Ms Prudence Lennox. Ms Liz Milner. 15:30-16:00 Wound Management in Primary Care. Nurse Manager Healthcare Rehabilitation Auckland

Transcription

1 Ms Liz Milner Nurse Manager Healthcare Rehabilitation Auckland Ms Prudence Lennox President NZ Wound Care Society 15:30-16:00 Wound Management in Primary Care

2 Overview Wounds we see in primary care Flap lacerations Burns Surgical wounds Chronic wounds Assessment Assessment Bloods hints and tips When to refer Key risk factors At risk lower legs 2

3 Assessment 3

4 Laboratory investigations Investigation Haemoglobin White cell count Platelet count Erythrocyte sedimentation rate; C reactive protein Urea and creatinine Albumin Glucose, haemoglobin A 1C Markers of autoimmune disease Rationale Anaemia may delay healing Infection Thrombocytopenia Non-specific markers of infection and inflammation High urea impairs wound healing. Renal function important when using antibiotics Protein loss delays healing Diabetes mellitus Indicative of rheumatoid disease, systemic lupus erythematosus, and other connective tissue disorders 4

5 Laboratory investigations Investigation Cryoglobulins, cryofibrinogens, prothrombin time, partial thromboplastin time Deficiency or defect of antithrombin III, protein C, protein S, factor V Leiden Haemoglobinopathy screen HIV status Serum protein electrophoresis; Bence-Jones proteins Urine analysis Wound swab Rationale Haematological disease Vascular thrombosis Sickle cell anaemia, thalassaemia Kaposi's sarcoma Myeloma Useful in connective tissue disease Not routine; all ulcers colonised (not the same as infection); swab only when clinical signs of infection 5

6 Flap lacerations Key points: Control bleeding Flaps with haematomas need to be drained they don t heal Use grading tools Hints & tips: Wound closure strips technique is everything Silicone wound contact sheets can be better to secure a flap Assessment for light compression should be undertaken 6

7 Skin tear grading 7

8 Burns Key points: Estimate the % of tissue damage Classification is critical Use recommended best practice silver dressings Hints & tips: Understand the mechanism & resulting first aid to assess severity Do not apply creams to a new or highly exuding burn 8

9 Burns classification 9

10 Surgical wounds Key points: Inflammation vs infection know the difference Waterproof dressings to reduce potential infection Assess risk of dehiscence alternative sutures removal Hints & tips: Assess removal of clips & sutures if causing a local inflammatory response Incision and drainage wounds pack once to the base don t over pack and plug 10

11 Chronic wounds with exacerbations Key points: How often are they presenting to you? What support is in place? Is best practice being followed What has changed recently for the client Hints & tips: Track referrals, attendance at clinics Communicate with the community nurses Self care is often encouraged can the client cope with this? 11

12 Aetiology is key Vascular -venous, arterial, lymphatic, vasculitis Neuropathic - diabetes, spina bifida, leprosy Metabolic - diabetes, gout Connective tissue disease - rheumatoid arthritis, scleroderma, systemic lupus Pyoderma gangrenosum Haematological disease - red blood, white blood and platelet cell disorders Neoplastic - basal cell carcinoma, squamous cell carcinoma, metastatic disease Infectious - bacterial, fungal, viral Traumatic - pressure ulcer, radiation damage 12

13 At risk lower legs 13

14 Dressing selection Moisture balance Maintain Too dry Add moisture Too wet Remove moisture Absorption / Retention / Sequestration Debridement Treat infection 14

15 When to ask for help & refer If passion drives you, let reason hold the reins Benjamin Franklin 15

16 Take home messages Understand wound healing Know what you are seeing, understand what's going wrong Wound product knowledge What will be achieved by the dressing choice Set limits of days/visits Develop a culture of regular clinical governance References: All photos used with consent 16