Wound care (Pressure Ulcer) Descriptions During community placement, my mentor and I visited M (patient), a 75years old lady, who was presented with a Pressure Ulcer, on the heel of her right leg. On arrival, my mentor asked me to manage M’s wound. However, I have observed and participate in carrying out this skill (wound care) with my mentor on several occasions. I explained the procedure to M and gained her consent to carry out the procedure. The preparation and application of aseptic technique was quite challenging in M’s home, however I washed my hands, worn apron and gloves, and adopt aseptic technique. When I remove the old dressings and assessed the wound, I observed that M’s wound was slightly exudates, odour, sloughs and dry skin (flakes) around the wound. When M asked me, how the wound was, I was not confident to answer her question, but rather turn to my mentor, who then answered her. I displayed the sterile pack on a flat surface and I dipped the gauze into a warm normal saline and gently cleaned the wound; I cleaned the slough and remove the dead tissues, under my mentor’s supervision and I also applied intrasite gel unto the wound bed, and put an antimicrobial heel dressing and securing it with a two way stretch bandages (tubifast). Feelings I was nervous, when my mentor asked me to carry out this procedure and thus, became very careful not to cause more pain to M. Being an invasive procedure, I was worried not to infect the wound when it was exposed, and when I could not answer her question, I felt uncomfortable. Evaluation Being an invasive procedure, I adopt aseptic techniques; Hart (2007) state’s that, employing aseptic technique helps to create an environment (asepsis) free from living pathogenic micro-organisms. Aziz (2009) conceded that, it helps prevent wound from contaminations and other susceptible site, by organism that could cause infection (HCAIs). I gently remove the slough and dead tissues, and applied an intrasite gel unto the wound bed, and then I put an antimicrobial heel dressing on the wound. Fletch (2007) suggests that, the removal of necrotic tissue and thick slough from wound bed, helps to promote healing by creating moist balance and controls bio burden to ensures optimal healing environment. Barrett (2009) concurs that, the management of wound required dressing that can maintain a moist environment, absorbs exudates as well as remain in situ over number of days.
Carlton suffered an acute tissue injury on his foot after stepping on a sharp edge shell, which disrupted the layers of the skin. Immediately after an injury occurs, an inflammatory response begins, which serves to control and eliminate altered tissue/cells, microorganism, and antigens. This takes place in two phases. 1) The vascular phase, in which small vessels(arterioles, venules) at the site of injury undergo changes. Beginning, with
I cared for a 76-year-old end-staged chronic obstructive pulmonary disorder patient who was admitted for respiratory distress. The doctor requested that my nurse and I get the family together for a family meeting. During the meeting, the doctor communicated to the patient and his family members that the patient will be palliative and no longer be in the ICU. The family members were concerned about the transfer of care to the medicine unit, what to expect from palliative care and other options for care. This scenario did not go well because the patient and family would have benefited from a palliative nurse with expertise, respiratory therapist to discuss other options, pharmacist about medication change if needed, social worker to help guide the family through end of life care for their father. In addition, there was no collaboration with interprofessionals prior to the family
This reflective essay will demonstrate the concept of reflection. The model of reflection by Driscoll, 2007 has been followed in this essay to reflect the clinical skills that I have studied and practiced in week 7to week 9 of this unit which assisted me to get prepared for the practical experience which I will commence at the end of this semester. I have practiced numerous skills during the practicals class, but this essay will be a focus on taking care of bedsore and wound management.
Fig1. This is a picture of a leg with full blown necrotizing fasciitis, just prior to surgery. Note the discoloration. The skin feels crepitant and the area is extremely tender. A larger picture with detail is available by clicking this thumbnail print.
Maintenance of an appropriate healing environment is also essential throughout the management of diabetic foot ulcers. The choice of dressing is dependent on many factors including presence of infection, amount of exudate and the required frequency of wound bed inspection.
I have come to fully understand that in order to treat my patients in a way that is person centred, I have to treat each person as an individual and realise that every individual has different needs and different rights and preferences to me which may go against my morals and beliefs but I always have to maintain my professional boundaries and treat each individual with respect and dignity. If I was a nurse who witnessed a similar situation to Kat’s, where another healthcare professional was disregarding my patient or any patients views or requests I would go into the patient’s room and find out what the problem was. Then I would politely ask the healthcare professional to step outside of the room and I would gently remind them of the code of ethics ((Kozier, Erb's & Berman, 2010, p.97) and the Registered Nurses standards of practise (2016), and how every individual has the right to make their own independent decisions about their healthcare needs/goals based on their own values, morals and beliefs. I would further explain that the patients are our main priority and it is our responsibility as nurses’ to ensure that the patients are safe and are receiving the proper care. I would then explain to the patient what was happening and apologise to them about the situation, and I would rearrange and try to negotiate with the patient when the procedure could be performed. Then I would notify the Nurse Unit Manager on the ward to ensure that situations like this do not occur
This phase generates the necessary actions that are vital in preparing the wound for healing. The body is attempting to remove the triggering stimulus (if present), limit the tissue damage, and set the stage for repair and regeneration of the wound (Rowan et al., 2015). If natural biological healing does not progress satisfactorily, it can lead to a chronic wound with chronic inflammation, though this is most often associated with other disease conditions or a compromised immune system. On a larger scale, this is a significant, world-wide issue of concern for present and future research, because these types of non-healing or persistent wounds impact on the quality of life for an estimated 40 million people worldwide and are costly in many ways (Zhao, Liang, Clarke, Jackson, & Xue,
Due to the fact that people with chronic wounds are generally seen on a weekly basis in a clinic, the
Consent is an issue of concern for all healthcare professional when coming in contact with patients either in a care environment or at their home. Consent must be given voluntary or freely, informed and the individual has the capacity to give or make decisions without fear or fraud (Mental Capacity Act, 2005 cited in NHS choice, 2010). The Mental Capacity Act perceives every adult competent unless proven otherwise as in the case of Freeman V Home Office, a prisoner who was injected by a doctor without consent because of behavioural disorder (Dimond, 2011). Consent serves as an agreement between the nurse and the patient, and allows any examination or treatment to be administered. Nevertheless, consent must be obtained in every occurrence of care as in the case of Mohr V William 1905 (Griffith and Tengrah, 2011), where a surgeon obtain consent to perform a procedure on a patient right ear. The surgeon found defect in the left ear of the patient and repaired it assuming he had obtained consent for both ear. The patient sued him and the court found the surgeon guilty of trespassing. Although there is no legal requirement that states how consent should be given, however, there are various ways a person in care of a nurse may give consent. This could be formal (written) form of consent or implied (oral or gesture) consent. An implied consent may be sufficient for taking observation or examination of patient, while written is more suitable for invasive procedure such as surgical operation (Dimond, 2011).
As a standard precaution against bodily fluids or blood borne pathogens the medical assistant and the doctor would don their personal protective equipment (PPE) such as gloves, face shield, and gown. Next, the medical assistant will prepare the following materials in preparation of the procedure: 1% or 2% lidocaine in a 10cc syringe/25 gauge needle, skin prep solution, #11 scalpel blade with handle, gauze, hemostat, scissors, iodoform, tape, and culture swab. After the materials have been prepped the doctor will clean the abscess with skin prep and drape the wound with sterile fenestrated drape. Anesthetic in the form of lidocaine with a 10cc syringe and 25-gauge needle will be injected around the abscess. The doctor will allow 3-5 minutes for the anesthetic to take affect before making an incision into the abscess. Once the incision is made the doctor will allow pus to ooze and drain out. While the pus is draining out, the culture swab will be inserted in to the abscess where a culture is taken so the origin of the infection is identified incase further treatment is needed. Using the hemostat the doctor will explore the abscess and continue to soak up the pus with the gauze. With a syringe and normal saline the doctor will irrigate
This report will outline a personal reflection that occurred during the hospital placement in October. A 78-year-old male patient, a local GP, with a medical history of type II diabete mellitus for thirty years and severe peripheral neuropathy presented at the high-risk foot clinic for a weekly routine treatment. He wears a pair of darco boots and presented with neuroischemic ulcers on both feet. As this patient was allocated for student to treat for the day, and I obtained the patient’s permission before the treatment began.
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.
is the duty to do no harm. The nurse first needs to ask him or herself what
The global prevalence of Diabetes Mellitus is 5.1% and is constantly rising. It is anticipated to be 7.7% by 20301. It is calculated that 15% - 25% of Diabetic patients will suffer from diabetic foot infection and ulceration. Whilst 60–80% of them will eventually heal, 5–24% will end with amputation.
Although the importance of aseptic technique has been continually reiterated, I have realised its substantial role in the perioperative environment. Aseptic technique refers to the practice of creating and maintaining a sterile environment used for sterile procedures (Laws, 2010a). This is incredibly important as repetitive minor breaches of the sterile environment is one of the major factors increasing the risk of surgical site infection (Harrop et al., 2012).