SAMPLE. HLTEN406A Undertake basic wound care. Learner resource. HLT07 Health Training Package. Version 2
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1 HLT07 Health Training Package HLTEN406A Undertake basic wound care Learner resource Version 2 Training and Education Support Industry Skills Unit Meadowbank
2 Acknowledgments The TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank would like to acknowledge the support and assistance of the following people in the production of this learner resource guide: Writer: Carole Camp TAFE NSW Reviewers: Rhonda Albani Liz Bougaardt Amanda Culver Sherryl Dismorr TAFE NSW Project Manager: Amanda Culver Health and Aged Services Acknowledgements are also given to all teachers of the Enrolled Nurse Education Program. Enquiries Enquiries about this and other publications can be made to: Training and Education Support Industry Skills Unit, Meadowbank Meadowbank TAFE Level 3, Building J, See Street, MEADOWBANK NSW 2114 Tel: Fax: ISBN The State of New South Wales, Department of Education and Training, TAFE NSW, Training and Education Support Industry Skills Unit, Meadowbank, Copyright of this material is reserved to TAFE NSW Training and Education Support Industry Skills Unit, Meadowbank. Reproduction or transmittal in whole or in part, other than for the purposes of private study or research, and subject to the provisions of the Copyright Act, is prohibited without the written authority of, TAFE NSW. Training and Education Support Industry Skills Unit, Meadowbank. Developed by Training & Education Support Industry Skills Unit, Meadowbank TAFE NSW 2010
3 Table of contents Introduction General introduction Using this learner guide Prior knowledge and experience Unit of competence overview Assessment...14 Section 1 Aseptic technique/infection prevention strategies Section 2 Physiology of wounds and wound healing Section 3 Types of wounds Section 4 Wound assessment Section 5 Management of wounds Section 6 Current products for wound management Section 7 Evidence based practice Section 8 Skills in wound care Reference list Resource Evaluation Form Developed by Training & Education Support Industry Skills Unit, Meadowbank TAFE NSW 2010
4 Section 1 Aseptic technique/infection prevention strategies Aseptic technique provides a method for preventing microorganisms from entering a susceptible site by using sterile equipment and avoiding direct contact with the wound and its discharge. For nurses working in operating theatres and acute surgical units it is necessary to have knowledge of aseptic technique. In recent years however, studies have shown the use of a clean technique using tap water and clean equipment (particularly for shallow leg ulcers) is just as effective as the aseptic technique in terms of healing of wounds. The clean technique is discussed later in this unit and the conclusions are that nurses need to be capable of problem-solving in order to meet the needs of each specific client in various environments. Nurses should utilise evidence based practice (EBP) as a means of determining the care to be implemented for the client with a wound. The importance of consistency of technique and communication between the members of the wound management team cannot be stressed enough. Economic consideration must be kept in mind when clinical decisions are being made in relation to wound management and the use of wound care products. A useful website to explore is Page 17 of 60
5 Section 2 healing Physiology of wounds and wound Activity 1 TYPES OF WOUND HEALING 1. Primary intention: full thickness wound edges are approximated shortly after the primary wound has been created e.g. surgical wounds with nil tissue loss epithelialisation and wound contraction has little to do with healing (healing occurs by the formation of connective tissue) within hours the wound is sealed from bacterial contamination. Delayed primary closure: closure of grossly contaminated incisions should be delayed allowing time for host inflammatory and immune responses to control contamination e.g. contaminated wounds with nil tissue loss - colorectal surgery. 2. Secondary intention: You are required to visit internet sites such as those listed below or others you find helpful in order to gain additional knowledge relating to wound care. wound healing occurs by the formation of granulation tissue (without surgical intervention) contraction is the most important phenomenon in the spontaneous closure of large open wounds e.g. dehiscence of primary healing wounds, tissue loss due to trauma, chronic ulceration due to various causes i.e. arterial, venous, pressure necrosis 3. Partial thickness wounds: injury to the epidermis/dermis repair involves epithelialisation (approximately 12 days) eg. abrasions, skin grafts. Page 19 of 60
6 CLASSIFICATION OF WOUNDS 1. Acute wounds An acute wound occurs as a result of injury or surgical intervention e.g. surgical incisions, crushing wounds, shearing wounds or burns. They heal within a reasonable period of time. 2. Chronic wounds Chronic wounds do not heal easily, some never heal. They are the result of a predisposing condition, which impairs the tissue s ability to maintain its integrity or to heal e.g. venous and arterial ulcers, diabetic ulcers, pressure ulcers. Later resources will discuss other classifications under Types of Wounds. 3Rs OF WOUND HEALING (Note: The stages of healing overlap.) 1. Reaction (inflammation) injury to 3 days: vasoconstriction to control haemorrhage clot formation In the next 24 hours there is an acute inflammatory response at the wound margins and the formation of exudate. vasodilatation leads to: - the formation of serosanguinous exudate in the wound and: * redness (erythema) * heat * swelling (oedema) * pain * loss of function. INFLAMMATION (this is a normal process of healing) debridement the neutrophils and macrophages in the exudate remove dead cells and debris. 2. Regeneration (proliferation and contraction) 1-24 days capillaries bud to form new vessels and collagen forms new tissue granulation tissue forms Granulation moves inward from the wound margin. The epithelial cells at the skin margin begin to grow and in the next 36 to 72 hours the epithelium begins to cover the wound below the eschar (scab). The regenerating epithelium uses the granulation tissue beneath the scab as a base upon which to grow. Eventually the wound heals, with scar tissue closing the defect and regeneration of the epithelium. Once the epithelium covers the wound the scab drops off. Skin appendages such as hair follicles and sweat glands are unable to regenerate, and this scarred area will not contain these. Page 20 of 60
7 3. Remodelling (maturation) 24 days to 1-2 years activity within the wound decreases no new granulation tissue collagen reorganises scar tissue flattens and softens. Scar colour changes from pink to white. TYPES OF WOUND EXUDATE (DISCHARGE) Wound exudate has been demonstrated to contain anti microbial substances that offer protection, cleanse the wound and provide a moist environment that is conducive to healing. However, excessive exudate will macerate the surrounding skin as well as provide an environment for microorganisms to flourish and thus traumatise the wound. Activity 2 Describe the following types of wound discharge using the internet relevant text. 1. Serous: 2. Purulent: 3. Sanguineous/haemorrhagic: 4. Haemoserous/serosanguineous: Page 21 of 60
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