WOUND CARE CASE STUDY Question 1.

Interpret the impact of this wound on the client and his family: PSYCHOLOGICAL Loss of independence due to the impact of wound Inability to completely care for his dependent wife Inability to manage his high set family home on his own Socio-economic impact PSYCHOSOCIAL Social isolation due to wound Socio-economic impact PHYSICAL Delayed wound healing due to Type 2 diabetes Increase risk of infection because micro organisms thrive in a high glucose environment Inability to perform activities of daily living independently due to wound Decreased mobility due to wound FAMILY Inability to complete care for his dependent wife Inability to manage his high set family home on his own Unable to care for his wife and family home due to socio-economic circumstances Question 2. Provide at least three risk control measures you would implement for this wound dressing in the hospital/ward environment to reduce infection risk: RISK CONTROL MEASURE 1: ISOLATION & NURSE COHORTING I would implement isolation as a risk control measure to decrease the risk of entering further micro-organisms into the infected wound and to interrupt transmission of bacteria. I would also implement nurse cohorting (the physical segregation of MRSA patients in one part of a ward, with nursing by designated staff who care exclusively for these patients) to ensure that the mode of transmission is not through nurses and to promote fast wound healing and to avoid complications by not introducing new micro-organisms between patients. RISK CONTROL MEASURE 2: ADDITIONAL PPE + GOOD HAND WASH TECHNIQUE I would implement additional PPE when caring for this patient to ensure you are not the mode of transmission of micro-organisms/bacteria between patients and other staff. Additional PPE would include, gloves, apron or gowns and facial masks if need being. Regular and correct hand washing must be implemented to ensure you are not introducing new micro-organisms to your patient and you are not the mode of transmission between patients and staff. Staff and FAMILY should be educated on when you should do a hand wash (before and after caring JULIA KENNEDY 5100319712 1

for a patient, before and after eating, after touching a patients belongings, after going to the toilet, after handling money, after sneezing or touching face etc) and also educate staff and FAMILY about the alcohol base gel that can also be used in conjunction with hand washing. RISK CONTROL MEASURE 3: ASEPTIC TECHNIQUE Aseptic technique should be implemented when performing wound care to ensure you are not introducing new micro-organisms into the wound. Question 3. Factors I would consider in choosing a wound care product for this client are: 1. Infection I would want to use wound care products thatll help fight infection 2. Absorbent Due to the amount of exudate I would want to use an absorbent dressing to avoid exudate from seeping 3. Size Due to the size of this wound I wound want to use appropriate sized dressings 4. Mobility A dressing suited too withhold movement Question 4. What type of product/s may be appropriate? Give rationales for your product choice. 1. Hypertonic saline to fight infection and kill microorganisms with the aid of antibiotics (antimicrobial) ensuring not to get anywhere near good skin and to clean/debride 2. Antimicrobial dressing - to assist fight infection and to kill microorganisms thatll help clean/debride, promote granulation and epithelium tissue growth 3. Absorbent dressing (mepilex) to promote granulation and epithelium tissue growth and to decrease exudate from wound 4. Pressure band to aid with circulation 5. Silver dressing to help fight infection 6. Cadexomer iodine dressing highly absorbent, absorbs debris and can therefore be used to remove it from the wound bed, making cadexomer iodine a useful debriding agent, helps control exudate, kills bacteria and pathogens. 7. Foam dressing highly absorbent 8. Transparent films help prevent bacterial contamination, They help maintain a moist wound environment, facilitate cellular migration and promote autolysis of necrotic tissue by trapping moisture at the wound surface, waterproof Question 5. Please find attached Wound Assessment Tool for Mr. Brown

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Question 6. Education I would provide to this client in relation to his wound would be: 1. Keeping legs elevated 2. Managing diabetes 3. Incorporate infection control into wound management 4. Keeping the dressings clean and dry 5. Wearing loose clothing to avoid constriction 6. Referring client to a dietician Nutrition plays an essential role in wound healing 7. Minimal mobility 8. Ensuring the client is educated on when and what medication to administer Question 7. Discuss two other relevant resources you may use for your management of this client in their long-term care: RESOURCE 1: Dietician Nutrition plays an essential role in wound healing. Poor nutrition before or during the healing process may delay healing and impair wound strength, making the wound more prone to breakdown. Neglecting the nutritional health of an individual with a wound can compromise the entire wound management process. The following website is very useful and provides knowledge and education about nutrition and wound healing (http://www.worldofwounds.com/Home/Portals/0/Expert%20Guide%20Nutri tion%20Wound%20Healing_final_lr.pdf). RESOURCE 2: Endocrinologist Regular check ups with the endocrinologist will ensure youre monitoring and maintaining your diabetes correctly. An endocrinologist has the most current information, treatment guidelines and educational programs, that can help you successfully take control of your diabetes. Question 8. Three education topics I would include in educating the patient and family member to care for the wound between formal wound care dressings so as to prevent the risk of infection post discharge are: 1. Infection control measures Ensure good hygiene practices showering, washing hands. Ensure a clean environment (educate patient about cleaning services available) and ensure clothing is clean to promote wound healing. 2. Wound healing factors refer to dietician - Nutrition plays an essential role in wound healing. Poor nutrition before or during the healing process may delay healing and impair wound strength, making the wound more prone to breakdown. Neglecting the nutritional health of an individual with a wound can compromise the entire wound management process. 3. Wear suitable clothing clothing too tight around the legs may compromise circulation. Circulation is important to promote wound

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healing as red and white cells are transported to the wound site to help fight infection and promote good wound healing process. Question 9. Follow up care and/or discharge planning for this patient would include: 1. Transport Does Mr. Brown drive or will he need transport provided? For example, taxi, social worker, family? 2. Caring for other family Mr. Browns wife is dependent on him to look after her 3. Cleaning and cooking Will Mr. Brown be capable of cleaning and cooking or will he need services provided? 4. Grocery shopping Is Mr. Brown capable of grocery shopping for him and his wife or will be need other options available like shopping online and getting the groceries delivered or grocery shopping with a social worker for assistance? 5. Caring for pets Do Mr. and Mrs. Brown have any pets that theyre unable to look after anymore or will they need assistance in caring for their pets? 6. Home modifications Will Mr. Brown require home modifications to ensure he is independently capable of performing activities of daily living for him and his wife. 7. Mr. Brown will need to ensure he has regular visits to specialists to promote good wound healing and management. Specialists will include, dietician, general practitioner, endocrinologist, and podiatrist. 8. Medications Will Mr. Brown be capable of administering and purchasing own medications or will he need his medications picked up and delivered and/or put into webster packs to ensure correct and easy administration.

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REFERENCE Mary White, 2009, Role of an Endocrinologist, http://diabetes.lifetips.com/tip/114263/diabetes-treatment-products/diabetestreatment-products/the-role-of-the-endocrinologist.html Accessed 17/03/2013 Anonymous, Australian Wound Management Association, 2001, Nutrition and Wound Healing, http://www.worldofwounds.com/Home/Portals/0/Expert%20Guide%20Nutrit ion%20Wound%20Healing_final_lr.pdf Accessed 23/02/2012 Anonymous, 2009, Wound Care Dressings, http://www.independenceaustralia.com/uploads/health/Section%2013%20Wo und%20Care%20Dressings.pdf Accessed 23/02/2013

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