Apply Principles of Wound Management in The Clinical Environment

1. Medical History of The Healthcare User and The Wounds

This particular wound assessment is about Will Jackson who is a 77 years old man and has been diagnosed with Rectal Cancer five years ago. His current problems are a pain in her wounds from both diabetic foot ulcers and arterial ulcers. He is currently using these drugs: Telmisartan 40 mg. BD, Ventolin 4 puffs t.d.s, Esomeprazole 20 mg per day, Lantas 20 units (male), Warfarin 2 mg (per day), Fruicide 20 mg BD PRN: Endon 10 mg t.d.s, Hydromorphone 2 mg (BD). He fell at home with a head injury and a facial injury. Mr. Jackson has diabetic foot ulcers on the back of the toes) which require dehydration while in the hospital. It also has arterial ulcers in the lower extremities that turn into infections. Jackson also had pressure ulcers on his sacral bones that were subjected when he first fell into a hospital post. He has a stage three pressure ulcer and he certainly suffers a lot, particularly if he is in a supernatural state.

Types of wounds in this context are

Diabetic foot ulcer

A diabetic foot ulcer is an open sore or lesion that subjects in about fifteen percent of diabetic healthcare users and is usually under the feet. The percentage of people who build up ulcers will be hospitalized due to infection or other complications linked to the ulcer. People with diabetes can develop leg ulcers. Healthcare users with diabetic kidney, eye, and heart disease, such as those who use insulin, have a higher risk of foot ulcers. Excess weight and alcohol and tobacco consumption also contribute to the development of foot ulcers (Nather & Fang, 2016).

Arterial ulcer

An Arterial breakdown of fully thick skin is referred to as ulcer. Lack of arterial blood supply due to peripheral arterial disease causes arterial ulcers generally occurring in the lower limbs or feet. Increased age-related issues like diabetes mellitus, as well as hypertension, along with bad habits like smoking, overeating, or obesity can expose people to the risk in context to arterial ulcers (Stillman & Williams, 2020).

Pressure ulcer

A bony prominence as a result of pressure, or shear friction in skin’s underlying tissue hereby getting damage due to an injury, or a combination of both are defined as ‘Pressure ulcers’. Nursing preventions include following guidelines and interventions to reduce their occurrence. For example, constantly moving and rotating healthcare users, placing pillows under the pressure area, and changing dressings regularly (Charalambous et al. 2018).

Burn

A burn is a damage to the skin or other body parts resulting in cell death and tissue ischemia. Dry heat, moist heat, chemicals, electricity, and/or radiation cause burns. When a heat source comes in contact with the skin, the transfer of heat causes structural damage. Burns are categorized as first, second, or third-degree depending on the depth. Treatment is determined by the depth and size of the burn. Reducing the damaging inflammation’s effect associated with 24 hours of treatment helps to avoid deep tissue injury or burn wound conversion (Brennan et al. 2017).

Any investigation requisite for the wound

The wound of Mr. Will was mainly due to his poor oral intake and his medical history. For further investigation of the wound, the doctor at the hospital ordered a wound swab so that the pathological reports can make out if the wound is infected or not.

Wound management principles and techniques

There are five basic principles on behalf of wound management that are in the form of wound’s Cleaning, Haemostasis, as well as Analgesia. It also includes Dressing and follow-up advice, along with Skin closure.

2. The Expectation Process of Healing for Each Type of Wound

The healing process of Arterial wound

Poor circulation limits Mr. Will's healing response in healing wounds as the healing process are usually long and insufficient oxygen-rich blood level obstructs the functioning and shuts white blood cells down. White blood cells' bacterial elimination is needed to stop arterial damage and the spread from quick root infection. This problem makes worse by the dependence of the red blood cells on nutrient’s delivering through the strong circulation to the wounds. Bottom stuck Arteries create infection risk in wounds due to nutritional deficiencies during healing (Munteanu, Florescu, & Nitescu, 2016).

The healing process of diabetic foot ulcer

Diabetic foot ulcers can take several weeks to heal. Mr. Will's hyperglycemia ulcers may take longer to heal. The most effective way to cure his foot ulcers is to follow a strict diet and keep the feet free from pressure (Zhang et al. 2017).

The healing process of pressure ulcer

Since it’s in the 3rd stage it will require a lot of time. As Mr. Will is 77 years age is a factor that resists healing in a speedy process. This includes the like of poor nutritional status, impaired oxygen delivery due to chronic tissue illness, raising skin temperature, even the prevalence of dryness in skin and blood pressure. Not only has this shear frictional force contribute to late healing (Stillman & Williams, 2020).

3. Wound Management Plan

Besides wound offloading appropriate therapeutic procedures are required while managing diabetic foot ulcers. Some of the procedures include the use of specially designed footwear,to provide a moist wound environment daily dressings in saline water is necessary. Antibiotic debridement therapies, due to the presence of osteomyelitis or cellulitis are necessary. Blood glucose control is necessary while correcting or evaluating arterial insufficiency peripheral. The use of cultured human cells for Wound coverage or application of heterogeneous and recombinant dressings or grafts based on growth factors can prove to be beneficial. Alongside it a treatment based on hyperbaric oxygen in case of arterial insufficiency is present.

Stage 3 pressure ulcer’s care goals are covering, protecting as well as cleaning the area by laying emphasis on proper nutrition and hydration. To avail better results, supporting stage 3 pressure ulcer’s wound healing process, it is required to develop aggressive intervention techniques. The basic pressure ulcer’s management is considered to be reducing or relieving skin’s pressure, and debriding necrotic tissue. It is recommended to select moist transparent dressing film while wound dressing helps in the effective management of bacterial colonization.

Used for diffusing disease angioplasty or reconstructive surgery helps in the increasing of the blood flow peripheral for localized stenosis by an intervention that affects the arterial ulceration healing process. Chronic ischemia’s operative indications include non-healing ulcers, developing gangrene, disabling claudicating progression, and pain. The healthcare users should quit smoking, as well as controlling diabetes, hypertension, hyperlipidemia should be optimized. Sleeping in the head end raised bed can be beneficial in the healthcare userss alongside the following of simple foot as well as leg care bits of advice like walking. On the other hand dressings of a wound will be determined by the wound’s nature and avoidance of non-selective β blockers like Vasoconstrictive drugs.

4. Health Education for The Healthcare Users Regarding Wound Management

There are multiple co-morbidities in healthcare users with wounds that keep on interfering with the healing process. The healthcare users were diagnosed with rectum cancer, diabetes, hypertension, which can lead to prolonged or delayed healing as well. Co-morbid conditions that affect the health of skin need to be addressed in association with the healing ability. It is further considered to be paramount in developing a care plan competent in meeting health care goals effectively. Wounds need to be prevented along with properly managed it applies different exercise types. These exercise levels toward wound prevention and management produce physical along with mental beneficial effects. Exercise helps in controlling weight leads to healthy cardiorespiratory function, improved blood pressure as well as lowering of cholesterol levels. It can also impact the mood; sleep patterns as well as mental function. Wound’s prevention and management lay high emphasis on the aspect of getting nutritional support. It plays a vital role in maintaining integrity in tissues, repairing damaged ones to fight against infection due to microbial invasion. The body is unable to determine the good and the bad’s if the healthcare users are not having a balanced yet healthy diet (Prevost et al. 2019).

5. Pain Management Related to The Wound Including:

Diabetic foot ulcer

In this case, as empiric therapy, the doctor uses vancomycin (Vancocin, ViroPharma) due to a narrow spectrum, covering organisms of aerobic Gram-positive. Vancomycin should be used by the Physicians in combination with ceftazidime agent, aztreonam or carbapenems, cefepime, and piperacillin-tazobactam. They suspect a polymicrobial infection on one condition empirically, in case of a severe to moderate diabetic foot infection.

3rd stage pressure ulcer

In favor of Stage 3 Topical pressure ulcer’s treatment options like that of transparent films, composite hydrogel wafer, hydrocolloid, foam, alginate, or antimicrobial bandage are included. Nonsteroidal anti-inflammatory drugs help in reducing pain, like Advil, Motrin IB, containing ibuprofen along with Aleve also known as naproxen sodium. Topical pain medications while catering care, these stages help later or before the wound repositioning helpful in wound care (Lachenbruch et al 2016).

Arterial ulcer

The doctor tries to reinstate the affected area’s blood circulation while treating arterial ulcers. The ulcer will not heal completely with antibiotics use as it can only reduce symptoms. Treating the underlying cause ulcer will not heal completely. Besides using antibiotics doctors additionally use surgery in the direction of restoring blood flow associated with tissues as well as the organs. There are some surgical options to treat arterial ulcers, including angioplasty. An affected artery is opened using the balloon to improve blood flow in this procedure. Your doctor cannot restore blood flow, or, may recommend amputation if the wound has become heavily infected once restored, symptom goes away.

The process of pain education for the healthcare users is associated with the combination of several steps like getting enough sleep, increasing physical activity slowly, brace the surgery site, reduce stress, Avoid aggravating factors, and consider non-prescription pain medication (Hogans et al. 2018).

References for Wound Management Plan

Brennan, M. B., Hess, T. M., Bartle, B., Cooper, J. M., Kang, J., Huang, E. S., ... & Crnich, C. (2017). Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes. Journal of diabetes and its complications31(3), 556-561.

Bus, S. A., & van Netten, J. J. (2016). A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable. Diabetes/metabolism research and reviews32, 195-200.

Charalambous, C., Koulori, A., Vasilopoulos, A., & Roupa, Z. (2018). Evaluation of the validity and reliability of the Waterlow pressure ulcer risk assessment scale. Medical Archives72(2), 141.

Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system: revised pressure injury staging system. Journal of Wound, Ostomy, and Continence Nursing43(6), 585.

Hogans, B. B., Watt-Watson, J., Wilkinson, P., Carr, E. C., & Gordon, D. B. (2018). Perspective: update on pain education. Pain159(9), 1681.

Lachenbruch, C., Ribble, D., Emmons, K., & VanGilder, C. (2016). Pressure ulcer risk in the incontinent patient. Journal of Wound, Ostomy and Continence Nursing43(3), 235-241.

Meda, N., Abbas, M., Verma, H., & Tripathi, R. K. (2016). Arterial Ulcer. In Ulcers of the Lower Extremity (pp. 163-179). Springer, New Delhi.

Munteanu, A., Florescu, I. P., & Nitescu, C. (2016). A modern method of treatment: The role of silver dressings in promoting healing and preventing pathological scarring in patients with burn wounds. Journal of medicine and life9(3), 306.

Nather, A., & Fang, T. T. (2016). Diabetic Foot Wounds—Types of Wounds and Classification Systems. In Surgery for Diabetic Foot: A Practical Operative Manual (pp. 1-9). World Scientific Publishing Company.

Patton, D., Moore, Z., O'Connor, T., Shanley, E., De Oliveira, A. L., Vitoriano, A., ... & Nugent, L. E. (2018). Using technology to advance pressure ulcer risk assessment and self-care: Challenges and potential benefits. EWMA Journal19(2).

Prevost, V., Delorme, C., Heutte, N., Leconte, A., Bechet, C., Licaj, I., ... & Grach, M. C. (2019). Evaluation of patients’ needs to design and assess a patient education program in cancer pain. Journal of pain research12, 1813.

Stillman, M., & Williams, S. (2020). An arterial insufficiency ulcer in an individual with cervical spinal cord injury and hypotension. Spinal Cord Series and Cases6(1), 1-3.

Vinayagam, G., Selvakumar, K., & Kunche, S. R. (2018). A CLINICO-PATHOLOGICAL STUDY OF ULCERS OF LEG. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES-JEMDS7(10), 1237-1242.

Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Annals of medicine49(2), 106-116.

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