1. Principle Diagnosis Of The Patient
David Pearson main reason for visiting the hospital to seek help is osteoarthritis. This has been giving him trouble for the past 10 years. He developed hypertension 6 years ago and experiences breathing difficulties during the night which is relieved when he sits up. He also has polyuria, he goes to the toilet 12 times a day and twice during the night which affects his sleep. The main reason for admission to the hospital is due to osteoarthritis and total knee replacement has to be performed as an intervention (Rönn, et.al, 2011). A prosthetic knee is inserted and cement applied.
2. Evaluation Of Wound Management Plan
Wound Bed Status
Wound beds assessments involve checking granulation tissue which is red and fibrin sloughs which are yellow. Granulation is pink in color if it is healthy. Dark red granulation indicates danger, bleeding occurs on contact and indicate the presence of wound infection (Lozano-Platonoff, Mejía-Mendoza, Ibáñez-Doria, & Contreras-Ruiz, 2015). The level of Leucocyte at wound bed rises after 2-3 days especially macrophages. Macrophages aid a lot in cleansing the wound.
Frequency Of Dressing
The dressing should be left in place unchanged for 12-14 days after surgery when the sutures are removed. It should not be altered for up to a week after the placement done in theatres unless the dressing has moved out of place, leaking or has become saturated fully. When the surrounding skin becomes inflamed or discharges noticed, the dressing can also be considered for change. Pain and odor may also be considered and assessed for before changing the wound dressing.
A centimeter ruler is used to measure the length of the wound (Shetty, Sreekar, Lamba, & Gupta, 2012). This has to be done on a regularly in order to find out the size of the wound as well as to know how it is progressing, that is, if it is healing or deteriorating. Measurement is done in such a way that the open wound edge to open wound age at longest point is measured. It is done from head to toe and a 7cm ruler to measure the width of the wound.
Wound exudate is produced by the body in response to tissue damage. Exudate that is thick or milky liquid and may change to brown or yellow indicates an underlying infection that has to be treated promptly with antibiotics. Exudate facilitates healing since it consists of proteins and plenty of nutrients, growth factors and enzymes. During the inflammatory phase of healing, exudates increases. Exudates bathe the wound with nutrients and clean wound surface. Wounds should always be moist to prevent skin breakdown (Gray, et.al, 2011).
Condition Of Surrounding Skin
It can be done by checking the temperature, color, and shape of the surrounding skin. Increased Temperature of the surrounding skin is an indicator of whether an active infection is present or Not. Check if there is normal blood flow in surrounding skin, check for dryness or cracking of surrounding skin. Also, check for skin turgor for any sign of dehydration. Check moisture level because moisture –associated skin damage is important in preventing further skin breakdown. Using liquid dressing because it helps protect surrounding skin from moisture while adhesives reduce friction forces. Surrounding skin breakdown can delay healing and can worsen wound.
3.a) Explanation Of Wound Management
Wound care involves the cleaning of the wound, dressing, stitch removal and infection control. It is done after sutures have been removed, usually 12-14 days after theater. However, it can be initiated if the dressing becomes soiled or wet to minimize infections. Signs of infection, for example, redness, swelling, pain around the knee, increased temperature and leakage from the wound should be monitored. Infections may be prevented by use of antibiotics but in cases where symptoms persist, a physician should be consulted.
b) Pain Management
Pain can be managed by use of drugs such as morphine 10mg 4 hourly (Rastogi, & Meek, 2013) which should be taken as prescribed and instructed by the surgeon. The patient also has to be taught in various ways which may help alleviate the pain. This may include teaching the patient to get involved in activities which will keep his brain busy so as not to concentrate on the pain. The legs to be elevated and cold ice to be applied after exercise like walking.
c) Expectation Of Healing Process
Wound healing process is the process that involves the repair of an injured part of the body. It involves the replacement of an injured tissue by connective tissue. A scar forms when healing has occurred. Wound healing process comprises three phases: Vascular response, bleeding results when the dermis is injured because blood vessels are damaged. The damaged end of blood vessels constricts to reduce blood loss. Clotting is initiated when blood get exposed to the air, which is facilitated by aggregation (Young, & McNaught, 2011). The second stage is inflammatory response where inflammatory mediators such as prostaglandin and histamine are produced by mast cells which are initiated by activation of clotting factors and tissue damage. Wound exudate is produced as a result. At the proliferation stage, the wound is filled with new connective tissue and the size of the wound reduces due to coupling up of the physiological process of granulation, contraction, epithelialization, and maturation. It starts three weeks after injury in healthy people and can last for many months. A lot of factors can also contribute to delayed wound healing and the general health of an individual will influence the ability of healing in different ways. Factors resulting in lower tissue perfusion causes reduced blood flow to tissues leading to delayed healing. As people age, their skin elasticity reduces due to wearing out elastic tissue and collagen fibers in outer dermal layer also reduce
d) Potential Impacts Of Wound Discussed
Arthritis of the knee not only affects a person physically but also emotionally and socially. Activities of daily living such as walking, climbing stairs, doing stairs will be hard for even 6 weeks, and self-care activities such as bathing and dressing are compromised. Dislocation of a knee happens in some cases, getting up and down of the floor is limited and someone needs to be careful, use the help of a chair to stand. Since washing and dressing compromised, one shouldn't bathe unless the wound is fully healed, the patient should sit on the side of the bed or chair when getting dressed. Close monitoring, therefore, should be implemented for such a person.
Gray, M., Black, J. M., Baharestani, M. M., Bliss, D. Z., Colwell, J. C., Goldberg, M., ... & Ratliff, C. R. (2011). Moisture-associated skin damage: overview and pathophysiology. Journal of Wound Ostomy & Continence Nursing, 38(3), 233-241.
Lozano-Platonoff, A., Mejía-Mendoza, M. D. F., Ibáñez-Doria, M., & Contreras-Ruiz, J. (2015). Assessment: cornerstone in wound management. Journal of the American College of Surgeons, 221(2), 611-620.
Rastogi, R., & Meek, B. D. (2013). Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clinical interventions in aging, 8, 37.
Rönn, K., Reischl, N., Gautier, E., & Jacobi, M. (2011). Current surgical treatment of knee osteoarthritis. Arthritis, 2011.
Shetty, R., Sreekar, H., Lamba, S., & Gupta, A. K. (2012). A novel and accurate technique of photographic wound measurement. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 45(2), 425.
Young, A., & McNaught, C. E. (2011). The physiology of wound healing. Surgery (Oxford), 29(10), 475-479.