�Care of Patients with Wounds�

Facilitator name: Maige Charles

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4/16/2023

Learning tasks

By the end of this session, students are expected

be able to:

• Define common terms used in wound care
• Outline the purpose of wound care/Dressing
• Explain the principles of sterile technique
• Demonstrate the techniques of wound dressing

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Common Terms used in Wound Care

•  Application of dressings to a wound is one of the nurses’ responsibilities in order to enhance wound healing.
• A wound is a break in the skin surface which may result from accident injuries or by prolonged pressure over a body part.
• It may also be surgically created or self inflicted.
• Whatever the source of the wound, appropriate care must be given to promote healing and prevent complications.
• Aseptic technique should always be applied.

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4/16/2023

Different Ways of how Wounds can be Classified

• Body wounds are either intentional or unintentional.
• Intentional trauma occurs during therapy; examples are operations or vein punctures.
• Unintentional wounds are accidental wounds.
• For example, a person may fracture an arm in an automobile collision.
• If the tissues are traumatizing without a break in the skin, the wound is closed.
• The wound is open when the skin or mucous membrane surface is broken.

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Wounds According to Type and their Causes

• Incision wound: caused by sharp instrument.
• Contusion wound: caused by a blow by a blunt instrument.
• Abrasion wound: the skin surface is scraped, either unintentional or international.
• Puncture wound: caused by the penetration of the skin and often the underlying tissues by a sharp instrument, either intentional or unintentional.
• Laceration wound: the tissue torn apart, often from accident.
• Penetrating wound: penetration of the skin and the underlying tissue.
• Pressure: pressure ulcers were previously called decubitus ulcers, pressure sores, or bedsores.

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Description of Wounds According to the Presence or absence of Micro-Organisms

Clean wounds: These are wounds which have no pathogenic organisms.

• Normally they are made under aseptic conditions, such as a surgical incision.
• They usually heal in a short time (first intention healing).

Contaminated wounds: These are wounds which contain some pathogenic microorganisms.

• Such wounds may have been acquired by accidents.
• A contaminated wound is liable to infection but with good management it may heal without clinical manifestation of infection.

Infected wounds: These wounds are septic.

• They contain large numbers of pathogenic micro-organisms which cause destruction of tissue in the affected area

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Description According to the Presence of Absence of a Break in the Surface Tissue

Closed wounds: when there is no break in the skin or mucous membranes.

• Such wounds are usually caused by direct blows, traction or twisting.

Open wounds: involve the destruction of skin or mucous membrane thus creating

• communication between the underlying tissue and the outside air, cuts and incisions.

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Wound Healing

• Healing is a quality of living tissue; it is also referred to as regeneration of tissue.
• The way wound healing occurs varies with the individual person, location and type of the wound.

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Types of Wound Healing

• There are two types of wound healing: Healing by primary intention, and by secondary intention healing.
• Healing by primary intention occurs when the tissues surface have been approximated (closed) and there is minimal granulation tissue and scaring.

An example of wound healing by first intention healing is closed surgical wounds.

• Secondary intention healing differs from primary intention healing in three ways:
• The repair time is longer
• The scaring is greater
• The susceptibility to infection is greater

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4/16/2023

Healing by Primary Intention

• Healing by first intention occurs when the wound edges are well approximated and infection is absent.
• There is little granulation and scar formation is minimal.
• There is very little reaction and healing is usually fast.
• Most surgical incisions heal by first intention because the instruments used for cutting are sterile and the wound edges are sutured.

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Healing by Second Intention

• Healing by second intention occurs when the wound is infected and the wound edges are not approximated.
• A large amount of granulation tissue is required to fill the opening before healing takes place.
• The healing process takes a longer time and the resultant scar is large.
• In some patients the scar formation can be excessive and is known as ‘keloid’.

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Factors Affecting Wound Healing

• Extent of the wound: A small superficial wound heals more quickly than bigger and deeper wounds.
• Nutritional status: Poor nutrition delays wound healing.
• Provision of adequate amounts of protein, vitamin C and calories hastens the healing process.
• Location of the wound: Wounds on the feet and legs or less clean heal more slowly than wounds on the face or head.
• Age of the patient: Healing is more rapid in children and young adults than in elderly people.
• drugs.

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• Foreign bodies: Healing will not take place until foreign bodies are removed from the wound.
• These foreign bodies may be in the form of damaged tissues, imbedded fragments of wood, and metals of drainage tubes.
• Haemorrhage and haematoma: These prolong the healing time since they provide a good culture medium for the growth of micro-organisms.
• Presence of other diseases: Diseases such as diabetes mellitus prolong the healing time of wounds owing to a high amount of glucose in the blood.
• Certain drugs: Drugs that may alter healing rate include anti-inflammatory drugs, such as cortisone, and some immune-suppressive and cancer

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4/16/2023

Definitions

Wound: Disruption in the normal integrity and function of the skin and underlying tissues. Or is a break in the continuity of soft part of the body structures caused by violence or trauma to tissues

Asepsis: Sterile, a condition free from gems, infection, and any form of life.

Aseptic: Free from septic matter

Aseptic techniques: method used to prevent contamination in procedures where a sterile field is required

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Sterilization: Is a process of completely removing or destroying all microorganism on a substance by exposure to chemical or physical agents, exposure to ionizing radiation, or by filtering gas or liquids through porous material that remove micro organisms.

Decontamination: is the process of killing microorganisms except spores.

Dressing: Covering, protective or supportive, for diseased or injured part

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Purpose of Wound dressing

• To protect wound from micro organisms
• To absorb exudates
• To immobilize and support an injured part
• To reduce tension on the edges of the wound
• To apply pressure on the wound and prevent bleeding
• To promote psychological and physical comfort to toe client by minimizing moisture and bad smell
• To enhance healing
• To provide opportunity for wound inspection

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Principles of Wound dressing

•  These are basic rules considered during performing sterile procedures.
• They include;
• Strictly adherence to the aseptic techniques to minimize the potential contaminations and prevent infection
• Use non touch technique, sterile material in a sterile field to provide a barrier to restrict the transfer of micro-organisms
• If there is any doubt about the sterility of an item, it must be considered unsterile

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• The possibility of contamination increases with time, therefore the sterile field should be established as close to the time of use as possible

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Techniques of Wound dressing

•   Assessment:
• Assess the client’s general comfort
• Check the condition of the wound and the size of the dressing
• Determine special or additional equipment will be needed e.g. presence of drain in a wound

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Equipment:

Top shelf:

• Sterile equipment
• Dressing towels
• 2 non toothed dissecting forceps
• 2 dressing forceps
• 2 galipot
• Gauze swabs
• Pair of scissors
• Sterile Gloves

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4/16/2023

Bottom shelf:

• Plastic paper bag or receiver
• Bottle of antiseptic solution
• Receiver for used instruments
• Clean dressing mackintosh and towel
• Drum or pack with extra gauze swabs
• Adhesive plasters and bandages
• Cheatle forceps in a jar
• Hand rub

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Steps:

• Inform the patient about the procedure
• Screen the bed for privacy
• Close the nearby windows
• Bring trolley to the patient’s bedside
• Position patient comfortably and remove the bedclothes to expose old dressings
• Place dressing mackintosh and towel under the area to protect bottom sheet
• Wash hands and dry/use hand rub

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4/16/2023

• Open the dressing pack, and create a sterile working field by spreading the sterile towel under the dressing site
• Arrange equipment on the trolley in order, using a dissecting forceps. Put enough gauze swabs
• Pour appropriate antiseptic into the galipot, Do not touch the sterile area with unsterile material
• Remove old dressing by loosening the adhesive tapes gently, if dressings are sticky, wet them with normal saline for easy removal

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• Discard forceps into the receiver at the bottom of the shelf
• Observe condition of the wound
• If drains are present, remove the inner dressing layer by layer to avoid pulling the drain
• Wash hands again and put on sterile gloves if necessary
• If drains need shortening, cut the stitch between the drain and the skin before pulling (if first shortening)

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4/16/2023

• Use a sterile forceps to pull the drain and a sterile pair of scissors to cut it. Replace a sterile safety pin to hold the drain in position
• Dip a gauze swab into the cleaning solution, using a dressing forceps. Clean the wound from centre outward to wash away exudates from the wound. Use one gauze swab at one stroke only once. One forceps to be used for picking sterile swabs and the one for cleaning the wound.

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4/16/2023

• When the wound is clean apply sterile gauze swabs as required. If drains are present place gauze swab under each one so that the rubber drains do not rest directly on the skin surface and cause excoriation
• Secure dressings by pieces of adhesive plaster. Make sure the dressings are appropriately secured so that entrance of micro organisms into the wound is minimized
• Replace patient’s bed clothes and make him comfortable

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• Thank the patient, remove screen
• Clear, decontaminate and clean equipment as appropriate
• Wash hands, dry and record the procedure with observed findings in the patient’s chart

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Key Points

•  Take basic medication safety when using antiseptics solutions for wound cleaning and dressing. Read patient’s file to determine the correct prescribed drugs. Read medicine container three time to make sure the correct drug is used
• If the wound has stitches, do not use cotton wool swabs for cleaning because they tear against the rough edges of sutures and leave wasps of cotton in the wound.
• Always clean the wound from the centre outward to avoid carrying micro organisms into the wound
• Observe the condition of the wound every time you perform the dressing
• Avoid talking over the open wound

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• Step 7: Evaluation
•  What health education does the patient need?
• What are the common antiseptics used in cleaning a wound?
• Explain the process of cleaning the instrument after procedure

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