Presentation of Wounds

Across all the spectrums of health setting, wounds are very common. Wounds have a range of presentation including surgical or traumatic wounds to chronic wounds like leg wounds and diabetic foot ulcers. The less common wounds include pyoderma, vasculitis ulcers, calciphylaxis, and necrotizing fasciitis. With any kind of wound, understanding the aetiology is very important because it not only enables the victim to come up with an appropriate wound management plan but also to manage all the comorbidities associated with wound development or limiting the healing potential of the wound (Scott, et al., 2015). There are many clues which are used to determine the healing stage of a wound or whether a wound is healing or has been infected. Therefore, wound assessment must be done in a holistic way incorporating the key aspects of patient health status and that of the wound for the best possible outcome. This paper analyzes and discusses the underlying pathophysiology of a patient’s post-operative wound status.

From the examination, there are some clues related to the patients wound to be used in determining the status of the wound. The first clue is the island film dressing along with the incision and which is wet from a serious exudate output. Also, the wound has some dehiscence along the suture line. Finally, the skin surrounding the wound is dark pink, warm and painful (Qiao, Feng, Zhao, Yan, Zhang & Zhao, 2015). 

Although it’s normal for the skin which surrounds a wound to feel somehow warm, the skin around Mrs. Gina Bacci’s incision has been presented to go beyond the normal warmth of a healing wound. This is because it felt very warm to touch and did not show signs of cooling despite the fact that the patient had some days after her operation. From a medical point of view, that was an indication that her body had mounted campaigns against an infection which had attacked the wound. The common infections which affect wounds are as a result of bacteria, fungi, and virus (Scott & Miller, 2015). Mainly, the heat around the incision had been caused by the release of vasoactive chemicals to increase blood flow to the incision area. In addition to that, the victim’s immune system had generated a lot of heat by sending lymphocytes to generate antibodies to destroy the pathogens and phagocytes and ingest the dead bacteria (Bester & Van Deventer, 2015).

Determining Wound Healing Stage

According to the examination report, the wound had some dehiscence. Wound dehiscence is a surgical complication characterized by wound rupture along the surgical incision. Primarily, wound dehiscence is caused by sub-acute infections resulting from imperfect or inadequate aseptic techniques. The patient’s coated sutures such as vicryl had broken down at a rate corresponding with the tissue healing of the wound but hastened by pathogens such as bacteria and fungi (Bittner, Shank, Woodson & Martyn, 2015).

The examination has also pointed out that Mrs. Gina Bacci was experiencing increasing and continual pain from the wound. Generally, a patient is said to be healing well if the pain on the surgery or an injury wound is subsiding. Although medication to reduce pain is required in the first few days, the patient continues to reduce the usage of the painkiller drugs and finally discontinue them over time. However, the continual and increasing pain experienced by Mrs. Gina Bacci is a sign of wound infection (Van Waes, et al., 2016). Mainly, the pain was caused by skin damage, blood vessel injuries, ischemia and other pathogen related to infections. These factors had led to hypoxia which impaired the healing process of the wound and increased infection rates. For instance, the skin damage decreased tissue oxygen which in turn reduced the rate of leucocyte production giving bacteria and other pathogens an opportunity to colonize the wound. 

The skin surrounding the wound being dark pink also indicated that the healing process of the wound was not proceeding in the right way. The color implied that the wound tissue known as Eschar was present (Bharucha, et al., 2015). Commonly, Eschar tissue is dry or moist and appears as a thick and leathery necrotic tissue which is cast off from the wound surface. Eschar prevents proliferation and maturity phase of a healing wound by inhibiting the formation of healthy granulation tissue, epithelialization, and wound contraction. Because most eschar tissues support the growth of bacteria, this increased the risk of Mrs. Gina Bacci’s wound being infected.

From the discussion above, it is clear that Mrs. Gina Bacci’s wound condition is worsening because it has been infected. Also, a large number of the signs which come out clearly in the assessment are those of an already infected wound. Therefore, my first priority will be treating the wound to deter the condition from worsening and spreading further to affect the patient’s general health. Under this priority, the wound will be washed and cleaned thoroughly using detergents like soap and warm water. This will make it both moist and open to absorb any medication to be applied to it for treatment purposes (Ortega-Loubon, Fernández-Molina, Carrascal-Hinojal & Fulquet-Carreras, 2016). Antibiotic medicine will be applied on the wound. An antibiotic ointment such as Neosporin will help the wound heal faster by keeping it safe from some of the common agents of wound infection like bacteria and Fungi. They will also keep the wound clean and moist. After applying the antibiotic ointment, the wound will be covered with a gauze dressing or a bandage which will be changed on a daily basis.

Post-Operative Wound Status Examination

My second priority will be ensuring the wound is kept in a hygienic manner. This will entail regular cleaning of the wound and re-dressing on a daily basis. Also, the patients surrounding will be kept clean always. This will mitigate the risks of further infections after the first treatment. This will be a favorable environment where the patient will not encounter with contaminants. To redress the wound, clean medical gloves will be used to grab the old dressing and pull it off.  In a case where the dressing sticks on the wound, it will be moistened first before it can be pulled off (Bryant & Nix, 2015).

When dealing with patients with Postoperative wounds or incisions, appropriate management is imperative because it prevents further complications like wound dehiscence and surgical site infections. Modern wound management tenets are only applicable for closed incisions, subacute and chronic wounds. For instance, prevention of incision infections by cleansing the wound regularly, maintaining skin care and managing wound moisture are requisite in post-operative plan care. Also, cursory knowledge on the phases of wound healing will help understand the rationale and importance of post-operative incision and surgical wound management (Redmond, Davies, Cornally, Fegan & O’Toole, 2016). 

To manage the condition of Mrs. Gina Bacci’s wound which is a surgical wound, It will be ensured that the wound is always moist to support easy healing. Also, the wound would be dressed regularly to ensure that the wound remains clean (Agra, et al., 2016). However, in cases where dressing is required urgently before the previous one completes a whole day, aseptic technique will be followed strictly. The aseptic technique entails the use of practices and procedures which prevent a wound from pathogen contamination. It will entail the application of very strict rules and measures to minimize the risks of infections.

Surgical incisions will be done regularly in order to remove pathogens, debris, and exudate. This will be done with appropriate pressure which will involve utilizing the safest agent to avoid cases of cytotoxicity or mechanical trauma.  Typically, surgical dressing will be done for the wound after every 24 to 36 hours (Phillips, et al., 2016).  With time, the superficial epidermis will be expected to primarily close the incision line and appear as a sealed. Because it’s a closed surgical incision, the wound will be dressed in a way that the it will be protected from trauma, contaminants and manage exudate and prevent excessive pressure on the incision line.

Wound Infection

Timeframe will be set for suture or staple removal to be three to four days depending on a multitude of factors such as the progress of the healing process and the evident side effects on the skin surrounding the wound. Also, because the patient is expected to undergo pain from the wound, opioid narcotics will be administered to him. This is in consideration of the fact that opioid narcotics are the mainstays of post-operative pain management. Opioid narcotics will be combined with other non-steroidal anti-inflammatory drugs to significantly reduce opioid dosage and achieve adequate pain relief (Peterson, Jung, Hoffman & Rice, 2016). This will also reduce the deleterious side effects of opioids like altered mental status, respiratory depression, constipation, and urinary retention. There will be comprehensive and complete initial postoperative pain assessments which will table all the contradictions which may arise due to different pain relief methods used (NSAID allergy, allergy to specific dressings and cleansers).

Considering the fact that pain related to anxiety, post-operative armament, and other daily activities may limit the patients recovery time and also increase the perceived pain, also the interventions will be tailored to meet patient’s -specific needs like allowing the patient to assist in the process where possible, warming the wound cleansing solution, utilizing non-adherent dressing and positioning the patient for comfort when dressing her to reduce incision-related pains. (Cullum, et al., 2016)  

The patient’s suggestion will be considered in regard to her preferred or desired intervention and utilize them when feasible in order to make her happy and a sense of respected. The distractive measures will not be discounted in the management because they can help the patient recover faster: for instance, music therapy will be incorporated in the management to help reduce the patient’s anxiety, reported pain, and opioid use. Frequent reassessment to pain management plan will also be conducted frequently based on the type of pain, care setting and other patient’s comorbid conditions (Chetter, Oswald, Fletcher, Dumville & Cullum, 2017).

Other key consideration in my post-operative wound management will include the following factors: understanding the phases of wound healing; understanding the approach being used by the surgical wound to heal (primary, secondary, or tertiary); Post-Operative management of incisional pain and topical wound management. Attention to these and other ways of wound care will help me optimize the clinical outcome for my post-surgical patient (Varga & Holloway, 2016).

In summary, this paper has critically analyzed and discussed the underlying pathophysiology and causes of the patient post-operative wound status based on a given case study. Moving forward, it has also given a nursing priority of care for the patient with justification and rationale for each. Finally, nursing management has been drafted which will enable quick recovery of the patient. 

Wound Dehiscence

References

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