Over the last six weeks I have practice quite a number of clinical tasks which attending to wounds has been one. I must admit that prior to my clinical placement my knowledge of wounds was fairly poor not to mention being capable of removing sutures. The placement I am at is in a GP Super Clinic which provides primary health care to quite mix of patients. From an educational aspect it is good when you see the patients return for their required health needs as you can see their progress from their last visit.
In the world of medicine no two people are alike as we all differ from each other in how we function. This also relates to wound healing as there are a number of factors at play to how well a wound will heal. Medications such as anticoagulants such as warfarin that thin the blood will increase the clotting process time compared to patients that have no issues with medications. Other factors would relate to lifestyle and patient education especially with older males. One of the things I have noticed with a number of elderly males is that their skin condition is dry in surrounding areas around the wound and on areas on their legs and heels of their feet. A simple moisturising cream like sorbolene that you can purchase from most mainstream retail outlets would promote healthier looking skin condition which would prevent any further problems like pressure sores from happening overtime.
As a nurse I will make it one of my tasks to ensure that elderly men are educated in maintaining their skin but warning them also not to apply it on the souls of their feet in areas where they could slip and fall. Applying sorbolene can be done in areas where there is a carpet surface and allowing a few minutes for the cream to work into their skin before walking and advising them to wear footwear for protection.
In the last week I developed my own wound chart (see attached) which there are heaps of on the internet, but making my own suited my particular placement environment.
One patient I cared for I had to remove a number of sutures from an incision (minor op) that they had done. The wound was quite moist with quite a lot of slough or purulent which I had to clean off before removing the sutures. I should point out that the patients doctor viewed the wound and gave the instruction to clean the wound and remove the sutures which is what I did. The dressing we used on the wound was acticoat silver side down (antimicrobial barrier dressing) followed by NAD and Mefix to hold the dressings in place. There was a significant improvement on the second visit by the patient when we checked and redressed his dressing. The acticoat silver side down dressing really did its job in reducing the moist purulent appearance. The third visit was even better still with the wound looking much dryer even though there is still quite a way to go before the wound is fully healed.
The end result is a patient that is on the mend and seeing them improve each time they visit which makes their day as well as the nurses providing care to them.