Wound Management Principles And Complications

Types of Wounds

Mrs Gold was admitted to the palliative treatment unit because she was suffering from a malignant wound on her left groin. The condition of the wound deteriorated and further developed into the sinus. An offensive odour is coming from the wound. Mrs Gold need help with the dressing of her wound. Further, it was observed that her groin and peri-anal area have turned red. The pain of Mrs Gold has increased because of improper management of the wound. Mrs Gold also has a venous ulcer and the wound is also not healing properly. It is observed that Mrs Golf has a condition of fluid overload and signs of pneumonia and metastatic cervical cancer. Mrs Gold is noted to be drowsy and vague. Mrs Gold lives with her husband and they have decided not to opt for any further treatment. Mrs Gol also has previous conditions of chronic inflammatory lung disease (COPD), Gastro-oesophageal reflux disease (GORD) and coronary artery bypass graft (CABGs). Mrs Gold is currently taking Fentanyl 200 mcg + Midazolam 10 mg (24/24) medication with the help of a syringe driver. 

Medical history and examination of the patient and the wounds: Mrs Gold has a fluid overload ongoing problem in the body. Admitted to the hospital due to a malignant wound in her left groin area.

There are mainly two types of wound open wounds and closed wounds (Haertel et al., 2018). The open wounds are penetrating wounds which includes puncture wounds, surgical perforations and wounds, burns that are thermal, chemical, or electric. Attacks and scrapes, gunshot wounds, and other high-velocity objects that can puncture the body are all possibilities. The blunt force trauma is caused in closed wounds due to abrasion, skin tears and lacerations. The type of closed injuries is Blunt trauma that causes fluid overload to the skin and/or surrounding tissues is known as a hematoma, Ulcerations: A lesion is a fluid-filled region that forms epidermis or in the mucosa, Hematoma — a plasma area which forms deep within the skin or in the tissues and Injuries caused by crushing. The open wounds are always subjected to exposure from the viral, bacteria and fungal wounds. 

Wound management principles: There are four basic principles of would management which are as follows haemostasis, proper cleaning of the wound, analgesia, skin closure and the dressing of the wound. Follow up regarding the condition of the wound is also essential (Cho et al., 2021).

4 potential common problems/complications of complex and challenging wounds: There can be several issues related to the wound. One of such complications is infection in the wound (Newman et al., 2019). This is a serious issue regarding wounds. Infection in the blood causing sepsis is also a significant issue regarding would management.

Wound bed status (include colour/s): The area of the wound is red and green in colour. The lump is bigger and open in status.

Wound characteristics: The wound is in purulent status and further developed to sinus. Excessive odour is coming out from the wound. The peri-anal area outside the wound became red because of discharge from cervical cancer.

Wound Management Principles

Wound measurements: The wounds are measured in three parts. 1. First, the length of the wound is measured, 2. Second, the width of the wound is measured and 3. The depth of the wound is measured. The length of the wound is approximately 8-10 cm and the width is approximately 3 cm. The depth is around 3 cm. the size of the wound is 36cm^3.

Condition of surrounding skin (example- intact, breaking down): The wound is not managed properly the peri-anal area of the patient is red due to not managing the wound properly.

Wound exudate colour, consistency, odour): Excessive odour is coming from the wound along with discharge

Expectation of healing process for each type of wound; taking into consideration the wound and any factors that may impact on the healing process-example; chronic health conditions, location of wound, infection, mobility, age, nutrition.

The healing process of a malignant wound has several aspects which are as follows: the nutritional assessment- the patients with good overall nutrition on a daily basis have their wounds heal faster than the rest (Masson?Meyers et al., 2020). Hence, adequate nutrition plays an important role in the healing procedure of the wound. During the nutritional screening, numerous factors need to be taken into account which is the weight loss of the individual. If the individual has lost more than 4.5 kg of weight, or if the individual has decreased haemoglobin that is if the person has < 100 haemoglobin level then the healing process is slower. The chronic condition also affects the healing process in the case of Mrs Gold as she has a previous history of the rectovaginal fistula which is a type of colovaginal fistula where fibrous tissue develops in the rectum and the vagina. She has developed a rectovaginal fistula due to radiology.

Anti- cancer medicines could be beneficial to the healing process of malignant wounds (Nicodème et al., 2021). The possible advantage to the patient's perception of symptomatic treatment and health consequences, which may have a negative impact on the standard of life, must be weighed against the prospective benefits for the patient in terms of side effects. Surgery can be performed to decrease tumour mass, debride wounds, increase symptom-free time, and enhance the appearance of the skin on rare occasions. A malignant wound that is susceptible to full excision requires defect correction. Due to the magnitude of the illness, general health, recovery capabilities, haemorrhaging, and/or participation of neighbouring structures and systems, treatment may not be viable. Chemotherapy can reduce tumour size and improve tumour discomfort. The performance can be determined by the tumour’s chemosensitivity. Radiotherapy will eliminate malignant cancerous cells, resulting in a smaller wound.  Secretions, haemorrhage, and discomfort are among the symptoms that can be relieved. Wounds treated with irradiation may become cancerous at first. Skin responses occur when cells die. Hormone-blocking drugs can also be implied. However, the response is delayed, and it may take 4-6 weeks for the wound's growth and size to lessen. Body shape, consciousness, cognitive well-being, and standard of living can all be affected by cancerous wounds. Suspicion, depression, distress, rejection, frustration, remorse, sense of powerlessness, humiliation, social alienation, and low self-esteem are all basic mental responses. The non-healing characteristics of malignant infections can make people feel despair. When performing and evaluating the effect,  it is critical to look for these things.

Complications of Complex and Challenging Wounds

The hypothesis of the moist healing process underpins existing wound care and diagnosis. Exudate treatment in malignant wound strike an equilibrium between dry and profuse secretions. Traditional dressings like cotton and wax gauze are not indicated for the treatment of malignant sores. These items frequently attach to the site and get integrated with the cells within the lesion, resulting in substantial wound stress and increasing internal bleeding when removed. Use a bandage that allows for as little dressing adjustments as feasible to minimize the interruption to the patient's condition. To reduce exudate drainage and peri-wound aeration, choose absorbency, humidity goods and a secondary ventilation material that is flush with the wound and skin contouring. All this should be carried out after taking recommendations from the physician.

Health education for the patient regarding the wound. (i.e., nutrition, elimination, mobility and any preventative measures) in consultation with a registered Nurse.

It is essential for the nurses to provided education to the patients regarding the management of any form of the wound. The patients need to keep their nutrition level optimal. The elimination of the patients is also essential and because of the development of malignant wound in the groin, it can be difficult hence the patient needs to be explained about catheterization procedure so that elimination can be fulfilled. It is also recommended to touch the wound only after cleaning the hands properly. Application of ointment and gels as recommended by the physicians is also necessary.

In order to manage the pain of the Malignant patients WRHA Wound Care Recommendations: pgs 22-23 need to be used (Younesi Sinaki, 2018). Utilizing non-adherent coverings and keeping the skin hydrated can assist to relieve discomfort and safeguard sensitive nerve endings in the palliative ward. Characterization of the nociceptors implicated in pain control is required before suitable analgesia may be administered. Tumours pushing on or infiltrating neighbouring neurons, capillaries, and connective tissue can cause pain as noticed in the case of Mrs Gold. The activation of nerve fibres (nociceptive suffering) and/or pain produced by neuron malfunction can both generate malignant wound suffering (neuropathic pain). For the treatment of nociceptive pain, analgesic encompasses both non-opioids and opioids. Anticonvulsants (e.g. gabapentin), antidepressants (e.g. amitriptyline), and nerve blocks may be used to treat neuropathic pain instead of opioids. For the unpleasant surface of the skin irritation, nonsteroidal anti-inflammatory medications can be utilized. Assess the degree of the discomfort on a regular basis.

Holistic Assessment of the Patient that includes:

Medical history and examination of the patient and the wounds: Mrs Gold have a fluid overload ongoing problem in the body. Admitted to the hospital due to a malignant wound in her left groin area.

Type of wounds with definition and the causes of wounds: There are mainly two types of wound open wounds and closed wounds (Haertel et al., 2018). The open wounds are penetrating wounds which are puncture wounds, surgical Surgical perforations and wounds, burns that are thermal, chemical, or electric, Attacks and scrapes, gunshot wounds, and other high-velocity objects that can puncture the body are all possibilities. The blunt force trauma is caused in closed wounds due to abrasion, skin tears and lacerations. The type of closed injuries is Blunt trauma that causes fluid overload to the skin and/or surrounding tissues is known as a hematoma, Ulcerations: A lesion is a fluid-filled region that forms epidermis or in the mucosa, Hematoma — a plasma area which forms deep within the skin or in the tissues and Injuries caused by crushing. The open wounds are always subjected to exposure from viral, bacterial and fungal wounds.

Wound Characteristics

Any investigation required for the wound: No further investigation is required.

Wound management principles: There are four basic principles of would management which are as follows haemostasis, proper cleaning of the wound, analgesia, skin closure and the dressing of the wound. Follow up regarding the condition of the wound is also essential (Cho et al., 2021).

4 Potential common problems/complications of complex and challenging wounds: There can be several issues related to the wound. One of such complications are infection in the wound (Newman et al., 2019). This is a serious issue regarding wounds. Infection in the blood causing sepsis is also a significant issue regarding would management

Evaluation of Each Type of Wound :

Wound bed status (include colour/s): Surrounding area of the wound is red in the middle the wound is yellow and brown.

Wound characteristics: The venous ulcer is caused due to a problem in the circulatory system. Due to the insufficient flow of the blood, the area becomes extremely sensitive to pain.

Wound measurements: The length of the wound is approximate 15cm, the width is 12 cm and depth is 1 cm. the size of the wound is 180 cm²

Condition of surrounding skin: The surrounding area is intact and red in colour.

Wound exudate colour, consistency, odour) - any further assessment required example doppler, wound swab: High level of exudate is observed and excessive foul-smelling discharge is noted.

Expectation of healing process for each type of wound; taking into consideration the wound and any factors that may impact on the healing process-example; chronic health conditions, location of wound, infection, mobility, age, nutrition.

The healing process of a Venous ulcer wound has several aspects which are as follows: the nutritional assessment- the wounds of patients with good overall nutrition on a daily basis heal faster than the rest. Hence, adequate nutrition plays an important role in the healing procedure of the wound (Saghaleini et al., 2018). During the nutritional screening, numerous factors need to be taken into account. Out of which one of the factors is weight loss of the individual. If the individual has lost more than 4.5 kg of weight, or if the individual has decreased haemoglobin that is if the person has < 100 haemoglobin level then the healing process is slower (Belghmaidi et al., 2020). Chronic condition also affects the healing process. In the case of Mrs Gold she has a previous history of rectovaginal fistula which is a type of colovaginal fistula where fibrous tissue develops in the rectum and the vagina. She has developed a rectovaginal fistula due to radiology. 

The medical professional will demonstrate how to care for your wound. The following are the basic guidelines: 1. To minimize the risk of infection, keep the incision cleaned and wrapped at all times. 2. The physician will advise patients regarding how frequently the individual should replace the medication. 3. Keep the bandage clean as well as the skin around it. Avoid getting healthy tissue near the overly damp wound as this might cause the healthy tissue to weaken, leading the lesion to swell. 4. Cleaning the wounds completely as per your physician's recommendations before putting a bandage. 5. Keep the skin surrounding the incision cleansed and hydrated to preserve it. 6. The excessive pressure in the deep veins must be alleviated to effectively cure a venous ulcer. 7. To aid with healing, use medications as indicated.

Health education for the patient regarding the wound. (i.e., nutrition, elimination, mobility and any preventative measures) in consultation with a registered Nurse.

It is essential for the nurses to provided education to the patients regarding the management of any form of the wound. The patients need to keep their nutrition level optimal. Health education regarding the management of wounds also needs to be provided to the student, highlighting the importance of elimination and mobility. It is also recommended to touch the wound only after cleaning the hands properly. Application of ointment and gels as recommended by the physicians is also necessary.

Palliative care ensures that the integrity of the skin is maintained. Ibuprofen foam can be utilized as it gives rapid relief from pain. The dressings of the wound need to be done in a proper manner. The wound also needs to be cleaned properly. It is recommended to not use irrigation as it can increase the levels of moisture and thereby irritate the skin more. It is also advised for the dressing to have silicon adhesive as this will limit the damage to the skin.