WOUND MANAGEMENT USING ‘TIME’

Jeannie Randles RNGrad cert wound care

PG Cert & PG Dip Primary Health

Manage whole patient not just hole in patient

overview

Patient outcomes Wound outcomes Cleansing Products On going

assessment documentation

What the patient wants!!

Work in partnership Expectations General health Palliative wound

care Curative wound

care

Set your goals!

To heal palliative To treat infection To reduce exudates To protect Remove Escher To create wound

healing environment

To control odour To control pain

TIME

Devitalised tissue Slough Escher Dry/wet Granulation Epithelial islands Bacterial burden

TIME

TIME

Moisture balance Too wet?

(macerated) Too dry?

(desiccated) Moist healing

required?

TIME

What is happening at the margins

Rolled Epethelialising Granulating Punched out undermining

cleansing

Consider why cleansing is required

How to cleanse i.e. aseptic or clean

Products used to cleanse

Temperature of cleansing fluid

Environment patient is in

products

Think about goal Debriding Protection Pressure Pressure relief Moisture control Bacterial control

foams

Example above is allevyn non adhesive

Variety of dressings available for use with low to heavily exudating wounds

Available with antimicrobial additives

Check absorption of dressing

Antimicrobials

Inadine Iodosorb AG dressings Honey Polyhexamethylene

biguanide

films

Used to protect Waterproof Avoid multiple

layers Used to secure

primary dressings Monitor for

folliculitis Damaged skin easy

to monitor

Hydrofibre

Vertical wicking Moderate to heavy

exudating wounds Protects periwound Available added to

waterproof backings

Available as antimicrobial

Alginate

Seaweed dressing Haemostatic Available in sheets

or ropes Available with

antimicrobial addition

Moderate to heavy exudating wounds

Horizontal wicking properties

Hydrocolloid

Occlusive dressing creating bacterial and viral barrier

Maintains moisture preventing desiccation

Patient can shower Pain reduction due

to moist environment

Secondary dressings

Comfort Absorption Compression Cosmetic

appearance Compliance Hygiene

Adjunctive treatments

Compression Pressure relief Medication Psychological

support Education Financial support

Case study

73 year old female Congestive heart

failure COPD Diabetic Venous

hypertension Ulcer present 6

weeks Now necrotic

Case study

63 year old male Dementia Smoker 10/day Dietary intake poor #patella after fall Developed

pressure ulcer to heal whilst in hospital

34 year old female Depression Lichen planus

(inflammatory condition)

Oedema to lower limb

conclusion

Think about goal of care

Tissue Infection or

inflammation Moisture control Edges or

epithelialisation Document

Further reading

Hard-to-heal wounds: a holistic approach (May 2008)

Topical negative pressure in wound management (May 2007)

Management of wound infection (spring 2006)

Identifying criteria for wound infection (fall 2005)

Focus Document: Lymphoedema bandaging in practice (fall 2005)

Wound bed preparation in practice (spring 2004)

Understanding compression therapy (spring 2003)

Pain at wound dressing changes (spring 2002)

Sites to check out

ewma.org/english/position-documents.html

www.awma.com.au www.worldwidewounds.com www.woundsinternational.com Wound care education resources Also remember courses at CPIT include

wound assessment and management courses!

www.wounds-uk.com/pdf/content_9364.pdf