1. Assess the Patient’s Wound Condition - The first recommended step to consider in wound management is thorough objective observation and preliminary investigation of the wound. Subjectively, they should be asked about the incident that caused the wound. They should also give their personal information, age, lifestyle, etc. Through the combined knowledge of both subjective and objective data, the nurse or doctor should be able to analyze the patient’s condition and the classification of the wound depth and appearance and how this can impact dressing (Dealey & Cameron, 2008).
The wound may look simple but this can cause several complicated structures inside the skin. Wound is generally classified as acute or chronic. According to Sussman & Jensen (2007), wounds can be further classified in order or according to stages to understand the depth or severity of the injury of a person especially the tissue injury.
- Superficial - The first stage can be classified as “Superficial” where the effect is seen only in the epidermis or the outer layer of the skin.
- Partial Thickness - Wounds can be classified in “Partial Thickness” or skin loss if this extends through the epidermis or the outer layer but not through the dermis or the thick layer of the skin.
- Full Thickness - Wounds can be classified with Full Thickness if the injury extends to the epidermis and dermis which is the deeper part of the skin
- Subcutaneous - Additionally it can also be classified as “Subcutaneous” if the wound extends to the subcutaneous layer part of the skin or tissue which is the fatty part and the most sensitive that houses the blood vessels and nerves.
2. Characterize the Wound - They should be able assess or characterize the wound bed. The measurement, the edges and the exudate and the phase or stage of wound, each type of wound may require a different wound management care plan especially chronic wounds such as surgical wounds where significant loss of tissue is found. These wounds have a high infection rate - high degree burns, traumatic injuries and diabetic patients. Wounds can also show signs of red colorization that shows a healthy normal healing, but yellow wounds may show longer healing because of bacteria and infection. The black wound is the hardest to treat. This can show signs of bacteria spread while some patients with leg ulcers can even show wound odors that should also be eradicated through proper intervention and treatment.
3. Nutrition Check – At this stage, the medical practitioners should not overlook the importance of adequate nutrition that can impair or delay wound healing. The deficiency of different nutrition can be diagnosed using anthropometric data comparison, measurement of body weights and height. Below 7g/dL serum prealbumin is an indication that the patient may suffer from malnutrition. Healing can be effective and fast especially if they are given proper nutritional food that should replenish the required vitamins and minerals for proper treatment.
4. Treatment of Infection and Dressing – Infection should be secured through proper treatment to prevent colonization or spread of bacteria. The consideration of best dressing that can be applied while there are also chronic wound that needs to be opened for days for draining. Dressing is once again dependent on the type of wound. The objective is to control the factors such as infection and spread of bacteria to further promote an effective healing process. The type of wound, the size and depth including the physical and psychological characteristic of the patient should be taken in strong consideration when choosing the dressing type.
Allow the patient to be in best position for treatment. Hand-washing before cleaning the entire wound, flush of liquid such as saline solution from the opening to keep the wound free from bacteria and keep it from bleeding. The removal of necrotic tissue is important especially for surgical processes or healing may take time if this has not been removed before dressing (Granick & Gamelli, 2007).
Dressing or surgical procedure is once again dependent on the wound and the patient’s condition while strong pressure should be avoided not to damage the healthy tissue. The collection of different wound part or specimen especially for chronic wounds for observation is also a good part of treatment to identity certain bacteria and exact treatment. For different types of wound dressing, the method should be chosen for best suitability. All materials should be prepared before dressing including alginate, hydrofiber, debriding agent, gel, adhesive, gauge or film etc.
Different types of dressing:
- Hydrocolloid – Usually used on light wound, burn and necrotic wound
- Hydrogel – For wound with very little fluid which may be painful this type of dressing is used
- Alginate – For moderate to high wound drainage this type of dressing should be applicable
- Collagen – For chronic wounds, surgical, transplant, high degree burn and huge wound collagen dressing should be recommended.
For economic consideration according to Baranoski & Ayello (2008) suggested to clean the wound rather than sterile, for home care, saline solution can be replaced by 8 teaspoon salt and a gallon of hot water, frequency of dressing should be on a timely manner, use of iodine, hydrogen peroxide and other chemicals is not always necessary but depending on the patient’s condition and assessment. This should be a cost effective solution not just for doctor and nurse but also for the patient.
5. Proper Documentation and Monitoring - All the stages of treatment from assessment to care is highly critical it should be properly recorded or documented for proper checking and future references. This is highly essential for continuous management of pain, proper medication and support for hospital and home care. The description of wounds, type, color, tissue, treatment process and effectiveness and the management and types of medical and surgical care given should all be specified in the documentation (Iyer, Levin & Shea, 2006).
The proper knowledge and management of wounds can maintain and restore the skin integrity and speed up the healing process. Although the skin may not be restored to its original form, the proper treatment provided by the medical practitioner should provide convenience to the patient to restore the lost tissue. It is highly important that the management planning of wounds is appropriate according to their assessment which dictates the step-by-step stages of treatment. The choice of dressing including the documentation and monitoring process should support the effective management of the wound.
Doctors and nurses should not neglect to consider the physical and psychological conditions of the patient since this can improve or disrupt their treatment. Patients should be given proper support and inform them how they can cooperate to help the treatment. Their cooperation should simplify the complex process which is definitely a part of wound management process. Chronic wounds may be more difficult to treat but with proper selection of treatment, care and maintenance of a professional, it should provide patients with a dynamic method to systematically eradicate pain and bacteria for immediate healing process.
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