Promoting skin integrity is achieved through proper selection of dressing and wound care. A traumatic wound is a tear in the skin that occurs dominantly on older adults’ extremities (Payne ; Martin, 1993). A wound causes damage to the dermis and the epidermis of the skin. There are minor wounds that can be treated by first cleaning the affected area with soap and water, placing an antibiotic ointment on it and protecting it with a clean bandage.
There are serious wounds that need medical attention. It is treated to prevent further danger to the person. Serious wounds are those wounds that will not stop bleeding after application of direct pressure for five minutes, cuts that are deep or long that needs to be stitched, cuts that hinders a person from doing normal activites, wounds that is caused by the removal of several layers of the skin of the person and wounds that affect the nervous system, bones, tendons or joints (ACEP, 2008).
External Wounds are caused by the type of force on the skin and they are abrasions (scrapes), punctures (deep wounds that are narrow), avulsions (torn out skin tissue), lacerations (cuts), contusions (compression wounds), ulcers, and burns (caused by flame or chemicals) (WIMEI, 2007). The first step in treating a wound is by placing pressure on the affected area for five minutes to control any bleeding. The next step is infection control wherein any bacteria is prevented to enter the wound. (Kaplan, 2007) Taking care of a wound requires debridement which helps remove the causative factor that will worsen the wound’s condition.
The exudate, necrotic tissue and any dirt is removed from a wound to promote healing and promote skin integrity (Miller, 2008). The patient with a wound needs to be tended to immediately to prevent infection. A serious wound needs to be cared for by a nurse. The nurse monitors the progress of the healing process of the patient’s wound. Cooperation of the patient is needed to achieve the proper healing of the wound. The wound is protected from becoming contaminated or have any contact with moisture, secure skin flaps and prevent any other injury to the affected area (Payne ; Martin, 1993).
The three phases in normal healing of a wound are the following: (1) Reaction Phase (2) Regrowth Phase and (3) Remodeling Phase. The Reaction Phase commences after the injury wherein the blood vessels constrict and formation of a blood clot occurs. Inflammation of the wound is noticed in this stage wherein the neutrophils and macrophages attack and debrides the affected wound from dirt, necrotic tissue and bacteria. In the Regrowth Phase, construction of new cells occurs and granulation tissue forms at the base of the wound. The wound is being repaired in this stage by new cells, blood vessels and granulation tissue.
On top of the granulation tissue, the new layer of epithelium is formed. A scab is formed from dried blood and it is detached from the skin due to the formation of the new epithelium. A scar is then formed. The Remodeling Phase is the final stage of wound healing. The fibroblasts decrease in number in the new scar that continues to contract. The scar is weak in the beginning but after a few days, the scar strengthens as a new collagen is formed. (WIMEI, 2007) (Advameg Inc. , 2007). Small wounds heal fast while larger wounds heal slowly.
Certain factors can impede or hinder a wound from healing faster and this includes infection, injury induced to the affected site again, decreased oxygen supply to the wound and lastly, a wound heals slowly if there is a great tension on the wound that results to making the wound open up (WIMEI, 2007). Wound healing is slower when the patient has a medical condition. Medical conditions may be a disease for example diabetes. Malnutrition hinders wound healing as vitamins A, C and K are needed. The older the person is, the slower the healing process and a person who smokes has a slower healing process.
(WIMEI, 2007) (Casey, 2000). Inflammation of the wound is a part of the normal wound healing process but if there was an infection, it can be detected if there is increased pain, increased exudate, if heat is produced from the wound, or if the wound has turned red and is swelling. (Casey, 2000). Nurses are required to take care of the patients with open wounds and they should not be a risk factor for impeding the healing of the wound of a patient. The nurse should provide health care and they should also be protected from the risk of being infected.
The patient is stabilized and the injury is noted to prepare the proper action to achieve wound healing. The patient is stabilized and the injury is noted to prepare the proper action to achieve wound healing. The patient is assessed by taking in consideration of any medical health condition, any medications currently being taken by the patient and any allergies that the patient might have. The nurse should inspect the wound for any contamination and check the degress of progress of the tissue involved in the wound. Anesthetizing the traumatic wound with a local anesthetic will help the patient experience a painless procedure.
The wound is then cleansed of debris that is visible with an instrument and the wound is then irrigated with a saline solution that lessens the sting felt in the wound. The patient is given a tetanus prophylaxis, antibiotics or any other medication to prevent infection of the wound and a tetanus prophylaxis will prevent muscle spasm of the jaw or locking of the jaw (WIMEI, 2007). The traumatic wound is then closed by placing an ointment to maintain the warm temperature of the wound and it can reduce the crust that will form on the surface.
The ointments used have antibacterial properties and the most commonly used ointments are polymyxin, bacitracin and neomycin. (WIMEI, 2007). A dressing helps heal the traumatized wound by protecting it and keeping it under a warm temperature. Its primary function is to absorb any fluid and exudate matter and it will keep the wound from drying otherwise it will slow down the process of healing (WIMEI, 2007). Dressings may allow air to pass through to the wound and they are called nonocclusive dressings. Dressings may not allow air to reach the wound and they are called occlusive dressings.
Occlusive dressings also increases the effectiveness of the topical medication used on the wound (MacNeal, 2006). Examples of nonocclusive dressings are activated charcoal, alginate dressings and dextranomer hydrophilic granules. Occlusive dressings are water-retentive foams, hydrocolloids, hydrogel and thin films (WIMEI, 2007). The different types of dressings depend on the type of wound and what is the action of the dressing on the wound. Hydrogel dressings are for managing burns, pressure ulcers, tearing of the skin and used in surgical wounds. Hydrocolloid dressings do not allow air, water and bacteria to enter the wound site.
Alginate dressings absorb exudate well for wound drainage. It could leave a wound dehydrated and may impede the healing process of the wound. That is why it is not used in dry wounds. Thin films or transparent films are used allowing the autolytic debridement of wounds that are necrotic and provides a moist environment for the wound. The wound is easily and visibly monitored if a thin film is used as a dressing (Miller, 2008). When a wound is yellow, necrotic with high or low exudate, the slough must be removed and the exudate should be absorbed by a hydrocolloid dressing with hydrocolloid paste if the wound is deep.
Hydrogels may be used or alginates may remove the slough. When there is a cavity wound with high exudate, the exudate should be absorbed and a moist environment is maintained preferably with an alginate or foam cavity dressings. If there is a cavity wound with low exudate the aim is to keep a moist environment for the wound with a hydrogel dressing. When the wound is a malodorous wound, it should be cleared from any infection, lower the odor, the exudate should be absorbed and the wound should be protected with alginate or foam with activated charcoal.
If there is a sign of infection, systemic antibiotics are given to the patient (Miller, 2008). A research study was made for the comparison on the effectiveness of a gentian violet topical application to a moist hydrocolloid dressing and efficacy of radiotherapy-induced moist desquamation wound healing. Thirty-nine patients with wounds are the subjects of the study and there was a decrease in wound size and pain but dressing comfort and appearance received a low patient’s satisfaction. The patients have limited physical movement with the gentian violet topical application.
The factors that impact the use of this type of dressing is the drying effect and the ease of mobility of the patient when using this type of dressing for wound healing (LW & WI, 2000). There are recommendations that could positively impact current practices related to wounds and dressings. First is to identify and treat the cause of the wound. Assessment of the healing ability of the patient is important. The patient must be educated regarding the process of wound healing and the proper dressing to promote skin integrity.
Protecting the wound from infections and changing the dressing whenever required to maintain hygiene and providing the best health care to the patient (Sibbald, et al. , 2007). There are two questions that remain unanswered and warrent further discussion or research on the topic for dressings, wound care and promotion of skin integrity. They are: 1. Does the use of honey as a dressing promote wound healing and skin integrity? 2. Why do hospitals, doctors and wound-care nurses still favor using the hydrocolloid DuoDerm?
Duoderm hides the condition of a wound, drainage is trapped within, skin tissue is further broken down, hard to remove, DuoDerm pulls off the healthy skin tissue when changed and they are not frequently changed. Conclusion Appropriate selection of a dressing for a person with a wound depends on the severity of the wound and the medical health condition of the patient. The nurse and patient should be educated about the effect of the particular dressing to be used in a wound. Effective healing of a wound will occur when the causative risk factor is eliminated, infection is prevented and proper nutrition is taken.
The extent and condition of the wound is taken into consideration for the wound-care nurse to assess and provide the correct dressing. Infection control and prevention of re-injury to the affected traumatic wound will determine the wound healing process. The factors to consider the appropriate dressing for proper wound healing promotes and maintains skin integrity. The possible health risk factor could affect the patient and the wound-care nurse if proper hygiene is not met. Mere testing of a dressing product will not ensure good progress of a healing wound.
In order to reduce threats to skin integrity is by cleansing with water and soap. Further studies should be made on possible natural products that may be used as substitute to available wound dressings. Promotion of wound dressings that are less expensive products and materials should be done to prevent other people from still using banned products in other countries. The factors that can affect a person’s skin integrity is proper nourishment, light, water and availability of oxygen. The overall health of a person depends on the maintenance of one’s skin integrity.
A wound will prevent the maintenance of skin integrity and so it will impede the patient’s well being. References: Lippincott Williams ; Wilkins (2000). Cancer Nursing-Abstract: Volume 23(3) June 2000 p 220-229 The Effects of Hydrocolloid Dressing and Gentian Violet on Radiation- Induced Moist Desquamation Wound Healing. Retrieved on February 5, 2008 from http://www. cancernursingonline. com/pt/re/nca/abstract. 00002820-200006000-00010. htm;jsessionid=H4pbTQS0245WWSjzJ2JFTJM1hcl1TYShpzhFg7CTFM2ZZn5hmBvT! -809317659! 181195629! 8091! -1 Casey, G (2000). Modern wound dressings.
Retrieved on February 15, 2008, from http://www. nursing-standard. co. uk/archives/ns/vol15-05/pdfs/p4751w5. pdf Sibbald, G. , Orsted, H. , Coutts, P. ; Keast, D. (2007). NursingCenter – Library – Journal Issue – Article-Best Practice Recommendations for Preparing the Wound Bed Update 2006. Retrieved on February 15, 2008, from http://www. nursingcenter. com/library/JournalArticle. asp? Article_ID=727997 Manuel Villanueva (2000). PATIENT SKIN CARE AND PRESSURE ULCER CARE (SAY NO TO TOPICAL dUODERM-TYPE DRESSINGS. Retrieved on February 15, 2008, from http://www. manuelsweb. com/skinwoundcare.
htm Fishman, D (2007). Phases of Wound Healing. Retrieved on February 15, 2008, from http://www. medicaledu. com/phases. htm MacNeal, R. (2006). Treatment. Retrieved on February 15, 2008, from http://www. merck. com/mmhe/sec18/ch202/ch202c. html? qt=wound%20dressing;alt= sh#sec18-ch202-ch202c-53 Advameg Inc. (2007). Wound Care. Retrieved on February 15, 2008, from http://www. surgeryencyclopedia. com/St-Wr/Wound-Care. html American College of Emergency Physicians (2008). Wound Care. Retrieved on February 15, 2008, from http://www. acep. org/practres. aspx? id=26274 Kaplan, J. (2007).
Wounds. Retrieved on February 15, 2008, from http://www. merck. com/mmhe/sec24/ch299/ch299f. html Wild Iris Medical Education, Inc. (2007). Wound Care. Retrieved on February 15, 2008, from http://www. wildirismedicaleducation. com/courses/205/index_ems. html Payne, R. L. ; Martin, M. (1993). Wound Care/Dressing Protocol -SKIN TEAR. Retrieved on February 15, 2008, from http://www. kendallhq. com/catalog/ClinicalInformation/Skin%20Tear. pdf Miller, J. (2008). Wound Care Types of Dressings. Retrieved on February 15, 2008, from http://endoflifecare. tripod. com/imbeddedlinks/id10. html