Term Paper Sample: Instructions for Wound Cares

Interviewer: Good morning Dr Aguilar, I am Name, a nurse from the Care1st primary and urgent care clinic. I would love to have an interview with you on your organizations wound packing policy and some of the challenges nurses face on it.

Dr Aguilar: It is okay. I am free at the moment. We can have the interview.

Interviewer: I have found out through research that the traditional soaked gauze is still used by the surgeons for packing and dressing open surgical cavities and wounds. It is a problem to nurses because patients wounds take long to heal and becomes much of a problem to nurse such wounds. How does your organization address the problem?

Dr Aguilar: At the moment also, we still use the gauze to nurse our patients. We are still looking for a way to address the problem. We have a wound policy but it is outdated.

Interviewer: How it is enforced at the organizational level?

Dr Aguilar: Every nurse is presented with the policy. The nurses that dont follow the policy are at risk losing their licenses.

Interviewer: What are the difficulties surrounding the policy?

Dr Aguilar: One of the main challenges is that the policy is outdated and using it on patients poses a big risk for their recovery.

Interviewer: What are the measures to determine if the policy is followed?

Dr Aguilar: Senior nurses have been given the responsibility to ensure that every patients wound is properly dressed and they also come for changing as per the instructions given in the policy. The patients also give a feedback and report their recovery progress.

Interviewer: Thank you Dr Aguilar for your responses and time.

Introduction

Some surgical wounds are allowed to heal by the secondary intention, despite most of them being closed primarily. Secondary intention involves repeated dressing and packing of the raw wound surfaces. The long term care of such kind of wounds has devolved under the care of nurses in the outpatient or community setting, the initial cavity packing or wound dressing is handled by a surgeon in the operating theatre. The growth of the discipline of the wound care is unknown to many surgeons (unaware). The traditional soaked gauze is still used by the surgeons for packing and dressing open surgical cavities and wounds.

Objectives

Allowing the wound to heal in an environment that is moist, unless the goal is to keep eschar in a non-infected or dry condition.

For an ischaemic wound, the objective is to protect the wound until vascular status can be restored to increase the healing potential or to be gangrenous dry where auto amputation will be the objective.

The use of any packing or dress in wound care is of limited value until those factors that inhibit or delay have been pinpointed and addressed. The management and treatment control policies should address the local symptoms to address, minimize and manage the issues that may arise during and after wound packing and dressing to facilitate faster healing process.

Strategies

Necrotic, sloughy and infected wounds require thorough surgical debridement, mainly in the operating theatre. The wounds are often allowed to heal by delayed primary or secondary intention. The wounds can be deep or superficial, with varying amounts of exudate that require frequent packing and dressing changes. The surgical gauze has been used by surgeons for initial wound dressing and packing. In the modern setting, nurses can favour modern dressing for both the chronic and acute surgical wounds. Correct dressing can be done choosing the appropriate dressing since gauze dressing is not cost effective, not conducive to wound healing and uncomfortable when it comes to changing the wound dressing. This policy summarizes the modern alternatives, ways and some best procedures as alternatives to the surgical gauze for use by nurses to assist in wound packing and dressing to facilitate faster healing.

Action program

In order to care and facilitate fast healing for patients, Care1st and urgent care clinic prepared this policy that contains effective methods, wound dressing alternatives and precautions that the nurses should deploy.

Hydrocolloids

They are occlusive dressings, indicated for rehydration of low and dry exuding superficial wounds. The dressing promotes autolysis and angiogenesis where the enzymes debride and break down the wound of necrosis and slough.

Application: there should be frequent inspection of the dressing for rolling up edges, leakage and whether a part of the bubble has reached the change indicator. The dressing should be change if any of these occurs.

Removal: press down gently and slowly on the skin and lift the corner until the edges are free and its no longer adhered to the skin.

Precautions: Avoid the high exuding wounds.

Avoid wounds that need frequent review.

Avoid the diabetic foot ulcers

Avoid the neuro-ischaemic foot wounds

Alginates

May be applied to the exuding lesions including donor sites, diabetic foot ulcers, pressure ulcers, leg ulcers and granulating wounds. Alginates are also suited for sinuses and deeper cavity wounds. An example is Sorbsan.

Application: Alginates are placed on the surface and covered with a secondary dressing held with a bandage or surgical tape. The dressing change interval depends entirely on the wound state.

Precaution: Avoid application in dry wounds. Wound exudate is needed to activate the fibres to become hydrophilic gel. The patient may experience a drawing sensation upon initial application because the dressing draws fluid from the bed of the wound. The sensation may be reduced by irrigation with saline before dressing.

Hydrogel

Hydrogels are suited for the management of necrotic wounds, sloughy wounds pressure sores and ulcers. Hydrogels assist in removal and debridement of devitalised and necrotic materials from exuding wounds by providing a moist environment at the surface of the wound.

Application: Apply direct to wound crater, cover with appropriate dressing or film such as Atrauman impregnating the dressing.

Removal: Irrigate to remove.

Precautions: Avoid in infected wounds.

Avoid in wounds having moderate or high exudate levels.

Avoid if sensitive to of the hydrogel components.

Hydrofibre

It is a soft absorbent material that transforms to a gel when on contact with the wound fluid that creates an environment for wound healing. The dressing forms a soft gel when it comes to contact with the exudate which promotes tissue granulation and help debride necrosis and slough.

Application: For surface wounds the dressing should overlap an inch onto skin contact and leave at least 1 inch outside deep wounds for easy removal.

Removal: Remove the dressing when medically indicated.

Precautions: Dont use in dry wounds.

Avoid in bleeding wounds.

Foam

Designed to meet one of the goals of wound care (create a moist environment to facilitate wound healing). Use as primary dressing on epithelizing and clean healthy wounds.

Application: Leave in place from 3-7 days on wounds depending in the level of exudate.

Precaution: Not suitable for dry wounds covered with necrotic tissues because the intention is to maintain and protect the dry eschar.

Financial Expectations

Dressing Actual Cost/unit 10x10 cm (approx.) Relative cost

Gauze swab 5.5p 1

Alginate Kalstostat

Sorbsan 173p

152p 31

28

Hydrocolloid Granuflex

Tegasorb 233p

221p 40

40

Hydrogel Novogel

Hydrosorb 290p

274p 53

50

Hydro fibre Aquacel 263p 42

Foam Allevyne

Lyofoam 263p

112p 48

20

Low adherence Jelonet

Mepitel 34p

270p 6

49

Appendix

References

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Bulger EM, Snyder D, Schoelles K, et al. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18(2):163-173.

Cone, D., Brice, J., Delbridge, T., & Myers, J. Emergency medical services.

Discharge Instructions for Wound Cares - The American Association for the Surgery of Trauma. (2017). Aast.org. Retrieved 21 December 2017, from http://www.aast.org/discharge-instructions-for-wound-cares

Joint Committee to Create a National Policy to Enhance Survivability from Mass-Casualty Shooting Events. (July 1, 2015.) The Hartford Consensus III: Implementation of bleeding control. American College of Surgeons. Retrieved December 20, 2017, from http://bulletin.facs.org/2015/07/the-hartford-consensus-iii-implementation-of-bleeding-control/

Shina A, Lipsky AM, Nadler R, et al. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. J Trauma Acute Care Surg. 2015;79(4 Suppl 2):S204-S209.

TCCC Guidelines for Medical Personnel. (Jan. 31, 2017.) Tactical Combat Casualty Care. Retrieved December 20, 2017, from www.cotccc.com/wp-content/uploads/TCCC-Guidelines-for-Medical-Personnel-170131.pdf.

Watters JM, Van PY, Hamilton GJ, et al. Advanced hemostatic dressings are not superior to gauze for care under fire scenarios. J Trauma. 2011;70(6):1413-1419.