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Wound Care
- 1. Wound Care Practicalities andSelf-Care LNNM Conference, Friday 12th May 2017 Jemell Geraghty, Lead Nurse Tissue Viability Lydia Barry, Specialist Sister Tissue Viability Royal Free London, NHS Foundation Trust. NW3 2QG jemell82@hotmail.com
- 2. Background: Wound CareSupport Accessing health care is problematic for homeless people due to: • Difficulties in registering with a GP • Lack of access to phone or transport • Disordered lifestyle • Previous experience of attitudes from health care professionals (Crisis, 2002). We need to improve client experience in general practice and make every contact count Crisis (2002) Critical Condition – Homeless People’s Access to GPs. London: Crisis
- 3. Types of wounds •Traumatic wounds • Burns • Leg Ulcers • Abscesses • Self – harm wounds • Chronic sinuses • Surgical wounds • Diabetic foot ulcers • Skin related conditions or wounds • Fragile scars
- 6. When do clientsappear with wounds? • Increase in pain • Infection and symptoms • Other associated problems such as leg/groin pain/cramp • Excess bleeding • Fear • Desperation • Trust
- 7. Wound development: Why? History •Previous occurrence of wound or ulcers • Varicose veins • IVDU or skin popping • Diabetes • Renal impairment • Immunosuppression • Medication • Skin conditions • Injury or trauma • Allergy or skin condition • Poor diet -malnourished
- 8. Wound Assessment: Diagnosis •Examine • When did it occur? • How? • Previous occurrence? • Describe what you see • Feel, palpate surrounding skin • Assess pain • Other contributing factors Wound Location Wound Bed Wound Edges Wound Assessment Wound Size Signs Of Infection Surround skin: Colour & Temp
- 9. TIME: Model forWound Bed Preparation T – Tissue Viable or non viable I – Infection or Inflammation M – Moisture Imbalance or balance E – Edges of Wound International Advisory Board on Wound Bed Preparation. Schultz GS, Sibbald, RG, Falanga V et al (2003) Wound bed preparation: systematic approach to wound management Wound Rep Reg 11; 1-28 T - Does the wound contain non viable tissue such as necrotic tissue, slough, non-viable tendon or bone? I - Does the wound have signs of bacterial contamination, infection or inflammation? M -Does the wound have excess exudate or is the wound too dry? E - Edge wound undermined and is the epidermis failing to migrate across the granulation tissue?
- 10. Wound bed: TissueTypes Necrosis: Otherwise known as non viable or dead tissue. Necrotic tissue occurs when certain skin cells in or on one part of the wound die off, either due to an infection, disease or age. Often presents as black hard tissue or brown. It can be wet or dry. * Be aware of underlying bone/tendon
- 11. Wound bed: TissueTypes Slough: Non viable, devitalised yellowish tissue. Is formed by an accumulation of dead cells. Must not be confused with pus or fatty tissue. It can present as yellow stringy, moist tissue but it can also be dry.
- 12. Wound bed: TissueTypes Granulating: Pink, red healthy tissue the wound rebuilding its structure preparing for the final stages of healing. It should not be friable/bleed easily and there should be no malodour.
- 14. Infection: Observe • Localisedpain • Smell • Increase in inflammation & redness • Oedema • Exudate increase & change in colour • Surrounding skin • Friable wound bed • Systemic unwell: temperature/febrile Collier, M. (2004). Recognition and Management of Wound Infection. World Wide Wounds, http://www.wounds-uk.com/pdf/content_11934.pdf
- 15. Observe it maybe a skin condition, allergy or sensitivity!
- 16. Case examples: Whatto look out for! Skin Damage Critical Ischaemia CellulitisCarcinoma (SCC) Calciphylaxis Diabetic Foot
- 17. Wound Management: Practicalities &Self Care • Cleansing • Moisturising • Protecting the surrounding skin & wound edge * Be aware paraffin based products are highly flammable - if used in large quantities
- 18. Surrounding skin: Excoriation: Excessiveexudate in contact with skin over a period of time can cause what often presents as superficial skin stripping and often described as “burning”. Disturbs the skin pH and causes damage. Maceration: Maceration is defined as the softening and breaking down of skin resulting from prolonged exposure to moisture. Maceration is caused by excessive amounts of fluid remaining in contact with the skin or the surface of a wound for extended periods. Need: Regular dressing changes, cleansing and skin barrier cream/films.
- 19. Wound Management: MoistWound Healing
- 20. Antimicrobials: Prevent &treat wound infection MEDIHONEY® is a natural product and has been used on wounds in adults and children of all age Do not use MEDIHONEY®: • On third degree burns • If you have a known sensitivity to honey, algae or seaweed. • To control heavy bleeding
- 21. Antimicrobials: Prevent &treat wound infection Should not be used where: • There is a known iodine hypersensitivity; before and after the use of radio-iodine (until permanent healing); • If the patient is being treated for kidney problems • Is pregnant or breastfeeding; • In cases of Duhring's herpetiform dermatitis (a rare skin disease). Must be used under medical supervision: • In patients with any thyroid diseases; • In newborn babies and infants up to the age of 6 months as povidone-iodine may be absorbed through unbroken skin; • When treating deep ulcerative wounds, burns or large injuries
- 22. Antimicrobials: Prevent &treat wound infection Although there are no known contra-indications to the use of Aquacel Ag, the dressing will be of little value if applied to wounds that are very dry, or covered with hard black necrotic tissue. Silver: The presence of sodium ions from wound exudate, the silver ions are released to exert a sustained antimicrobial effect against a wide range of organisms including methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE), thus preventing colonization of the dressing and providing an antimicrobial barrier to protect the wound.
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- 24. Why bandage? Keeps dressingin place Covers wound/ulcer Prevent contamination Manage exudate and malodour Support the limb Comfort Help reduce oedema Protection Foundation for compression Can be used safely in nearly all cases Can be applied by almost all clinicians Easy to learn and share skill
- 25. How to promoteself care and concordance. • Establish trust and respect • Listen to their story • Engage and promote independence • Promote concordance • Give encouragement and positivity about wound healing • Chronic wounds can cause isolation and depression
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- 29. Participant 03 diary: “When I started this journey my ulcers were as below... (participant has drawn a picture of her own leg ulcers before and after with this comment ...looked like I had been bitten by a shark!”). “Ulcers starting to “Fizz” because the dressings need to be changed”. “They haven’t got a clue and this thing about methadone being a painkiller that’s a massive belief that people think .”
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