Wound Management: A Handbook for Community Nurses

Joy Rainey9781861562890, 1861562896

The day-to-day responsibility for wound management is a role usually undertaken by nurses. It includes assessing the wound, selecting an appropriate treatment, and evaluating the patients’ progress. In order to do this effectively the nurse needs to understand the healing process, recognize the factors which may delay wound healing, understand how wound healing can be optimized, know how to recognize complications if they arise and know how to treat them.This text, specifically written for community nurses, including practice nurses, provides a picture of wound healing for both acute and chronic wounds that may be encountered in a community setting. An overview of the function of the skin and phases of wound healing are examined prior to looking at the relationship between wound healing and the patients’ health and lifestyle.The reference is written in a question-and-answer format, and includes relevant case studies.

---

Table of contents :
EEn……Page 1
Wound Care – A Handbook for Community Nurses……Page 2
Copyright Info……Page 6
TOC……Page 7
Series Preface……Page 9
Preface……Page 11
Q1.2 What problems occur when the skin is broken?……Page 13
Q1.3 How is the skin made up?……Page 14
Q1.5 What is the definition of a wound?……Page 15
Types Of Tissue……Page 16
Q1.7 What do the terms ‘primary’ and ‘secondary intention’ mean?……Page 17
Q1.8 What are the phases of wound healing?……Page 18
Q1.9 What is meant by moist wound healing?……Page 21
Q2.1 Why is it important to assess a wound thoroughly?……Page 23
Q2.2 The nurse only has about 10 minutes to see each patient. Wouldn’t a brief note be sufficient?……Page 24
Q2.3 What should be included in a wound assessment?……Page 25
Q2.4 How should wounds be measured?……Page 27
Q2.5 What sort of issues must be considered when purchasing a camera?……Page 28
Q2.6 What can be done about wound odour?……Page 29
Q2.7 What points should be considered in regard to pain?……Page 30
Q2.9 How should pain be managed?……Page 31
Q2.11 What is slough and how should it be treated?……Page 32
Q2.14 How do I recognise an infected wound?……Page 33
Q3.2 What effect does age have on wound healing?……Page 35
Q3.4 How does diet affect wound healing?……Page 36
Q3.5 What dietary advice should be given to help improve wound healing in a poorly nourished patient?……Page 38
Q3.7 Are supplements of vitamins and zinc useful to promote wound healing?……Page 39
Q3.9 How does smoking affect wound healing?……Page 40
Q3.11 Do social factors have a role in wound healing?……Page 41
Q4.2 When should wounds be cleansed?……Page 42
Q4.5 What is an emollient?……Page 43
Q5.1 Ideally a wound should have a moist healing environment. How is this achieved in practice?……Page 45
Q5.4 Can micro-organisms get under dressings?……Page 46
Q5.6 Are occlusive dressings recommended?……Page 47
Q5.9 What is an alginate dressing?……Page 48
Q5.11 What is an enzyme dressing?……Page 49
Q5.13 What are foam dressings?……Page 50
Q5.16 What are hydrocolloids?……Page 51
Q5.19 Can proflavine cream be used to pack wounds?……Page 52
Parabens……Page 53
Q5.22 Can wound dressings be combined?……Page 54
Q5.23 What types of dressings can be used as secondary dressings?……Page 55
Q5.24 Are there any products that should be avoided with vegetarian patients?……Page 56
Q6.1 How should surgical wounds be managed?……Page 57
Q6.2 What factors can affect the healing of surgical wounds?……Page 58
Q6.4 What is the recommended treatment for pilonidal disease?……Page 59
Q6.6 Is there a recommended management following removal of ingrowing toenails?……Page 60
Q7.1 Patients with burns and scalds frequently attend the GP surgery. Which should be referred to accident and emergency?……Page 62
Q7.3 What is the best treatment for minor burns and scalds?……Page 63
Q7.6 What advice should patients be given about caring for healed donor sites?……Page 64
Q7.9 When are adhesive wound closure strips appropriate?……Page 65
Q7.10 When is surgical glue appropriate?……Page 66
Q7.11 Is there a simple method for managing lacerations?……Page 67
Q8.2 What are the principal causes of leg ulcers?……Page 68
Q8.5 What is a typical medical history of a patient with venous disease?……Page 69
Q8.8 What is the typical medical history of a patient with arterial disease?……Page 70
Q8.10 What should be included in the assessment of a patient presenting with leg ulcers?……Page 71
Q8.11 What clinical investigations may be necessary?……Page 72
Q8.12 How can vascular status be assessed?……Page 73
Q8.14 How does venous disease cause ulceration?……Page 75
Q8.16 Why are patients with rheumatoid arthritis susceptible to ulcers?……Page 77
Q8.18 Why are patients with diabetes mellitus prone to ulceration?……Page 78
Q8.19 What advice should patients with diabetes be given about foot care?……Page 79
Q8.20 Should diabetic ulcers be managed like other arterial ulcers?……Page 80
Q8.23 What primary dressings should be used on leg ulcers?……Page 81
Q8.26 Some patients with leg ulcers seem sensitive to the products used. How can this be avoided or treated?……Page 82
Q8.29 How should venous ulcers be treated?……Page 83
Q8.32 When does a trauma to the leg become an ulcer?……Page 85
Q8.35 What is the role of compression hosiery in preventing recurrence of venous ulceration?……Page 86
Q8.38 What measurements should be taken before ordering stockings?……Page 87
Q8.39 There are different classes of compression hosiery. What are their uses?……Page 88
Q8.41 Are there any hazards associated with the use of compression stockings?……Page 89
Q8.43 What is a ‘well ulcer’ clinic?……Page 90
9 – Pressure sores……Page 93
Q9.4 What are the intrinsic factors that cause pressure ulcers?……Page 94
Q9.5 What are the extrinsic factors that cause pressure ulcers?……Page 96
Q9.6 How can patients at risk of developing pressure damage be identified?……Page 98
Q9.7 How can pressure sores be prevented?……Page 102
Q9.8 What should be taken into account when selecting an appropriate support surface?……Page 103
Q9.9 What type of support surface should be selected?……Page 104
Q10.1 How is wound infection recognised?……Page 107
Q10.2 What factors increase the chances of wound infection occurring?……Page 108
Q10.5 What is cellulitis and how should it be treated?……Page 110
Q10.6 What is the single most important thing that can be done in clinical practice to reduce the risk of cross-infection?……Page 111
Q10.7 What is MRSA?……Page 112
Q10.9 How should a patient who is a carrier of MRSA be treated?……Page 113
Q10.11 What precautions should be taken in the GP surgery for a patient with MRSA infection?……Page 114
Q10.13 What is the recommended management for wounds colonised with MRSA?……Page 115
Q10.14 Do staff need to be screened for MRSA?……Page 116
Q11.1 What is a fungating wound?……Page 117
Q11.4 Some wounds such as those on fingers or elbows can be difficult to dress. Any tips for application?……Page 118
Q11.5 What causes skin maceration?……Page 119
Q11.8 What types of wound are suitable for treatment with larvae?……Page 120
Q11.13 Are there any sources of information about wound care on the internet?……Page 121
Q12.1 How can the nurse ensure that the best possible care is provided for the patient?……Page 123
Q12.3 What information is needed?……Page 124
Q12.4 What does it mean to ask an answerable question?……Page 125
Q12.5 How do I search for evidence?……Page 127
Q12.7 So if I go through all this process, identify my problem, find some evidence that helps answer it and introduce some chang……Page 128
Q12.8 What is clinical audit?……Page 129
Q12.9 What is meant by investigating patient experiences?……Page 132
Q12.10 What am I going to do with the results?……Page 133
Q12.11 What sort of questions should be asked?……Page 134
Q12.12 What are the advantages and disadvantages of undertaking a patient survey?……Page 135
Q12.13Have you any thoughts about interviews and focus groups?……Page 136
Q12.15 What is reflective practice and critical incident analysis?……Page 138
Q12.16 There seems to be so much to do in evaluating the care provided to the patients. Where do I start?……Page 140
Glossary……Page 141
Resources……Page 145
References……Page 148
Index……Page 155