The case study presented depicts the condition of Mr. David Perason who is a 57 year make hailing from England. He is a retired merchant navy man by profession. He along with this wife and his four sons migrated to Australia in the year 1987. The past medical history of the patient shows that he has been suffering from osteoarthritis for the last 10 years which kept on increasing because of his job as an Engineer.
Additionally Mr. Pearson had developed hypertension which had occurred about six years ago. Recent problems with him constitute his problem of weight gain, which has resulted in the risk of diabetes. The current health condition of the patient shows that his orientation is proper and that he is oriented to time and to place. The reason of the admission of the patient to the hospital is the total knee replacement of the patient of the right knee.
The medical condition of the patient reports that he is suffering from hypertension. He also mentions that his right hip and knee are in pain while it is in rest and it also rises when I the mobile condition. The pain scale shows 6-7 when in rest and 8 when in motion.
The patient also reports that while he is trying to cover long distances, most of the time he runs out of breath in addition to having difficulties to breathe at night which makes him sit up at night. Inspite of the fact that he love food, the patient is trying to follow a diet plan however there has been no such effect because of it. He also mentioned that he has an alcohol problem. Elimination for him occurs about 12 times a day while he gets up twice at might. He also suffers from constipation problems and therefore requires to use laxative about once a week. He also has problems in sleeping at night as he has to get up several times for going to the toilet and also he had bouts of breathlessness along with the occurrence of osteoarthritis pain.
Evaluation of the wound management plan
Wound bed status (include colour/s) – The wound bed status shows bruising of the leg that is ecchymosis, which is followed by the surgery. The color of the wound bed shows blue to deep red. There is inflammation in the first stage of the wound bed, this is followed by proliferation and the final one is the maturation of the wound (Matatov et al., 2013).
Wound measurements – The wound measurement shows that the incision is about 10 inches.
Condition of surrounding skin (ie intact, breaking down) –The condition around the wound shows that the skin is intact since the wound have been stitched after the surgery. However there is necrosis of the soft tissues in some places (Rosenberg et al., 2014).
Wound exudate (colour, consistency, odour) –The wound exudate is clearless to pale in color with a thick consistency, which a pungent odour.
Frequency of dressing change- The dressing change is done twice a day, once in the morning and once in the night.
Wound management
The primary aim of wound care or wound management is to prevent the contamination from happening in the area of wound and to properly clean the infected wound for any kind of surgical closure or the healing of the second intension. In order to obtain the objective of assessment of the wound, it is required to provide a complete sedation or anaesthesia which might be indicated (Pastar et al., 2014).
It is possible for the wounds to be lavaged and to be debrided immediately. There is also a scope of biopsy that needs to be considered for most of the chronic as well as the non-healing wounds (Gause, Wynn & Allen, 2013). For the treatment of the wounds, an aseptic technique is required for the treatment of the wounds which uses the things like sterile gloves, instruments, and bandage materials. It must also be kept in mind that the process of wound healing occurs in a moister and wet condition.
For pain management, pain education has been defined as any planned activities which are designed in order to improve the health behaviour of the patient along with the improvement of the health status of the patient (Stevens et al., 2014). This activity of pain management helps the patient to facilitate the knowledge of the patient in order to help them to interpret their pain and help them get directed towards an effective along with the ongoing self-management. In order to bring about the understanding of the complexities of pain and understand the importance of self-determination as well as sustainable self –management, it is important to develop skills that are facilitatory in nature (Itatsu et al., 2014). The expectation of the healing process is long as it takes a long time to heal after an incision has been made for the surgery of total knee replacement. There are also persistent wound leakage which increases the risk of the periprosthethic infection of the joint (Rosenberg et al., 2014).
The expectation of the healing process depends on the location of the wound, as well as the age and chronic health condition of the given patient. According to the given situation, the patient has a condition of chronic health conditions like diabetes. Presence of this makes the process of wound healing much slower (Webster et al., 2014). Diabetes makes the wound less susceptible to healing and the wound takes a long time to dry up. Additionally the patient presented here is an older adult, therefore the age of the person also becomes an inhibiting factor for wound healing. With the increase of age, the immunity of the person declines so does the secretion of the coagulating factors therefore the healing process becomes long enough (Kosins et al., 2013).
The process of wound healing mainly occurs through two distinguished processes. These are the primary intension healing and the second intension healing. According to the primary intension healing, this process occurs only when the tissue surface has been closed. This might be because of the stiches, or skin glue or staples and tapes. When there is a closure of this kind, there is very little tissue lost.
This process is also often called the primary union or the first intension healing. In case of surgical incision, the process is primary intension. Another method is the secondary intension healing which occurs when the wound is extensive and also involves a considerable amount of tissue loss (Yu-Wai-Man & Khaw, 2015). It is in such cases that the edges of the tissues cannot be brought together to heal. Through this process the pressure ulcers heals. In terms that the secondary intension is different from the primary is intension is that the repair time required is longer, the scarring is greater and there are higher chances of infection.
Most of the surgical wounds are accounted as acute wounds, however there might be complications due to the intrinsic and the extrinsic factors. The complications might be dehiscence and infection. There are a number of factors that are associated with the complications like smoking, rheumatoid arthritis and diabetes. Factors like malnutrition affects the process of healing along with obesity which influences breakdown of the reduced tissue oxygenation (Pierpont et al., 2014).
References
Daeschlein, G. (2013). Antimicrobial and antiseptic strategies in wound management. International wound journal, 10(s1), 9-14.
Dreifke, M. B., Jayasuriya, A. A., & Jayasuriya, A. C. (2015). Current wound healing procedures and potential care. Materials Science and Engineering: C, 48, 651-662.
Gause, W. C., Wynn, T. A., & Allen, J. E. (2013). Type 2 immunity and wound healing: evolutionary refinement of adaptive immunity by helminths. Nature Reviews Immunology, 13(8), 607.
Itatsu, K., Sugawara, G., Kaneoka, Y., Kato, T., Takeuchi, E., Kanai, M., … & Nagino, M. (2014). Risk factors for incisional surgical site infections in elective surgery for colorectal cancer: focus on intraoperative meticulous wound management. Surgery today, 44(7), 1242-1252.
Kosins, A. M., Scholz, T., Cetinkaya, M., & Evans, G. R. (2013). Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis. Plastic and reconstructive surgery, 132(2), 443-450.
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.
Monstrey, S., Middelkoop, E., Vranckx, J. J., Bassetto, F., Ziegler, U. E., Meaume, S., & Téot, L. (2014). Updated scar management practical guidelines: non-invasive and invasive measures. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(8), 1017-1025.
Pastar, I., Stojadinovic, O., Yin, N. C., Ramirez, H., Nusbaum, A. G., Sawaya, A., … & Tomic-Canic, M. (2014). Epithelialization in wound healing: a comprehensive review. Advances in wound care, 3(7), 445-464.
Pierpont, Y. N., Dinh, T. P., Salas, R. E., Johnson, E. L., Wright, T. G., Robson, M. C., & Payne, W. G. (2014). Obesity and surgical wound healing: a current review. ISRN obesity, 2014.
Rosenberg, L., Krieger, Y., Bogdanov-Berezovski, A., Silberstein, E., Shoham, Y., & Singer, A. J. (2014). A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT. Burns, 40(3), 466-474.
Rosenberg, L., Krieger, Y., Bogdanov-Berezovski, A., Silberstein, E., Shoham, Y., & Singer, A. J. (2014). A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT. Burns, 40(3), 466-474.
Soares, K. C., Baltodano, P. A., Hicks, C. W., Cooney, C. M., Olorundare, I. O., Cornell, P., … & Eckhauser, F. E. (2015). Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis. The American Journal of Surgery, 209(2), 324-332.
Stevens, D. L., Bisno, A. L., Chambers, H. F., Dellinger, E. P., Goldstein, E. J., Gorbach, S. L., … & Wade, J. C. (2014). Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical infectious diseases, 59(2), e10-e52.
Webster, J., Scuffham, P., Stankiewicz, M., & Chaboyer, W. P. (2014). Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database of Systematic Reviews, (10).
Yu-Wai-Man, C., & Khaw, P. T. (2015). Developing novel anti-fibrotic therapeutics to modulate post-surgical wound healing in glaucoma: big potential for small molecules. Expert review of ophthalmology, 10(1), 65-76.
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