Chronic Wounds: A Case Study

Wound management is one of the cornerstones for nursing care however, effective wound care extends far beyond the application of the wound itself. Nurses may be required to assess, plan, implement, and evaluate wound care; therefore, order to fill these roles it’s critical to have an understanding of the several different areas of wound care such as, integumentary system, classification of wounds, wound procedures, and documentation. Knowledge in each of these areas will allow nurses to make well informed decisions about wound care, and as a result play an active part in wound healing.

The first couple of paragraphs include an explanation of what is considered a complex wound and the current available treatments. It is beneficial that the authors include an explanation of what the problem is so that the reader can have a better understanding of why this issue is of concern. The paragraphs then transition towards the types of treatments available for the problem and a description of why the current treatments are not sufficient for restorative care.

Today, despite precise surgical techniques to cut out dying tissue, artificial skin and other high-tech treatments, hard-to-heal wounds remain a huge problem. Diabetic foot ulcers alone strike about 600,000 people annually and lead to thousands of

Guo, S., & DiPietro, L. A. (2010). Factors Affecting Wound Healing. Journal of Dental Research. 89(3): 219–229.

Implications of discharging patients who do not understand their wound care discharge instructions, and follow-up care can lead to several problems. The problems included: poor health outcomes, increased risk of infection, increased health care cost, decreased insurance reimbursement, low HCAHPS scores, non-compliance with health care recommendations, recurring hospitalizations, and increased morbidity. An example that involves several implications listed above would include a patient who is non-compliant with his diabetes care, does not understand his wound care instructions and how his diabetes effects wound care healing, does not have a follow-up appointment and the wound becomes severely infected requiring a long readmission stay in the

Harper, Young, and McNaught, (2014) explain the four distinct phases of wound healing that are identified as hemostasis, inflammation, proliferation and tissue remodeling. Hemostasis is the body’s response to prevent exsanguinations; thusly, the cascading response to injury causes constriction of blood vessels but if continued, leads to tissue hypoxia and acidosis. The next stage of healing is inflammation. This stage is a result of cells that inhibit and prevent infection and once the resulting threat of infection is gone, inflammation will subside. Prolonged inflammation can lead to chronic wound formation. The next stage of healing is proliferation which consists of angiogenesis, formation of granulation tissue, collagen deposition, epitheliazation and wound retraction. It is during this stage the extracellular matrix is laid down forming

Caring for patients with wounds is commonly encountered in a nurse’s career in most health care settings, whether it is in neonatal, mental health, community, or aged care. In the past, wound dressings were created to absorb all exudate, believing that dry wounds will reduce the risk of infection. Within the last fifty years, the concept of moist wound therapy has become the most effective approach to wound care. Before treating any wound, it is important to discover the underlying cause and consider other possible factors that may impact on the healing process and deliver a systematic and rational approach towards wound care assessment. Nurses must have a basic understanding of

Delayed and the dehiscing of wound can be a result of issues in the suturing of a wound. Sometimes, forces that are applied to the wound area can also cause the wound to open up and get infection. As a result of abdominoperineal resection, slowed wound healing started to advance due to certain risk factors. Infection was one of the causative factors that prevent the wound to heal slowly. Through the bacterial contamination and possibly the influence of staples into a wound that has potentiate an infection. Furthermore, due to inadequate tissue oxygenation that can be resulted from vasoconstriction could have occurred as there could have been blood volume deficit and as the patient has an ongoing unrelieved pain in

The practice problem is wound management (skin tear) or skin integrity in elderly patients. Elderly patients are vulnerable to skin injury (Campbell, Coyer, & Osborne, 2016). Keeping up with successful wound management practices is a challenge for healthcare providers, especially in an aging population (Campbell, Coyer, & Osborne, 2016).

The skin can be disruptive at any moment a of a person life time. This disruption can create a potential complication such as infection, hemorrhagic to name a few. These complications increase the risk for generalized illness and death, lengthen the time that the patient needs health-care interventions, and add to healthcare costs. Pressure ulcers, wound caused by unrelieved pressure that results in damage to underlying tissue, are one of the most common skin and tissue disruptions and are costly in terms of healthcare expenditures. Nursing responsibilities related to skin integrity involve assessment of the patient and the wound followed by the development of the nursing plan of Care, including the identification of appropriate outcomes, nursing

A wound is an injury or the damage of living tissue, and the skin is usually cut or broken, depending on the type of wound. Wounds may be caused from an accidental or intentional incident, an underlying medical condition, surgery, or an infectious disease. Depending on the severity of the wound(s), it will need to be tended to. If the wound is severe enough to require the medical care of professionals, a diagnosis will be made by examining it visually. If fat, muscle, or bone is exposed, or the wound is deeper than one half of an inch, means that the wound is severe enough to require medical attention. After a diagnosis is made, the medical personnel will find out the extent of the wound’s damage and the effects it may have had on the wellness

As well as explain to J.G. other health behaviors that will contribute to the healing process. It is important for J.G. to have the proper nutrition because it will aid healing as well as managing his blood sugar since he’s diabetic. Since he is diabetic and is susceptible to loss of sensation and circulation, it is important that he wears loose shoes and shoes that protect the toes from friction and hitting objects. Mobility is also a significant factor (Heller, 2014). If J.G. cannot get out of bed and walk a round, it is important for his daughter to turn him ever 2 hours to avoid pressure ulcers from forming.

When a tissue experiences the disruption of normal anatomic structure and function, it forms a wound. The process of restoring injured tissue to its normal structure and function by proliferation of neighboring living cells is called tissue regeneration (Sorg & Reinke, 2012). However, when regenation cannot occurs, wound healing occurs by replacement with a connection tissue and formation of a scar (Porth, 2011). Wound healing process involves the restoration of the integrity of injured tissues. It consists of three continous or overlapping phases: inflammation, proliferation, and wound contraction and remodeling phases (Porth, 2011). Any interruption, prolongation, or changes in the course can lead to delayed wound healing. The inflammation phase starts at the time of injury with both cellular and vascular responses. this phase is critical because it prepares optimum environment for wound healing (Porth, 2011). During the vascular response, blood vessels constrict and blood clots form to reduce blood loss as well as to fill the tissue gap. After that these vessels dilate and increase capillary permeability to allow plasma and blood components to leak into the wound. The accumulation of fluid causes the wound to appear swollen, red, and warm to touch (Sorg & Reinke, 2012). Platelets and white blood cells release cytokines and growth factors to stimulate the collagen synthesis, activate the transformation of fibroblasts to myofibroblasts, start the angiogenesis, and support

Wound healing is a dynamic process consisting of four continuous, overlapping, and precisely programmed phases. The events of each phase must happen in a precise and regulated manner. Interruptions, aberrancies, or prolongation in the process can lead to delayed wound healing resulting in a non-healing chronic wound.

Wound healing is a dynamic, interactive method involving soluble mediators, blood cells, extracellular matrix, and parenchymal cells. Wound healing has three phases: the inflammatory section, the proliferative part, and the maturational or transforming phase. These phases could overlap in time (Porth, 2011).