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Metaphorical

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wound care

wound care

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  • 1. New approach to understand wound care By Khalid Remaly
  • 2. Metaphors illuminate all kinds of concepts. Williams Harvey described the heart as a pump and, as we couldn’t know much about how the heart worked until the water pump was invented
  • 3. Farming is a team activities devoted primarily  to the practice of producing and managing crops. Farmer job is to provide the best conditions  for the planting as natural process to take place. It is long with multiple phase process. 
  • 4. Understand your Patient and wound   challenges assessment. Plan to overcome. Plan to manage.  
  • 5. Remove dead tissue and control  contamination
  • 6. Why do We Want to Remove Necrotic Tissue? Necrotic tissue inhibits healing  Necrotic tissue is a medium for infection.  Necrotic tissue in a wound stimulates the  inflammatory response.
  • 7. Using of anti septic  should be limited to the early stage of highly contaminated wound. For the further stage  you should switch to modern antimicrobial agent.
  • 8. presence of exudate in a wound  will provide an environment that stimulates healing. WBC ENZYMES GROTH FACTORS Exudate contains various  components, including: lysosomal enzymes, WBC's, EXUDATE lymphokines and growth factors.
  • 9. Absorbent dressing in heavily exudation  wound. Moist retentive dressing in dry wound. 
  • 10. Take the necessary procedures to keep the  wound warm. Warm up saline before cleansing.  Use dressings of low frequency change.  Change secondary dressing before getting  wet.
  • 11. Proper selection of the dressings.  Remove dressing gently.  Avoid fibrous dressing on wound bed. 
  • 12. Inspect skin  Moisture control  Proper positioning and transfer  techniques Nutrition  Avoid pressure on heels and bony  prominences Monitor and document 
  • 13. Alterations in mobility  Level of incontinence  Nutritional status  Alteration in sensation or response to  discomfort Medications that delay healing  Decreased blood flow to lower  extremities when ulceration is present
  • 14. Friction Immobility Shear Pressure Ulcers Pressure Incontinence Malnutrition
  • 15. Location  Stage and Size  Periwound  Undermining  Tunneling  Exudate  Color of wound bed  Necrotic Tissue  Granulation Tissue  Effectiveness of Treatment 
  • 16. Wound and Risk Assessment every visit  Documentation on Wound Assessment Form every 7  days when 1 or more pressure ulcer exists Physician assessment and documentation on  Physician Wounds Care Assessment tool
  • 17. Stage I Stage II Stage III Stage IV
  • 18. Overall strategy and scope of the treatment plan depends on patient’s condition, prognosis, and reversibility of the wound.
  • 19. Prevent complications or the deterioration  of an existing wound Prevent additional skin breakdown  Promote wound healing 
  • 20. Dressing considerations should include: Patient’s condition and prognosis  Ease of use  Ability to maintain moisture  balance Frequency of change 
  • 21. Cleanse Debris from the  Wound Possible Debridement  Absorb Excess Exudate  Promote Granulation  and Epithelialization When Appropriate Possibly Treat Infections  Minimize Discomfort 
  • 22. Indicated for Mechanical Debridement ONLY Causes Injury to New Tissue Growth  Is Painful  Predisposes Wound to Infection  Becomes a Foreign Body  Delays Healing Time 
  • 23. Goal is to minimize the Decrease Frequency  frequency of dressing of Dressing Changes change Daily dressing changes  increase chances of infection and disrupts the healing of tissue Optimal wear time is  3-7 days
  • 24. Assess “Risk for Breakdown”  Utilize skin creams and lotions for  dry skin Utilize barrier products as needed  to minimize irritation from incontinence Reposition frequently  Use pillows in bed for positioning 
  • 25. Remove Wound Debris  Sustain Moist  Environment Soften Necrotic Tissue  Debride the Wound  Reduce the Risk of  Bacterial Contamination and Infection Reduce Odor 
  • 26. Dry to Minimal  Exudate Moderate Exudate  Copious Exudate 
  • 27. TREATMENTS: GOALS: Maintain skin integrity  Skin to remain clean and odor Preferred agents (dry skin)  free Aloe Vesta skin cream  Protect and moisturize skin Preferred agents (at risk for  breakdown due to incontinence/pressure) Aloe Vesta protective  ointment
  • 28. Dry to Minimal Exudate GOALS: TREATMENTS: Minimize dressing changes  Maintain moist  Preferred agents: environment Prevent infection  Hydrocolloid  Prevent additional skin  (DuoDERM ) breakdown
  • 29. Moderate Exudate GOALS: TREATMENTS: Minimize dressing  changes Preferred Agents: Maintain moist Hydrofiber (Aquacel)   environment Hydrocolloid (DuoDERM)  Prevent infection  Prevent additional skin  breakdown
  • 30. Copious Exudate GOALS: TREATMENTS: Minimize dressing  changes Preferred Agents: Manage Exudate Hydrofiber (Aquacel)   Prevent infection  Prevent additional skin  breakdown
  • 31. Mechanical Debridement  Autolytic Debridement  Sharp or Surgical Debridement* 
  • 32. Treatments: Goals:  Removal of exudate Preferred Agents  Odor control Non-Adherent Gauze   Pain control Dressing . Zinc Oxide Paste  (Viscopaste) Non-Pharmacological Activated Charcoal Dressing measures to control odor  (Carboflex) include:  Oil of Wintergreen Atropine solution may be  Charcoal briquettes or used to control bleeding Coffee grounds  Dryer Sheets Metrogel cream can be used to control odor
  • 33. Treatments: Diagnosis of wound infection:  Based on clinical signs Preferred agents: (fever, increased pain,  Hydrofiber (Aquacel Ag) friable granulation tissue, foul odor) DO NOT USE: Providine Iodine  Iodophor  Dakin’s solution  Hydrogen peroxide  Acetic Acid 
  • 34. Comfort and Shear Reduction Products: Pillows  Heel/Elbow DO NOT USE DONUT TYPE  DEVICES IN WHEELCHAIRS Protectors Foot Cradles  Sheepskin Pads 
  • 35. Multiple Pressure Points (greater than 2 turning surfaces)  Standard Mattress  3-4” Eggcrate Overlay on Standard Bed  Gel Mattress Overlay  Wheelchair Foam Pad  Wheelchair Gel Pad Multiple Pressure Points (fewer than 2 turning surfaces)  Static Air Mattress  Alternating Pressure Pad and Pump  Low Air Loss Mattress (requires approval)
  • 36. High quality crops.  High economical value  Happy customer 
  • 37. High quality healing  results. Saving hospital costs.  Happy patients. 

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