Case Study(Skill Analysis) Need to demonstrate an understanding of wound assessment,aseptic technique in wound management and the causative factors in wound breakdown.The evidence for the discussion needs to demonstrate an understanding of safe and compe Essay Example
Post operative management of the wound is complex, and with interrelated procedures. Good management is important in order to avoid wound breakdown, bleeding and to reduce pain as much as possible. Before admission for an operation it is important for a nurse to collect information of the patient. Such information includes medical history, patient’s health which includes nutrition status assessment, information on allergies and also family medical history. This information is important in post operation management of the wound. There are known conditions that can affect the healing of the wound and good prognosis (National Institute for Health and Clinical Excellence, pp 30-80). This is why it is important for a nurse to collect data of the patient before operation in order to come up with the collect management strategy of a patient. Proper management reduces infection and bleeding. Knowing the medical history of the patients is important for a nurse to be assessing the healing process of the wound. In the case of Sophie Smith, it is clear that she has been using 10mg prednisone daily. This information is important for long use of steroids is known to affect healing of a wound after operation. She is also allergic to penicillin and this is important to a nurse so as to avoid allergic reaction during treatment. Sophie is also malnourished and this can delay the healing process. She weights 46kgs and a height of 168cm thus she is below the normal body mass index (Leal and Kirby pp7-31).
The role of a nurse in consent is to inform the patient and the family member of the operation procedure, the time it will take, the importance of the operation, and the required care to be taken before the operation is performed. The nurse informs the patient of the importance of fasting before operation and good nutritional status. The nurse also informs the patient of good hygiene in order to avoid infection after operation. The nurse informs the patient of the healing process and early signs of complication. This is important as it would help in minimizing infection of the wound as much as possible (Leal and Kirby pp7-31).
The nurse is required to collect data of vital signs pre and post operation. In the case of Sophie Smith it was important to collect data on her medical history. This is important for it showed she was allergic to penicillin thus it was to be avoided during the procedure and treatment. Data collection is important for the doctor to know the right treatment of a patient. This is true in case of Sophie for she presented with wound breakdown which would be as a result of use of steroids for a long period. Steroids are known to cause delayed wound healing post operation. Malnutrition, rheumatoid arthritis and use of steroids are important data for they are known to cause abdominal dehiscence. This is important data for it explains why Sophie had a wound breakdown. This is crucial data in management of the wound in order to avoid infection as much as possible. Post operation assessment is of great importance for it shows vital signs of infection and thus it guides the nurse on how to manage the wound to minimize infection (Burton, pp98-107).
Wound assessment post operation is monitoring of the wound healing process. The parameters that are involved include the size of wound, involvement of tissue, condition of the skin surrounding the wound as well as anatomical location. Wound assessment assists in predicting likelihood of complications and shows the expected progress of the wound. This allows the nurse to detect infection at an early stage to avoid complications. This allows the nurse to use the appropriate measures to aid healing and avoid infection. This may include removal of bandages and cleaning of the wound as well as to administer antibiotics in case there are signs of infection. Wound assessment is important as it allows the nurse to manage the wound before dehiscence occurs. This is important in order to avoid complications and reopening of the wound (Leal and Kirby pp7-31).
The priorities a nurse should consider when assessing the wound includes the color of the skin surrounding the wound to find out if the patient is anemic. The nurse should also assess whether the wound has purse which would suggest whether the wound is infected. The nurse should assess whether there is inflammation of the wound. Through post operation wound assessment it revealed the status of Sophie’s wound thus alerts that aseptic technique was to be applied to manage the wound for quicker recovery. This gives time for appropriate management such as use of systemic antibiotics and removal of drains to avoid dehiscence. Removal of the sutures and staples is important for it allows easy assessment of the wound (Leal and Kirby pp7-31).
Aseptic wound technique is a method of assessing the wound to find out if there is any infection. It emphasizes on hygiene while handling the wound. Hand washing is part maintaining hygiene to ensure there is no wound infection. Aseptic technique is important during post operation wound management for it works towards quick recovery and healing of the wound. Aseptic technique also drainage of the wound and removal of dead cells for quick recovery (James, Leach, and Shayeghi, pp57-88).
Applying appropriate topical therapy.
To achieve healing it is important to prioritize hygiene. The nurse should observe hygiene and keep the wound dry. This minimizes chances of infection so as the wound can heal properly. Dirt leads to infection and this can cause complications leading to poor healing of the wound. Elimination of infection and necrotic tissue aids in healing of the wound. This is a priority in aiding healing of the wound. The nurse should work towards protecting trauma and invasion of bacteria into the wound. Purse is a symptom of infection. The nurse should always keep the wound clean and dry to avoid infection which can lead to complications like dehiscence (Leal and Kirby pp7-31).
The nurse should assess the wound frequently to ensure there is no infection. If there is infection, causative factors should be identified and dealt with appropriately. As in the case of Sophie malnutrition, use of steroids and rheumatoid arthritis could be the main cause of her wound infection. Excessive bleeding could be due under use of electro coagulants during operation. It is therefore a priority of the nurse to stop bleeding in order to avoid anemia that is leading to infection and poor wound healing (Burton, pp98-107)
Providing systemic support for wound healing.
This includes good nutrition, circulation, antibiotics and fluid. These are essential for wound healing. In relation to aseptic technique, avoiding bleeding is an important aspect in wound healing. This ensures proper blood circulation which is important for wound healing. A nurse should prioritize curbing bleeding in order to avoid anemia that can delay wound healing. A nurse should use enough anti-coagulant to stop bleeding. A blood clot around the wound is important as it protects bacteria from infecting the wound. It is therefore important for a nurse to work towards stopping bleeding. Anemia is also known to cause reduced immunity and thus excessive bleeding can lead to lowered immunity. This means that a patient with a post operation wound can be easily infected. Good circulation delivers nutrients and oxygen needed for the wound healing. A patient should be advised to eat food that is rich in nutrients that aid wound healing such as vitamins and proteins (Leal and Kirby pp7-31).
Elimination of causative factors.
A nurse should advice the patient on good nutrition that is vital in aiding wound healing. This includes adequate intake of vitamins which are important in wound healing. Vitamin c is crucial for it aid in collagen formation that is important for wound healing. The patient should be advice on taking enough proteins to repair the body tissues. Good nutrition is important as it is a way of reducing causative factors. Poor nutrition can lead to infection and dehiscence. A nurse should also make sure that Sophia does not use penicillin for she is allergic to it. This can lead to an allergic reaction hence a complication. Nurse should work towards managing rheumatoid arthritis which causes a microcirculation leading to poor wound healing process. Steroids also contributes to poor wound healing and so they should be eliminated for healing to take place (National Institute for Health and Clinical Excellence, pp 30-80)
Causative factors in case of Sophie Smith.
Sophie smith has been using steroid prednisone for a long time. Steroids are known to reduce healing process of the wound. This is because steroids are believed to influence incidence of abdominal dehiscence. Sophie has also been sick with rheumatoid arthritis which is known to reduce post operation wound healing process by affecting microcirculation. The wound lacks oxygen and nutrients which are important for wound healing. The bleeding could be caused by underuse of electro coagulant during operation procedure. A wound that is infected should be opened and cleaned to heal by secondary intention. Observing hygiene is the key to the wound healing. The pain Sophie was going through is a sign of infection which could be caused by the reduced immunity due to malnutrition and anemia. Anemia could be due to excessive bleeding which Sophie was going through. From the data collected, it is clear that Sophie is malnourished because she weighed 46kgs and a height of 168cm which shows that she had a body mass index of 16.3 which is below the normal body mass index of 18.5. With the causative factors known to the nurse it is possible to manage the wound and aid in its healing. It is the role of nurse during consent to advice the patient on factors that can interfere with wound healing after operation. This would assist a patient in cooperating with the nurses’ advice to aid the wound healing. With knowledge of what can affect wound healing a patient would be willing to work towards wound healing (Morris, pp 7-125)
Burton Francis. Best practice overview: surgical and trauma wounds. Wound Essentials. London.(2006). Pp 98–107
James Peter, Leach Kalamara, and Shayeghi Martin. The worldwide obesity epidemic. In: Gould
D Caesarean section, surgical site infection and wound management. Nurse Standard. UK. (2007) 57–66
Leal Anderson and Kirby Peter. Blister formation on primary wound closure sites: a comparison
of two dressings. Wounds. UK(2008) pp 7-31
Morris Collins. Blisters: identification and treatment in wound care. Wound Essentials. London.(2008)pp7-125
National Institute for Health and Clinical Excellence. Prevention
of Surgical Site Infection. NICE, London (2008) pp 30-80.
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