through the normal stages of the healing procedure.

Chronic wound: it can result in to further complications if care is not taken properly. Chronic wound can create pain and inflammation. 

 

 

Q3.    Review the following case studies and underline if you think it is either an Acute or chronic wound.

 

Acute

Chronic

Sam had a motor bike accident and sustained a leg wound that required stitches, there is serous discharge coming from the wound. 

?

 

6 weeks later Sam’s leg wound has an area where there is thick yellowish drainage into the dressing

?

 

John M. is 66 years old and has been a widower for 6 year, his neighbour has noticed that John has had no appetite, has lost weight, and has had a meaningful decline in function. She visits more frequently, bringing meals and trying to encourage him to eat. On her most recent visits she has noticed a foul odour in John’s home. He attributes it to his poor housekeeping and hygiene. She perceives the odour in his home to be fouler and notices that the front of his shirt over his abdomen is damp. She is very worried and after a lot of coaxing she convinces John to go to the hospital, and calls an ambulance.  An abdominal examination reveals an extensive open wound with copious discharge and a foul odour, which has permeated the whole area. The wound extends from about the midline of his abdomen to his left flank, measuring 22 cm by 16 cm. a biopsy of the wound is performed and confirms a malignant squamous cell carcinoma.

 

?

A 55-year-old woman was admitted to the surgical ward for exploration of a persistent sinus on the lower left leg,  An ultrasound examination showed a cavity suspected to be an abscess, which was then explored and drained

 

?

Mrs brown is a 65 year old lady who is a diabetic with peripheral neuropathy, 8 weeks ago she sustained a scape on her left leg while weeding some dense bush in her backyard, she treated it herself but it is not healing and has gotten bigger and begun to ulcerate with some parts turning dark brown, finally she went to her GP and he admitted her to hospital where she was facing cleaning and debridement of the wound which was diagnosed as a diabetic neuropathic ulcer.

?

 

A 65 year old gentleman was operated with abdominoperineal rectal excision and a sigmoideostomy. Ten days later total wound dehiscence and evisceration (bowel contents protruding through the abdominal wall). Abdomen had to be left open collecting small bowel contents in a specially designed fistula bag, the patient went home with ongoing wound dressings over a period of 3mths.

?

 

 

 

 

Q4a. Jack Sparrow has a surgical wound with a Jackson Pratt drain, which of the following are correct in regards to management of jacks drain (Tick 4 correct answers.)

      ?Check for infection

      Maintain bulb patency as per Drs Orders

      ?Immediately remove if you think it is blocked

      ?Adhere to facility policy and procedures when caring for a Jackson Pratt Drain

      ?Document the amount of drainage

      No need to check the connections as this is a closed system

 

Q4b. Mr Jones who has a history of chronic venous disease and leg ulcers has returned from theatre after hip surgery and is fitted with elastic compression stockings (TED) and sequential compression device (SCDs).

Which of the following 3 points are NOT true when it comes to the management techniques of compression devices.

      The stockings are not to be rolled down, cut or otherwise altered

      ?Thigh-length stockings prevent proximal VTE better than knee-length stockings

      SCDs are not worn when a patient has an active VTE because of the risk of PE

      If the stockings are not fitted and worn correctly, venous return is impeded

      ?SCDs will still be effective if they are not applied correctly

      ?They apply external pressure to the lower extremities by means of an electric pump

      TED stockings are a part of VTE prevention in hospitalised patients

      SCDs are inflatable garments wrapped around the arms

 

Q5a. Provide a brief outline in regards to the historical development of contemporary wound management strategies (Max 150 words, reference)

There are five strategies for the historical wound management described below:

Haemostasis: it is the process causing bleeding to stop. It is the spontaneous process.

Analgesia: it follows the easier closure of the wound. Infiltration of a local anaesthetic is common process.

Dressing along with follow up advices: it reduces contamination and infection. Non-adherent laceration can be added.

Cleaning of the wound: it reduces the infection by promoting healing. Disinfectants can be used.

Skin closure: skin adhesive strips, adhesive glue for skin, sutures, and staples can be used.

 

Q5b. Visceral wounds often involve the internal organs of the body, specifically those within the chest (heart, lungs) or abdomen (as the liver, pancreas or intestines) often injury is by gunshot or stabbing.

Steven was involved in a fight late at night, he was stabbed and sustained a deep penetrating abdominal wound. He was transferred to the emergency department where he underwent damage control surgery for a laparotomy to discover the extent of damage and a temporary closure to part of his wound was made with a vacuum dressing, he was to have further surgery once stable 

Which of the following may NOT be included as wound management strategies for visceral wounds

      Pain control

      Keep wound area clean

      Daily wound dressing change

?    Watch for bleeding

 

Q5c. Research your community or online to identify educational resources, community services, and or professional organisations associated with wound management and prevention programs located in Australia. List a minimum of 2.

Wound healing institute Australia

Wound Management Institue Australia

 

References

Achten, J., Vadher, K., Bruce, J., Nanchahal, J., Spoors, L., Masters, J. P., ... & Costa, M. L. (2018). Standard wound management versus negative-pressure wound therapy in the treatment of adult patients having surgical incisions for major trauma to the lower limb—a two-arm parallel group superiority randomized controlled trial: protocol for Wound Healing in Surgery for Trauma (WHIST). BMJ open8(6), e022115.

Brennan, M. (2017). Wound management: effective treatment factors and strategies.

Cancio, L. C., Barillo, D. J., Kearns, R. D., Holmes IV, J. H., Conlon, K. M., Matherly, A. F., ... & Palmieri, T. (2017). Guidelines for burn care under austere conditions: surgical and nonsurgical wound management. Journal of Burn Care & Research38(4), 203-214.

Dolete, G., TIH?UAN, B. M., TUTUNARU, O., MOCANU, I. C., BALA?, C., LAVINIA, I., ... & MAIER, S. S. (2018). Development and sequential analysis of a collagen-chitosan wound management biomaterial.

Knight, R., Spoors, L. M., Costa, M. L., & Dutton, S. J. (2019). Wound Healing In Surgery for Trauma (WHIST): statistical analysis plan for a randomised controlled trial comparing standard wound management with negative pressure wound therapy. Trials20(1), 186.

Lindholm, C., & Searle, R. (2016). Wound management for the 21st century: combining effectiveness and efficiency. International wound journal13, 5-15.

Lipsky, B. A., Dryden, M., Gottrup, F., Nathwani, D., Seaton, R. A., & Stryja, J. (2016). Antimicrobial stewardship in wound care: a position paper from the British Society for Antimicrobial Chemotherapy and European Wound Management Association. Journal of Antimicrobial Chemotherapy71(11), 3026-3035.

Park, J. W., Hwang, S. R., & Yoon, I. S. (2017). Advanced growth factor delivery systems in wound management and skin regeneration. Molecules22(8), 1259.

 

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