Introduction
The process of wound assessment requires accurate and appropriate interventions while dealing with the patients. There are some major components which the operator must consider to effectively access an infection, and they require a range of skills and knowledge. These factors are the knowledge of relevant anatomy and physiology, the understanding of the various factors that accelerate wound growth, and the ability to listen and understand the patient’s needs. In wound accessing, the doctor should have an idea concerning the number and location of wounds, the required treatments depending on the type of infection, the type of wound in accordance to various grading given, and the procedures to follow to achieve the treatment objectives (Collier, 2011). An aseptic technique in wound management aims at hindering the introduction of microorganisms into the wounds during treatment period. These techniques are practices before, during, and after the wound surgery procedures. Two forms of aseptic techniques are used which are: general asepsis, concerned with the patient care outside the operating theatre, and surgical asepsis concerned with preventing infections during surgery time (Rowley & Beer, 2010).
Wound management is an important issue and failure to manage the wound properly causes the infections to prolong for days. Nurses and doctors have the responsibility of ensuring that the patients are well treated, and the area with infections taken care of. In the case of Sophie, the nurses failed to monitor the healing process, which caused the infections to accelerate. Wound dressing is a factor that accelerates would breakdown if not perfectly done. In this discussion, the issues related to post operative assessment, ...
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...chnique. NHS Foundation Trust. Journal
from Infection Control Department. 2
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Currently health care facilities use individual, multi-component interventions, or series of interventions to prevent pressure ulcers. Either health care staff is not implementing these strategies into their patient’s care or some changes obviously need to be made. Interventions to prevent pressure ulcers consist of using the Braden Scale for initial and repeated skin assessments to determine the patient’s risks for pressure ulcers, specialized support mattresses, heel supports, and frequent repositioning for bed bound patients, encouraging mobility, moisture management, nutrition, hydration, and reducing friction or shear forces on parts of the body at increased risk for pressure ulcers (Sullivan & Schoelles, 2013).
With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in the position of providing pressure ulcer care and prevention. Immobility, advanced age, incontinence, prolonged pressure or friction, inadequate nutrition, dehydration, anemia, hypoxemia, multiple comorbidities, sensory deficiency, thin skin, prominent bony prominences, circulatory abnormalities, pain, and smoking are important risk factors. The barriers in the implementation of preventive measures are staff shortage, shortage of pressure relieving devices (e.g., foam or air mattresses), excessive workload, and uncooperative patients. The Centers for Medicare and Medicaid Services has classified the pressure ulcers as a preventable Hospital Acquired Conditions and stopped reimbursing for such hospital acquired conditions. In the United States, the cost of an individual patient care per pressure ulcer includes skin cleanser, moisturizer, dressings, wound debridgement, antibiotics, analgesics, turning sheet and support surfaces, nursing time for risk assessment, monitoring, and repositioning. It is the second most common claim after wrongful death and greater than falls or emotional distress. No matter what causes the pressure ulcers, the presence or absence of pressure ulcers is generally regarded as a performance measure of quality nursing care and overall patient health. Pressure ulcers can be avoided by applying simple interventions like factor assessment scales and regular turning of the patient. Proper hydration, a balanced diet, activity, wound care, and keeping patient’s skin and body dry are treatment, as well as, preventive measures of this problem. A thorough physical assessment, risk assessment (using a risk assessment tool like Barden scale), repositioning, patient and caretaker education, effective communication, and
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
...k two nurses to change the dressing- one to lift the folds of skin and the other to pack the wound. Continuing to mark the date and the margins of the wound, Katie’s nurses and doctors were hoping for a survival. Nutritional support at this point was entered via gastrointestinal tubing and by this time Katie was going through major psychological wounds that needed healing as well. Sadly the doctors were not able to prepare Katie to go home. Despite fasciotomy and the surgery, her infection continued aggressively. Her wound after surgery had a foul-smelling drainage, which increased in amount every day. Local cellulitis developed at the IV site on her arm. Just 10 days after the first surgery she underwent a second infection spreading around her hip area. Despite all efforts by Katie and the hospital staff, she died of septic shock and multisystem organ failure after 30 days in intensive treatment. Although flesh-eating disease is always life threatening and in most cases results in a fatality, it doesn’t have to have an unhappy ending if you use prompt recognition and go to clinical expertise within the first sign of the disease. Don’t let it get you!
Education of the patient will begin. Depending on the size of the abscess and how extensive the procedure was the patient may need a relative or friend to drive them back home. Not only would the patient need a ride back home, they may need to be watched for 24 hours. As part of pain management pain medication may be given to the patient to decrease pain. Antibiotics may be given to fight or prevent infection caused by the bacteria. The patient will also need to list all medications that they are taking so there will not be any contraindications with the medications that the patient is given. Advise the patient that more than one follow-up appointment will be necessary in order to properly treat the wound. Before the end of the appointment, the medical assistant should give the patient written instructions along with an emergency number and the number to the practice incase the patient has any questions or concerns. Advise the patient to return to the practice if they experience any fever, chills, or the abscess returns. If red streaks appear around the wound tell the patient to call the emergency department immediately. After the the procedure and patient education has been completed, make sure all the step of the procedure has been documented in the patient’s record and all follow-up procedures have been
Prevention of hospital-acquired infections: review of non-pharmacological interventions. Journal of Hospital Infection, 69(3), 204-219. Revised 01/20 Haugen, N., Galura, S., & Ulrich, S. P. (2011). Ulrich & Canale's nursing care planning guides: Prioritization, delegation, and critical thinking. Maryland Heights, Mo. : Saunders/Elsevier.
Pain and suffering is something that we all would like to never experience in life, but is something that is inevitable. “Why is there pain and suffering in the world?” is a question that haunts humanity. Mother Teresa once said that, “Suffering is a gift of God.” Nevertheless, we would all like to go without it. In the clinical setting, pain and suffering are two words that are used in conjunction. “The Wound Dresser,” by Walt Whitman and “The Nature of Suffering and Goals of Medicine,” by Eric J Cassel addresses the issue of pain and suffering in the individual, and how caregivers should care for those suffering.
In 1865 before an operation, he cleansed a leg wound first with carbolic acid, and performed the surgery with sterilized (by heat) instruments. The wound healed, and the patient survived. Prior to surgery, the patient would need an amputation. However, by incorporating these antiseptic procedures in all of his surgeries, he decreased postoperative deaths. The use of antiseptics eventually helped reduce bacterial infection not only in surgery but also in childbirth and in the treatment of battle wounds.
The reduction of pressure ulcer prevalence rates is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer development causes increased costs to the medical facility and delayed healing in the affected patients (Thomas, 2001). Standards and guidelines developed for pressure ulcer prevention are not always followed by nursing staff. For example, nurses are expected to complete a full assessment on new patients within 24 hours at most acute-care hospitals and nursing homes (Lahmann et al., 2010). A recent study on the causes of pressure ulcer de...
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...s and measurement to decrease healthcare- associated infections. American Journal Of Infection Control, pp. S19-S25. doi:10.1016/j.ajic.2012.02.008.
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.
The normal wound healing process mainly consists of four main stages being haemostasis, inflammation, proliferation or new tissue formation, and tissue remodeling or resolution. For a wound to heal well the above mentioned stages should occur in a sequential and orderly manner. Disturbances, abnormalities and delays in any of the above stages may lead to impaired healing or even chronic wounds. In adults, this process of normal healing takes place in the following steps (1)rapid haemostasis (2)appropriate inflammation (3)mesenchymal cell differentiation, proliferation, and migration to the wound site (4)suitable angiogenesis (5)prompt re-epithelialization and (6) proper synthesis, cross-linking, and alignment of collagen to provide strength to the healing tissue.