Nursing and Patient Led Intervention Case Study

Nursing and Patient Led Intervention Case StudyDoris presented affront to left medial malleolus that has been caused by banging her left complication on fire 6 weeks ago. The spite measures 4 cm x 5 cm, filled 90% slough, 10 % granulation on aggravate bed and had abundant odour to exudate.SMART OUTCOME / OBJECTIVETo bowdlerize the size of Doris ulcer from the current 4 cm x 5 cm to 2 cm x 3 cm within 6 weeks.NURSING AND PATIENT LED INTERVENTIONSIntroduce yourself to Doris and gain consent.Introducing yourself to diligent role is respectful, polite and important in providing human ad pose. Nursing Midwifery Council (NMC) (2013) emphasises that patients should voluntarily give their valid consent before any disturbance or procedure is undertaken. Furthermore, the NICE (2015) guideline states that part of patient-centred care is providing patients with sufficient breeding about their condition and encouraging them to participate in restoreth care decision-making.Assess Dori s distract prior to cleaning the violate.To reduce discomfort to patient and to structure the sound judgement for patients dressing-related pain and implement effective management strategies immediately (World Union of suffer Healing Societies, 2014 Hollinworth, 2005). Gou and DiPetro (2010) explain that outrage meliorate involves programmed phases and once interrupted, could plump to impairment and delays in wound healing. However, most healthcare practitioners fail to assess levels of pain before cleaning the wound (Baranoski and Ayello, 2008). When pain is unmanaged, this could lead to complications and delayed wound healing (Hollinworth, 2005).Ask Doris if she has any allergies.It is significant on assessment to find out whether patient has any allergies. It assists in making decisions such(prenominal) as prescribing medications and foil any further allergic reactions and other complications (NICE, 2015).Perform hand washing employ the correct techniques pre and post pr ocedure.Hands should be rinse before and after patient contact. Adhering to standard precautions is essential in all aspect of patient care (NMC, 2015). According to Rowley and Clare (2011) proper hand washing before patient contact entrust prevent the risk of acquiring infections. Infection is the biggest risk that can delay wound healing. It likewise means your patient will be steady-going from risk of acquiring cross infections whilst carrying out care (World Health presidency, 2009).Perform and maintain aseptic non-touch technique for all procedure to wound care.The use of aseptic non touch technique reduces risk of patients acquiring infections. The aseptic non-touch technique is suggested when dressing the wound (WHO, 2009). Rowley and Clare (2011) have stressed that aseptic non-touch technique could reduce the risk of hospital acquired infections. Hence, the use of this technique could serving reduce the risk of infecting wound. As stated in the study of Guo and DiPietr o (2010), infection could disrupt and delay the function of wound healing.Irrigate wound with saline at room temperature.Irrigation is to clean out the wound. Cleansing removes debris and pathogens. However, one major drawback of this rise is that irrigation may minutely remove areas of newly granulating create from raw stuff, thus will delay healing bear upon (Kerstein, 1994). However, the National Institute for Health and Care Excellence (NICE, 2015) guideline states that necrotic hearty present in the margins of the wound could be sites for bacterial proliferation and should be removed through debridement. The SIGN (2010) guideline, nevertheless, could non find studies comparing debridement and no debridement in venous ulcer management. The guideline examined a number of debridement methods. Additionally, a prospective, double-blind, randomised controlled trial (RCT) (Weiss et al., 2013) suggests that tap piss is as effective as normal saline for wound irrigation. There were no significant differences in the infection rates between wounds that were irrigated with tap water and those irrigated with saline solution. On the other hand, using tap water could be as effective and less costly for wound irrigation. The Scottish Intercol offshootiate Guidelines Network (SIGN, 2010) recommends that leg ulcers should be washed with tap water and dried carefully.Obtain wound swab as needed.Wound cultures is a tool to determine possible infection in the wound bed (NICE, 2012). However, reliability is touch on with consistency and the extent to which results are accurate. There would be a consensus over whether or not to clean the wound before swabbing. Donovan (1998) and Kiernan (1998) all advise irrigation with warm up normal saline to which remove excessive debris and exudate, thus removing surface contamination. Bowler et al (2001) suggest that the laboratory should be informed if the wound is not clean so as to exclude wound contaminants. It must also be noted that antiseptic cleansing solutions must be avoided as the results may be distorted (Cuzzell, 1993 Kiernan, 1998).Assess the wound and document findings on wound assessment chart.Proper wound assessment can significantly influence the intervention and prognosis (NHS, 2014a). In addition to assessment, the patients past medical history should also be taken. It allows healthcare practitioners determine the cause of the leg ulcer. The NHS (2014b) states that it is also important to treat the underlying cause of patients ulcer to prevent recurring of venous leg ulcer after treatment.Measure Doris wound and take photograph to sit as a baseline for wound care.Measuring wound diameter and taking a photograph would provide information to healthcare practitioners if wound contraction has begun and whether the wound is responding positively to interventions (NICE, 2015).Refer Doris to Tissue Viability oblige.A specialist nurse such as the tissue viability nurse would help promote woun d healing. Tissue viability nurses have extensive knowledge on how to manage acute, chronic or complex wounds (NHS, 2014a). They also provide advice and support for healthcare practitioners, patients and their families or cares (NHS, 2014a SIGN, 2010). Since they are responsible in supporting wound care management in different healthcare settings, working closely with them would ensure that Doris flummox quality care. A tissue viability nurse would also dispense advice on compression bandaging and other interventions to promote wound healing.Dress wound using hydrocolloid dressing.Dressings the wound will create a clean and optimum environment for wound healing (NICE, 2012). Based on the Cochrane Review moist environment promotes wounds to heal more quickly than a dry one (Palfreyman et al, 2006). Meanwhile, wounds left to dry form a scab or eschar which forces migrating epidermal cells to move deeper, prolonging the healing process (Kerstein, 1994). However, it could be argued ano ther drawback of wound dressings that can be sometimes develop sensitivities to ingredients and can be toxic to the wound (Robinson, 2000). Therefore, choice of wound dressings will be dictated by the nature of the wound (Grey, et al, 2006). Wound dressing could be as simple as non-adherent dressing (NHS, 2014a). The NICE (2015) guideline states that there is substandard evidence to support advanced dressings as more effective than conventional dressings in wound management. Another drawback is caution on removing of an adherent dressing which causes pain and may accidentally remove areas of newly granulating tissue, thus will delay healing process (Kerstein, 1994). Meanwhile, wound like Doris that is highly exuding and can be dress and cope with hydrogel dressings to avoid maceration (Jones et al 2006 Kerstein, 1994). Moreover, secondary dressings can be used as well to relieve pain such as hydrocolloid and to suck more exudate like alginate (NICE, 2012). meliorate Doris about th e dressings, showering, bathing and how long dressings can be left in place and to contact District Nurse if dressing becomes loose or removed.Patients awareness of potential causes of poor/delayed wound healing (Kerstein, 1994). This would enable Doris to receive patient education about wound care and intervention and management. The NICE (2015) guideline states that part of patient-centred care is providing patients with sufficient information about their condition and encouraging them to participate in healthcare decision-making regarding their care.Discourage Doris of rubbing and scratching the wound.Scratching, rubbing and picking the wound can delay healing process and cause further injury to the tissue (Stander et al, 2003).Educate and encourage Doris to eat a balance diet and explain that protein is vital to wound healing and recovery.Optimal nutrition is essential to wounds healing. Informing the patients on the importance of good nutrition and improving the patients diet if needed is important for good prognosis of wound healing. Educate patient on essential diet for good wound healing e.g. protein (fish, meat, cheeses and eggs) and vitamin c (found in orange juice and vegetables) ( Bale, S and Jones, 2006). According to Dealey (2005) poor wound healing may indicate the patients nutritional status needs to be enhanced. If wound healing is poor accompanied by cant over loss referral to dietician and prescribing practitioner for further advice and to consider supplemental nutrition for patient.Educate Doris to perform range of exercises whilst sitting.It activates venous pump by mobilising calfs and feet whilst sitting and improve circulation and aid in wound healing (Callum, 1994). The NHS (2014b) states that it is also important to treat the underlying cause of patients ulcer to prevent recurring of venous leg ulcer after treatment. Performing a range of exercise during sitting could help improve wound healing (NHS, 2014b). will contact number to D oris and instruct to call if there any other concern and arrange follow up visit.Arranging regular follow up to recognise risk factors and prevent further skin breakdown and reduce the risk of recurrence (NICE,2012).Refer Doris for Doppler assessment and for further compression therapyThe aim is to expose potential arterial insufficiency that needs treatment and management (NICE, 2012). This will enable to provide information for long term intervention on maintaining lawfulness of the skin around the wound. Doppler assessment is necessary since this would assist healthcare practitioners in assessing leg ulcers. Although it is not diagnostic of venous ulceration, Doppler assessment could define a safe level for compression bandaging (NICE, 2015 SIGN, 2010). Doppler assessment is also helpful in determining when compression bandaging should not be used or is contraindicated (NICE, 2015). Hence, this assessment remains to be an important tool in reducing tissue damage due to bandage pressure. This type of assessment would provide information on the ankle brachial pressure index (ABPI). If ABPI REFERENCESBale, S and Jones, V. (2006) Wound Care Nursing a patient-centred approach (2nd edn). London Mosby Elsevier.Baranoski, S. Ayello, E. (2008) Wound care essential approach pattern Principles.Bowler, PG.,Duerden, BI., Armstrong, DG. (2001) Wound microbiology and associated approaches to wound management. Clin microbial Rev 14244-69.Callum, N.(1994) The Nursing Management of Leg Ulcers in the Community A critical Review of Research. University of Liverpool, Department of Nursing, Liverpool.Cuzzell,JZ. (1993) The rectify way to culture a wound. Am J Nurs 93 (5)48-50.Dealey, C. (2005) The Care of Wounds a guide for nurses (3rd edn). 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