Wound Care Education

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 timeline for this project is around six months. The final goal is designing a new educational training manual related to chronic wound management for nurses in the home health care agency.

A meaningful event from my clinical experience was during week six when one of my colleague and I along with the RN performed a wound care procedure on one of my client who had pressure ulcers on her coccyx area and wound on the right foot. It was my first time doing wound care on a client who has severe wound type. Client is a 90 years old female who has been admitted to the unit for Osteomyelitis, it is an infection of the bone, caused by bacteria breaking into the body’s tissues and entering the bloodstream through an open wound (LeMone, p.1382). The client said a dog bit her foot at a park few years ago and that’s how she got the wound. Client has a wound care dressing order that needs to be changed daily with Betadine soaked gauze for all areas,

Dale Gordon has been a patient in the ICU for 6 days after developing complications after open heart surgery. He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him.

Over the last century, registered nurses' participation in wound management has actually varied from that of following rigorous dressing routines to autonomous practice (Moore, 1997). In the past, nurse education frequently enhanced the overall results at the time. An adherence to apprenticeship-style learning, where registered nurses frequently had minimal knowledge of the results of the dressing they were putting on a wound, contributed considerably to a theory-practice space or gap of research in wound management. Registered nurses were not actively associated with the decision-making procedure (Madsen, 1999).

On assessment, the wound was slightly exudates, odour, sloughs and dry skin patches on the surroundings. Sprakes (2010) state that, holistic assessment of patient and the wound are essential in order to facilitate the wound healing process. Ousey and McIntosh (2010) points out that, chronic wounds are exacerbated by a sequence of misdiagnosis, neglect, incompetence or inappropriate treatment strategies. I observed that, M’s wound was with exudates and sloughs; this

Pressure ulcers that occur in the long term care setting are increasing in the number of incidences each year in the United States. Consequences and complications of pressure ulcer development include pain, sepsis, cellulitis, bone, and joint infections. Pressure ulcers are also associated with an increased morbidity and mortality rate, negative emotional and physical effects on patients and caregivers, and are the second leading cause of litigation in long term care facilities. The cost of treatment for pressure ulcers in the United States is estimated at 11 billion dollars annually. This has led to many programs that focus on education and intervention to prevent the development of pressure ulcers, even being addressed in public initiatives such as Healthy People 2010. Appropriate information and education for healthcare providers, patients, and families has proven to be a key factor in the prevention of pressure ulcer development. Wound management is an area of healthcare that must include a comprehensive plan for the best outcome. A care plan that includes a well-educated care team composed of various disciplines working together for holistic care of each patient has seen the best results for patients who suffer from pressure ulcers.

Throughout the procedure, I was able to interact with the patient and communicate effectively with him, discussing his pertinent health history as well as his experience in dealing with his chronic wound. Such communication and patient interactions bring an abundance of positive feelings to any clinical situation. I also felt positively about the decision of the nurse and healthcare provider in the use of barrier cream to prevent further maceration of the peri-wound skin,

From observation, currently, the risk of delayed wound healing is managed, by nursing interventions and verbal health promotion, which may be due to the deficiency of packages designed for patients. This is supported by Collier (2003), who highlights the importance of nursing assessment, interventions and evaluation in improving wound healing. However, the importance of patients’ education, about balanced nutrition and dietary control of diabetes, may not be under estimated, as this may reduce the risk of infection and improve wounds healing (Casey, 1998, Dealey, 2005, Kemp, 2001, Timmons 2003, Ward, 2002). According to patients’ experience, their knowledge about nutrition helped them to achieve wound healing (Wound Care Information Network, 2008). For example, balanced proteins intake may encourage tissue repairs, as well as vitamin C intake may reduce the risk of infection, which may improve wound healing (Kemp, 2001, Ward,

A full assessment of the wound should be carried out prior to selection of dressings. Any allergies should also be noted. The wound should be traced, photographed and measured providing data for comparison throughout the treatment. Consent should be gained prior to photographing the wound and the patient should not be identifiable from the photograph (Benbow 2004). All information should be documented in patients’ records, using the wound assessment tool. The pressure sore was identified as grade two

After the initial investigation, the BSN nurse would then research current treatments for pressure ulcers as they relate to diabetic patients. To properly care for a diabetic foot ulcer, the BSN nurse would suggest debridement and a dressing to prevent tissue dehydration, absorb excess fluid, and to prevent wound contamination (American Diabetes Association 2006). Patient education would also be necessary to ensure she does not bear weight on the affected limb to promote healing. According to the American Diabetes Association, the biggest challenge for healing a diabetic wound is keeping the patient from bearing weight on the affected limb. The BSN nurse may be equipped to handle the patient education better than the ADN nurse due to the amount of research done on the subject.

Sherman Red is an 80-year-old male who was diagnosed with diabetes six months ago and is now admitted to the local hospital for a diabetic ulcer to his right great toe. The toe is infected and the patient is diagnosed with possible sepsis. The scenario depicts a presentation of sepsis in the elderly. This shows how wound healing and care of a diabetic patient can be difficult if not followed closely. The complication that can result from a diabetic ulcer can be devastating. It is always important that a patient is in full compliance with the treatment to prevent other health problems. The infection of the wound could have been avoided if treatment was taken seriously. The nurse must conduct a head to toe assessment of the

My second clinic rotation is internal medicine and I’ve had many encounters, both with patients and colleagues, which have made me pause and reflect. One of those encounters, in particular, will still be on my mind long after I finish typing this reflective journal. The patient at the center of it all is a lady I’ll refer to from here on as “Mrs. Flowers.” Mrs. Flowers is an 81 year old female with dementia and diabetes. She arrived on our unit with a diabetic foot infection that had progressed from a simple toe ulcer to wet gangrene. Over the last 2-3 months, gangrenous changes encompassed the distal half of her left foot. During pre-rounds, our medical team unanimously agreed that we would contact surgery for a consult. At time, it was obvious

Performs patient teaching on surgical topics including DVT prevention and importance of skin preparation. While assessing a patient, Ms Davidson noticed that a patient has an open wound. She offered to clean and bandage patient wound. She

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.