I would first place the patient in a comfortable position and after the removal of the old dressings, the surrounding skins are cleaned using clean gloves. Nurses need to follow the principle of asepsis for preventing infections. I will first check what type of wound it is, is it an acute or chronic wound. Then I will examine the surrounding skin and check for loss of tissues. I will check the appearance of the wound and check for pus. According to the clinical guideline for nursing assessment the measurement of the wound and dimensions are important. I will measure the length, width, and depth of the wound through the clinical ruler. I will examine the edges of the wound. I will check for any sign of infection by checking the presence of exudates. Serosanguinous drainage is a common exudatethat is seen in wounds. It is thin, pink, and watery in the presentation. And Purulent drainage is, thicker and milky whose appearance can be yellow or grey. Thick fluid indicates signs of infection inconsistency and can be gray, green, or yellow in appearance. If the fluid becomes very thick, this can be a sign of infectionin the wound. Pain near the areas of the wound should also be assessed by obtaining the pain scores from the patients. (Bryant & Nix, 2015).
Clean denotes free of stains, dirt, or marks. It involves strategies to reduce the microbial load for preventing the transmission risk from one person to the other. It involves using clean gloves while addressing the wound and is used for the patients who are not at high risk for infection.
The sterile technique involves a reduction in microbial exposure and maintains the wounded areas as free from microbes as possible. It uses sterile materials or surfaces and used for patients who are at higher risks for infections. (Wound & Continence Nurses Society (WOCN) Wound Committee, 2012).
For the case of Mr. C sterile technique is preferred.
Alginate dressing is best for purulent draining wounds as this type of dressing can hold more than 20 times its weight and is highly absorbent. It is beneficial for absorbing moisture from the deep wound areas.(Zhao et al., 2020)
The process of wound healing can be divided into 4 distinct phases.These are hemostasis, inflammation, proliferation, and maturation. In the hemostasis phase, the wound is sealed by clotting. (Singh, Young & McNaught, 2017). Blood vessels constrict to limit the flow of blood and the platelets adhere to each other and form a seal in the broken blood vessel. Next, coagulation occurs and fibril threads bind to the platelet as a binding agent. In the inflammation, phase bleeding and infection are prevented through the leakage of protein, salt, and water causing swelling. The pathogens and bacteria are removed. The proliferative stage starts with rebuilding the new tissues and extracellular matrix. New blood vessel networks are also created and epithelial cells resurface the location of the injury. The final phase is the maturation phase where the wound fully closes. The cells that are no longer needed for the repair are removed by apoptosis. Collagen Crosslinking reduces the scars and makes the area stronger.(Singh, Young & McNaught, 2017).
It is a tool that collects the data in a minimum amount to guide the care plan and monitoring the residents to provide quality care. It detects the risks, needs, and strengths of the patient. (Potter et al., 2017). This will further help in providing quality care to an individual and better monitoring their health.
The tool will assess the lesions, skin ulcers, and wounds of Mr. C. it will also assess the pain management, special treatments, and programs that were given to the patient in the past few years.
A person who cannot walk on his own will need assistance for bathing. First, prepare all the items that might be required to avoid a last-minute mess. Lukewarm water is advisable for bathing and exposes only those areas that need to be cleaned and avoid the wounded areas of Mr. C. A shower chair is advisable as he has stumps and cannot stand. If he can clean his genital areas then make sure that they are been cleaned properly. Also, help him in dressing and combing his hair. (Potter et al., 2019).
If the patient is unwilling to go to the bathroom or due to the stump we cannot move then bed bathing is advised. A plastic bowl of water is used or re-packaged cloths for bed bathing which do not require water. Avoid contaminating the dressings and drains with water, always pat the skin to reduce damage because of friction, and help him in changing his clothes and comb his hair. (Potter et al., 2019).
The expansion of an infection in a community is termed as a chain of infection and it occurs in a cycle depending on the mode of transmission, infectious agents, source of pathogen, portal of exit, portal of entry, and susceptible host. (Potter et al., 2019).
reaking the chain needs some preventive measures such as maintaining hygiene and aseptic conditions, cleaning and sterilization of personal equipment, immunization, covering coughs and sneezes, sterilizing the medical instruments, and completing the course of antibiotics to avoid antibiotic resistance. (Potter et al., 2019).
Nosocomial infections are defined as the infections that are associated with healthcare and the infections that a patient gets in the healthcare which has not present when he was admitted to the healthcare.
he three most common nosocomial infections in Canada are urinary tract infections, pneumonia, and surgical site infection. The UTI is acquired because of the catheters that might get contaminated during insertion or when the urine bag is not changed frequently or when the urine in the catheter bag flows backward in the bladder. that are tubes inserted in the bladder. The symptoms are cloudy urine, bloody urine, fever, vomit, and strong odor. (Vásquez, Ampuero & Padilla, 2017). Pneumonia occurs due to the inhalation of contaminated aerosols containing Legionella species or influenza virus. (Khan, Ahmad & Mehboob, 2015). When the site of surgery is exposed to the bacterias like Staphylococcus, Streptococcus, and Pseudomonas then surgical site infection occurs. The infection can be superficial only and involves the skin.
References
Bryant, R., & Nix, D. (2015). Acute and chronic wounds: current management concepts. Elsevier Health Sciences.Retrieved from
Ketcheson, F., Woolcott, C., Allen, V., & Langley, J. M. (2017). Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study. CMAJ Open, 5(3), E546. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621950/
Khan, H. A., Ahmad, A., & Mehboob, R. (2015). Nosocomial infections and their control strategies. Asian pacific journal of tropical biomedicine, 5(7), 509-514. https://doi.org/10.1016/j.apjtb.2015.05.001
Möller, G., & Magalhães, A. M. M. D. (2015). Bed baths: nursing staff workload and patient safety. Texto & Contexto-Enfermagem, 24(4), 1044-1052.
Nøddeskou, L. H., Hemmingsen, L. E., & Hørdam, B. (2015). Elderly patients' and nurses' assessment of traditional bed bath compared to prepacked single units–randomized controlled trial. Scandinavian journal of caring sciences, 29(2), 347-352. https://onlinelibrary.wiley.com/doi/abs/10.1111/scs.12170
Potter, P., Perry, A., Stockert, P., Hall, A., Astle, B., & Duggleby, W. (2019). Canadian Fundamentals of Nursing - 6th Edition. Elsevier.com. Retrieved from https://www.elsevier.com/books/canadian-fundamentals-of-nursing/potter/978-1-77172-113-4.
Singh, S., Young, A., & McNaught, C. E. (2017). The physiology of wound healing. Surgery (Oxford), 35(9), 473-477. https://doi.org/10.1016/j.mpsur.2017.06.004
Vásquez, V., Ampuero, D. and Padilla, B., 2017. Urinary tract infections in inpatients: that challenge. Rev Esp Quimioter, 30(Suppl 1), pp.39-41. https://seq.es/seq/0214-3429/30/suppl1/08vasquez.pdf
Wound, O., & Continence Nurses Society (WOCN) Wound Committee. (2012). Clean vs. sterile dressing techniques for management of chronic wounds: a fact sheet. Journal of the wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society, 39(2 Suppl), S30-S34. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22415169/
Zhao, X., Liu, L., An, T., Xian, M., Luckanagul, J. A., Su, Z., ... & Wang, Q. (2020). A hydrogen sulfide-releasing alginate dressing for effective wound healing. Acta biomaterials, 104, 85-94. https://doi.org/10.1016/j.actbio.2019.12.032
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