Wound Management: Research, Holistic Assessment, Individualized Plan, Problem Solving Frameworks, Risk And Skin Assessment, Pressure Injury Support And Prevention

Moist wound healing refers to the practice of keeping a wound moist which leads to rapid and relatively faster healing than in the normal environment. It is proven by many studies that moist wound healing heals the injury or wound around 5-6 times faster than usual dry environment.

The nursing intervention which is implemented in moist wound healing strategy is

·         Debride the tissue and cleansing of the wound in order to removing the debris.

·         Providing moist environment by using proper dressing and covering the wound with wet cloth or moist bandaids.

·         Protecting wound from coming in contact with infectious elements and further injury as well.

·         Providing proper nutrition to the healing process so that the wound gets healed faster.

Benefits of moist wound healing

The major benefits of moist wound healing is that :

·         Wounds get improved faster and take less time to heal.

·         Kerantinocyte cells a major component of the epidermis functions more easily.

·         Autolytic debridement is facilitated

·         Reduce the risk of infection occurs in the wound

·         Preserving the growth factor present in the wound fluid

·         Stimulates the collagen synthesis

·         Reduces pain and scarring around the wound

Limitation of moist wound healing

Some of the limitations of wound healing is that too much moisture is not good for the wound as excessive moisture because the fluid comes out of wound is very rich in melting the protein and removing the wound bed from the skin but excessive fluid can also melt out the normal skin bed and tissues.

The holistic wound assessment involves the patient medical history such as past and existing medical conditions. The history involves the factors such as psychological, social and spiritual history. It also involves their wound care environment and specialised health services. The holistic wound assessment approach contributes in wound management by helping in considering all the factors that are involved and affects the healing of the wound and provides the framework or a baseline to tracking and monitoring the process of healing of the wound. It provides the setting and adjusting the goals related to the management of the wound. The factor included in holistic assessment are self assessment of the patient, medical and wound history of the patient, ability of the patient to communicate, patient’s choice and preference related to the care they want to receive, cultural and religious beliefs of the patient, and the language and need for an interpreter.

Individualised wound management refers to the reflective of ongoing assessments. It is used in the optimal management in order to enhance the effectiveness of the wound treatment. It includes maintaining communication with the patient related to the healing results of the wound. The important factors of individualised wound management plan of care are

 Social – Social factors that affect patients care and treatment are ethnicity and cultural beliefs.

 Psychological – the psychological factors that are considered are health conditions such as diabetes, cardiovascular diseases, peripheral vascular which can also lead to depression. 

Physical – It is important to consider the physical condition as the condition such as obesity, cardiovascular disease and others can impact our healing in wounds.

 Nutritional – The healthy and nutritious diet affect the process of healing such as protein, carbohydrates, minerals, vitamins etc.

 lifestyle factors – Smoking and alcohol consumption are two factors that adversely affect the healing of wound (Woundsource, 2022).

The information needs to be considered in individualised management plan of care starts from obtaining a through health history of the patient, the current list of medication which is taken by the patient. The information related to the diet combination including protein, carbohydrates, minerals, vitamins is important as it is essential for healing. 

The HEIDI problem solving framework is a structured approach which treat the person to its entirety and consider wound a larger approach rather than considering who the individual is. In HEIDI problem solving frame work stands for history, examination, investigation, diagnosis, and implementation.

History – The patient history provides several items and information related to the past medical and wound. 

Examination – This step is related to examining the patient in order to identifying the symptoms which are required to manage in order to heal the wound.  

Investigation – Investigation of other related issues in the body, reviewing other symptoms in order to encourage the fast healing (Thewoundguy., 2018).

Diagnosis – Diagnosis is related to following the results carried out after the investigation and examination of the body.

Intervention – intervention refers to the plan of care in order to heal the wound or the injury soon and treating the other related symptoms and issues in the body.

The TIME problem solving framework is structured for the healing of the wound it is consisted of four important factors that are tissue debridement, infection, inflammation, moisture balance and edge effect (Woundsource, 2016).

Skin and risk assessment is done in order to predict the pressure points for their injuries or the risk of pressure ulcer. Risk and skin assessment is considered to be a very important and useful preventive tool in order to prevent the skin pressure ulcers or take necessary interventions for healing and treating the wounds and pressure ulcers and other pressure points. Some of the common risk assessment tools are risk matrix, decision tree, failure modes, and effects analyses (effectivehealthcare, 2012).

Five different strategies to prevent the incidence of pressure injuries are

·         Get seniors moving – keeping the circulation better and keeping the seniors and pressure area moving and changing time to time

·         Checking the area of skin in order to identify the sign of developing pressure sores. In case there is any development of sores early intervention and preventive measures can be taken.

·         Keeping the skin dry and clean – it is essential to keeping the area of pressure ulcers clean and dry and preventing open and moisture environment away

·         Encouraging the patient to maintain healthy and nutritious diet – it is important o instruct the patient to maintain health and nutritious diet which help in healing and prevention to the development of the sores. 

·         Managing other chronic health conditions carefully – it is also important to managing other chronic diseases in order to prevent ulcers that are diabetes, blood pressure.  

Pressure reliving and redistributing devices help are widely accepted methods of trying to prevent the development of pressure ulcers for people considered as being at risk some of the pressure reliving devices are mattresses and heel troughs, and splints (Medlineplus, 2022).

·         Visceral injuries are the wounds in the internal organs, it is happened due to the blunt trauma in the leads to the solid organ rupture and visceral damage, and it causes haemorrhage, contamination with the visceral contents. Blunt abdominal injuries refers to the in children in the absence of the history of significant trauma are rare. The abdominal injury is the major cause of morbidity and mortality in the abused children (The Royal children’s hospital Melbourne, 2022).

·         The nursing care considerations included in this including the assessment and treatment are initial management, history taking, current health status and lifestyle and social circumstances, wound status and wound assessment.  

Antibiotics are the medicines that are used to fight and prevent the bacterial infection in humans and animals; they help in killing the bacteria and preventing it from growing and multiplying. In 1928 after the discovery of penicillin by sir Alexander Fleming antibiotics help in transforming the modern medicine and saving the several lives since then. Antibiotics helped in treating the serious infections in the 1940s (Medlineplus, 2015).

Moist wound healing is the practice of keeping the wound moist in order to speeding up the healing of the wound. In 1962, the idea of moist wound healing is discovered by George D. Winter after discovering the epithelisation which is the process of wound closure which is proceed twice which twice as faster in the moist environment that under the scam in the dry environment (Woundsource, 2016).

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Surgical drainage tube

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