Virulence, Reservoirs And Portal Entry: Understanding Wound Dressing And Its Complications

Understanding Virulence, Reservoirs, and Portal Entry

1.1

Virulence is a terminology that refers to the degree or severity of damage caused by a disease-causing micro-organism. When the micro-organisms affect someone, they may cause diseases. However, the level of damage is not static because it keeps on changing. This is what virulence Implies and seeks to clarify.

1.2

A reservoir is a carrier or passive host which acts as a source of a pathogen, but does not get affected by the pathogen it harbors. The passive host is safe from the pathogen because it cannot be affected in anyway. The pathogen can only hides in the host, but does not transmit any diseases to it. This is why it is called a carrier. It merely carries and accommodates the pathogens.  

1.3

Portal entry is a point or location of the host’s body at which the micro-organisms get entry so as to cause diseases. Before causing any attack, the disease-causing micro-organisms must get entry into the body. This is done through different parts of the body that has been identified by the micro-organism because it is appropriate to do so. Some of the common entry points in the body include the skin, mucous membrane, gastrointestinal and respiratory tracts,    

Before undertaking a wound dressing, the nurse should effectively communicate with a patient and discuss about a number of issues. First, the nurse should seek for clarification regarding the causes of the wound. Secondly, the nurse should ask for any complications such as pain and how they have been felt. Thirdly, the nurse should ask the patient to state the date and time when the injury occurred. Moreover, the nurse should ask for the medical history of the patient to determine if he has been suffering from diseases like tetanus. Last, but not least, the nurse should seek to know more about the payor source because it will determine how the care should be provided (Anderson, et al., 2014).  

There are different parameters that should be considered when dressing a wound. The parameters to be considered include the viability of the tissue; healing of the wound; wound spaces; presence of edema in the wound; dryness or wetness of the wound; and the conditions of the skin that surrounds the wound (Anderson, et al., 2014). A proper understanding of these parameters can provide the healthcare provider with an insight on how to handle the patient, make proper choices regarding the process, and deliver quality care.    

Parameters to Consider in Wound Dressing

Q4.

Cross infection is a common challenge in the wound dressing process. However, to minimize it, the healthcare provider should take the following measures:

Aseptic Technique: This refers to the sterilization of all the equipments used when dressing the wound. This should be done by ensuring that all the equipments and materials are clean and do not contain any contamination that might spread the infection to the healthcare provider or another patient. At the same time, when dealing with carers and patients, the healthcare providers should stick to the organizational guidelines and engage in activities such as sensitization and education.

Protection of the hand: To protect the healthcare provider from cross infection, he should wear gloves and clean his hand whenever he handles any patient (Anderson, et al., 2014). This is a simple task that can be implemented by any provider as long as proper education is given. The healthcare provider should be mandated to oblige by the organizational guidelines and strictly observe hygiene. Hands should be thoroughly cleaned before and immediately after attending to the client.

Q5.

One of the most significant activities of a healthcare provider is the documentation of the patient records. Before engaging in wound dressing, the healthcare provider should ensure that he captures all the essential health records of the patient. Accuracy in the handling of the data can help in ensuring that high quality services are provided to the patient (Anderson, et al., 2014). Information regarding the patient’s medical history, and the cause, date, severity, and treatment for the wound should be precisely recorded.   

Q6.

The responsibilities of the healthcare provider during wound assessment should include documentation, communication, and determination of the thickness, depth, size, and severity of the wound before identifying the most appropriate intervention to provide. Each of these activities is very important and should never be overlooked by the healthcare provider as long as he is concerned about delivering quality healthcare services to the patient.

Q7.

Holistic assessment is better than wound assessment because it has many advantages. First, it can help in improving the quality of services rendered to the patient. Besides, it is patient-centered, more detailed and reliable because it is evidence-based and grounded on applicable theories (DiCenso; Cullum & Ciliska, 2011). It should therefore be applied when assessing wounds as it can enable the practitioner to provide an all-round care and allow the wound to heal in a natural manner.  

Minimizing Cross Infection During Wound Dressing

Q8.

The three main stages of tissue repair are:

1. Inflammation
2. Organization and
3. Regeneration

9.

The following are the factors affecting the wound healing process:

Oxygenation: It helps in facilitating the process of wound healing by aiding in metabolism and the production of Adenosine Tri-Phosphate (ATP) energy.  ATP is very important because it nearly drives all the activities of the body including the wound healing process.

Infections: An infection in the body delays the wound healing process because it results into colonization, contamination, spread of infections, and replication of disease-causing micro-organisms in the wound (Anderson, et al., 2014). In other words, infections delay the process of healing of wounds because it complicates the condition.

Nutrition:  A patient nursing a wound should eat well. For a wound to heal faster, it requires certain nutrients that should be present in the food eaten. Meaning, it can be facilitated by the consumption of a balanced diet which basically contains all the essential nutrients required for a healthy living.

Age: The age of a patient influences the healing process of a wound. The rate of healing of a wound declines with one’s age. It is higher amongst the younger populations, but lowers amongst the elderly persons (Matatov, Redd, Doucet, Zhao & Zhang, 2013). Therefore, when attending to a patient, the healthcare provider should not fail to consider the age because it is an important factor in the wound healing process.

Stress: The presence of stress reduces the speed of the healing of wounds. Therefore, to heal faster, one needs to properly manage stress before it escalates into depression. Psychological status of a patient is very important and should be considered when attending to the patient. It is for this reason that the wound-nursing patients should be sensitized on stress management strategies. 

Alcohol Consumption: Alcohol increases the severity of wounds. So, a patient nursing wound should not engage in the use of alcohol because it can delay the healing process.          

10..

The following are some of the common psychological impacts of wound on a patient:

Anxiety: A patient nursing wound suffers from anxiety because of many reasons. First, there might be a fear of potential job loss because severe wounds might incapacitate a patient and prevent them from attending to their duties. Secondly, stress can arise from the economic burden posed by the wound. Thirdly, a wound-nursing patient may be stressed because of the feeling of dependence and loss of autonomy. Lastly, nursing a wound might result into isolation which can also cause stress and anxiety (Matatov, Redd, Doucet, Zhao & Zhang, 2013).

Psychological Effects of Wound on Patients

Depression: Depression is also a psychological effect of wound. It is caused my many factors. In the first place, it results from the feeling loss of worthiness. Besides,  a patient might be depressed because of the persistent pain from the wound. Moreover, depression might be caused by the feeling of embarrassment from changes such as wound drainage, bad odor, and the visibility of wounds on the body.  

11.

The following are the common complications and problems associated with wound:

Contracture Formation: These are deformities that result into the exaggeration of normal contraction of the wound edge. An example of infection is tetanus. Tetanus is a fatal infection that occurs in the Central Nervous System (CNS). It delays the healing process of the wound

Infection: Are caused by the overgrowth of micro-organisms in the wound. Infections can lead to a deterioration of the condition because it can delay the healing process.

Inadequate Scar Formation: The failure of scar to form effectively hinders the wound healing process. A scar is important because its development can help in facilitating the healing of the wound.

Bleeding: The wound causes bleeding (excessive loss of blood from the body) because it causes a break up in the blood vessels. Bleeding is bad because it can worsen the situation and condition of the patient.  

12.1.

Exudates refer to the fluid and mass of cell that is filtered from the blood vessels to the surrounding tissues. It mainly consists of cellular debris and proteins.  

12.2.

Primary intension refers to the process of cleaning a wound by bringing the edges together or using stitches to close the wound. Its benefit is that it does not cause a tissue loss.  

12.3.

Granulation is a wound healing process whereby a pink lumpy capillary and tissue is formed around the edges.

13.

No

14.

The most effective way of minimizing the chances of cross-infection is the strict observance of hygiene. Meaning, every healthcare provider, carer and visitors should be taught how to clean hands using clean water, soap and the most recommended detergents (Smith, et al., 2013). Proper education can be helpful in creating awareness to the carers, patients, and the healthcare providers.

15.

In order to assess the impacts of wound on a patient and his family, I will evaluate many things. First, I will assess the severity of the physical pain experienced by the patient. Besides, I will assess the psychological changes such as depression, anxiety and stress that might be felt by the patient. In addition, I will assess the social impacts of pain on the patient. This includes the relationship with family members (Matatov, Redd, Doucet, Zhao & Zhang, 2013). Lastly, I will look at the economic changes caused on the patient and his family members as a result of the wound. I will make a good use of appropriate assessment tools to do so. If I do these, I will not fail in my roles as a healthcare provider.

Complications and Problems Associated with Wound

16.

One of the tools used in the assessment of wounds is a tape measure. Tape measure can be used to determine the size of the wound (Fairman, Rowe, Hassmiller & Shalala, 2011). It is important to measure the size of the wound because it can help in determining its size before taking the most appropriate measures to manage it.

17

True

18.

True

19.

Registered Nurse (RN)

Physicians

Physical therapists

20.

I would advise other team members to adopt a multidisciplinary collaboration, evidence-based, holistic and patient-centered approaches. These are the most important strategies that will help in delivering high quality care to the patient (Melnyk, Gallagher?Ford, Long & Fineout?Overholt, 2014). They will enable the patient to effectively manage the condition and enjoy a faster and holistic healing process.  

21.

Stoma care is responsible for assisting the patient to improve the quality of life. A stoma nurse should always be close to the patient right from diagnosis, treatment, management until the healing process. It should therefore be the responsibility of a stoma nurse to prioritize the interests of the patient and discharge his duties by complying with the professional standards and codes of ethics governing the profession.

22.

The signs and symptoms of wound infection are:

• Redness around the wound
• Swelling around the wound
• Fever
• Increased pain around the wound
• Drainage

23.

Nurse

24.

I have a responsibility of assessing the patient, understanding the situation, before coming up with the most appropriate strategies to deliver holistic and patient-centered care in the management of the patient’s wounds (Fairman, Rowe, Hassmiller & Shalala, 2011). I also have a mandate to effectively communicate with the patient and make a proper choice of the treatment and intervention strategies to adopt.

25.

I can contribute t proper wound planning by carrying out a holistic assessment to determine the severity of the wound. When planning, I will have to involve other providers to help in providing appropriate care to the patient (Fairman, Rowe, Hassmiller & Shalala, 2011). Wound healing is a complex process that can be successful if approached using a multi-disciplinary approach.

26.

Follow organizational policies and procedures

27.

False

28.

Complete documentation

29.1

Alginate is an alginic salt-containing irreversible hydrocolloid which is used in the wound dressing process to help in the absorption of fluids and blood in the wound.

29.2

Foam is an absorbent and soft material used in the absorption of the drainage in the tubes. It can be used in secondary dressing of the wounds so as to help in providing cushioning and preventing bacterial infection.  

Wound Healing Processes

29.3

Hydrogel is used in keeping the wound to be moist, monitoring of the fluid exchange in the wound, and creating a moist healing environment for the wound. These are the reasons why it is used in the reasons why hydrogel is used in the wound dressing process.

29.4

Semi-permeable adhesive film dressing is a flexible and thin material used in providing adhesive support to the skin and prevents any damages to the wound.  

29.5

Hydrocolloid is a dressing technique used in keeping the newly healed skin to be in contact so as prevent tissue break down and promote the healing of the wound.

30

Hydrogel

31

The outcome of the nurse’s wound management would be evaluated by looking at a number of issues. First, I would consider the duration taking by the wound to heal. A successful management means that the wound would heal faster and within the shortest time possible. Besides, I would have a look at the documentation and analyze the way the nurse attended to the patient right from the beginning up to the very end of the process (Anderson, et al., 2014). Lastly, I would take time to assess the patient, communicate with him, and ask for his feedback. The responses from the patient will be used in evaluating the performance of the patient.

32

Chronic

Acute

Burns

Pressure ulcers

Wounds in the lower extremity of diabetic patients

33

I will closely monitor the progress of the patient and support him at all times. I will address the patient’s physical, psychological, and spiritual needs (Melnyk, Gallagher?Ford, Long & Fineout?Overholt, 2014). This will facilitate the healing process. I will also seek for the support of my colleagues to help in attending to the patient. All these will have to be done because a complex wound is more demanding and requires to be attended to more attentively. This is the only way through which the patient can be helped to manage the wound and improve his condition no matter how serious it might be.

34

Nurse

Physician

35

Staphylococcus aureus/MRSA

Streptococcus pyogenes,

Enterococci and

Pseudomonas aeruginosa 

References

Anderson, D. J., et al., (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(06), 605-627.

DiCenso, A.; Cullum, N. & Ciliska, D. (2011). Implementing evidence-based nursing: some misconceptions. Evidence Based Nursing 1 (2): 38–40. doi:10.1136/ebn.1.2.38.

Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. New England Journal of Medicine, 364(3), 193-196. DOI:  10.3912/OJIN.Vol19No02Man02

Matatov, T., Reddy, K. N., Doucet, L. D., Zhao, C. X., & Zhang, W. W. (2013). Experience with a new negative pressure incision management system in prevention of groin wound infection in vascular surgery patients. Journal of vascular surgery, 57(3), 791-795.

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve

healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15. doi: 10.1111/wvn.12021. Epub 2014 Jan 21.

Smith, M. B., et al., (2013). Pressure ulcer treatment strategies: a systematic comparative effectiveness review. Annals of internal medicine, 159(1), 39-50.