Hydrocolloid Dressing: A Case Study

In this book I have learned many things about severe burns. I learned that you sometimes have to wear a mask to keep your skin from getting puffy and hard. A few years ago I had a friend that fell in a fire and burned her leg pretty bad. She had to wear a brace that was just like the mask Kelly wore but for a leg and she had to wear it for 1-2 years because of how severe her burns where. There is lots of things to know about burns and how they can affect your life if you are burned.

Integra is a synthetic wound dressing frequently used to treat burn wounds (Figure 5). It is a bilayer composed of bovine tendon collagen glycosaminoglycan (chondroitin-6-sulphate) cross-linked to it, onto which a silicone (synthetic polysiloxane polymer) membrane is sealed to the upper surface to act as a protective temporary epidermis. The silicone layer is applied as a liquid monomer; curing occurs on the surface of the collagen at room temperature. It serves to control moisture loss from the wound. Water flux across this silicone membrane is the same as that across normal epidermis. The collagen-GAG matrix contains pores ranging from 70 to 200 µm that are invaded by host fibroblasts upon application to an excised wound bed. The pore size was carefully designed by adjusting the collagen-GAG mixture. In GAG-free collagen, the resulting structure was more closed than in collagen-GAG matrices. Smaller pores can delay, or even prevent, biointegration, whereas larger pores would provide an insufficient attachment area for invading host cells. Freeze-drying procedures followed by slow sublimation are used to control pore size too. The degradation rate of 30 days of the collagen-GAG sponge is controlled by glutaraldehyde-induced cross-links. The polypeptide collagen is used for its low levels of antigenicity (it has minimal rejection potential) and because it exerts a hemostatic effect on vascular wounds. Collagen is already found in skin. It is degraded by collagenase deposited

• This state-of-the-art facility is dedicated to providing expert care for all kinds of wounds, especially the types of chronic, non-healing wounds experienced by patients with diabetes, venous insufficiency and peripheral artery disease (PAD).

My new role as an adult/gerontology nurse practitioner (AGNP), will be part of team that provides care for Long-term acute care LTAC, Skilled Nursing Facilities (SNF), or Rehabilitation hospital. After gaining considerable experience, my focus in future will be working in home healthcare and primary care clinics. My scenario will involve an organization that provides innovative, collaborative, health care team for one hundred bed LTAC Hospital. Working as an LTAC registered nurse, I noted that, despite the variety of diagnosis, majority of patients’ presents to LTAC hospital have wounds that require complex wound care management. The wounds can range from pressure ulcers to non-healing illness/injury wounds such as diabetic foot ulcer, venous leg ulcers, and post-surgical wounds among others. For this assignment, my scenario will focus on the role of Nurse Practitioner (NP) on skin care and wound managements.

Nancy was an 80 year-old woman who was cooking dinner for her and her grandson. When the unthinkable happened, the long sleeved shirt that she was wearing caught fire. She yelled for help! Her grandson came to her rescue and helped her. 911 were called immediately. When the paramedics arrived on the scene, they evaluated Nancy and took her to the hospital due to her injuries. She sustained burns to the anterior and posterior right upper arm as well as the anterior and posterior thorax. Parts of her skin were black and charred and some parts of her skin had blisters. She was admitted into the hospital where doctors did further testing and treatment to her burns. Due to Nancy’s burns, her skin was severely affected.

I would inform the patient that most skin burns that are small and superficial will heal within one week and will not usually scar. After a superficial partial-thickness burn, the skin may become darker or lighter in color, but will not usually scar.

Burn and Wound Care program provides an individual approach to care through intensive therapies, innovative methods and collaboration with multiple interdisciplinary teams.

I have significantly developed my skill in wound care assessment and dressing, in developing this skill I now recognize the importance of documenting each dressing. Morison (2001) supports this in saying that by detailing pressure ulcer assessment it provides a basis for deciding the effectiveness of the current treatment.

E codes represent an external cause that made a patient’s condition such as a motor vehicle accident or accidental overdose of a prescribed medication. E codes are assigned in addition to the diagnosis for the patient’s condition. E codes are never the first-listed diagnosis. Superficial or surface injuries include cuts, insect bites, blisters, and scratches. List separate codes for each kind of injury, unless there is a combination code that describes all of the injuries. Sequence the code for the most serious injury first. Don’t assign injury codes for normal, healing surgical wounds or surgical wound complications. A burn is an injury on the body that results from exposure to heat, electricity, or some types of radiation. ICD-9-CM classifies

12. When treating a serious wound, remove any clothing and wash the area around the burn.

Perform sterile dressing changes as ordered, less than or excessive changes can affect the healing process and increase the risk for infection. There are also implications for infection control and delayed healing due to repeated wound exposure, and an increased risk of epidermal damage and irritant contact dermatitis by repeatedly removing adhesive products (Hollinworth, 2005). The wound should be packed with enough gauze to cover the open wound but it should not be packed in too tightly because that obstructs air getting to the tissues. Once the wound has been packed, a few dry pieces of gauze should be placed over the open wound followed by the abdominal pad. The area around the skin should be dry because moist skin can lead to breakdown and further skin complications. The last step of the process is to clearly label the dressing so that when other nurses and healthcare professional come to assess the client, they will know when and by whom the dressing was last changed by. The nurse should be explaining what he/she is doing as the application goes on, and teach the patient why sterile technique is necessary. By teaching, the nurse is informing the patient how he/she can be more involved in their own care and the importance of keeping their wound clean because it can lead to further and more

The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was developed in 2003 and updated in 2009 as a tool to utilize when assessing the methodology and quality of a CPG (Mohamed, 2014). An amended version of the AGREE instrument will be utilized to assess the quality and methodology of the Wound Preparation CPG published by the ENA. First the scope and purpose of the CPG will be discussed followed by stakeholder involvement. Next the rigor of development will be analyzed followed by recommendations and applications of the CPG. Lastly, the editorial independence and a summary will conclude this paper.

And as a nurse, following the instruction on how it is done, applying the right medication and doing it on schedule are very important for a quick wound healing process and a quality patient care (Waugh, 2014, p. 354). Not only that, wound and total skin assessment at least twice a day, good documentation and multidisciplinary collaboration are essential (Smeltzer, Bare, Hinkle, & Cheever, 2010, p. 209). Prompt notification to the doctor for any wound progress, collaboration with the dietitian regarding the proper diet to help speed up the healing process, a clear instruction to the nursing aid that frequent patient turning and repositioning, and changing the diaper timely will aid in the wound healing and prevent further skin damage and the development of a new one (Smeltzer et al., 2010, p.

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.

I get to see various types of wound, from pressure ulcer of different stages, unbelievable edemas, arterial and venous ulcers, diabetic ulcers, and many other wounds of uncertain causes. I have never expected to see those kinds of wounds. I have seen different drainage amount, color, and odor, various shapes and location of the wounds, and amputated edematous legs. I have learned also the different types of dressings and antibacterial ointments used. I had given the chance to observe a client on their high-tech hyperbaric oxygen therapy which makes the wound healing even faster. The most important lesson I have learned from the team members was, “DO NOT GET