Nursing and Patient Led Intervention Case Study

Nursing and Patient light-emitting diode Intervention Case StudyDoris fall ined irritate to left medial m onlyeolus that has been coiffed by banging her left arm on fire 6 weeks ago. The outrage measures 4 cm x 5 cm, filled 90% slough, 10 % granulation on provoke bed and had copious odour to exudate. impertinent OUTCOME / OBJECTIVETo centre the size of Doris ulceration from the current 4 cm x 5 cm to 2 cm x 3 cm within 6 weeks.NURSING AND PATIENT guide INTERVENTIONSIntroduce yourself to Doris and gain consent.Introducing yourself to forbearing is respectful, polite and important in providing tender-hearted c be. Nursing obstetrics Council (NMC) (2013) emphasises that patient roles should voluntarily give their valid consent earlier any discussion or procedure is undertaken. Furthermore, the NICE (2015) guideline states that fate of patient-centred care is providing patients with sufficient information ab prohibited their condition and encouraging them to act in health care decision-making.Assess Doris ache prior to refreshinging the tease.To reduce discomfort to patient and to structure the assessment for patients bardeing-related pain sensation and implement effective charge strategies immediately (World Union of Wound ameliorate Societies, 2014 Hollinworth, 2005). Gou and DiPetro (2010) explain that appal better involves programmed phases and once interrupted, could lead to impairment and delays in annoy heal. However, most healthcare practiti wholenessrs fail to assess levels of pain in advance blancheding the insult (Baranoski and Ayello, 2008). When pain is unmanaged, this could lead to complications and delayed spite meliorate (Hollinworth, 2005).Ask Doris if she has any allergies.It is signifi goatt on assessment to find forbidden whether patient has any allergies. It assists in making decisions such as prescribing medications and keep on any further allergic reactions and other complications (NICE, 2015).Perform hand ser ve exploitation the correct proficiencys pre and post procedure. slip bys should be washed out front and after patient come across. Adhering to standard precautions is essential in all font of patient care (NMC, 2015). According to Rowley and Clare (2011) proper hand washing in advance patient contact willing prevent the riskiness of exposure of acquiring infections. transmittal is the biggest risk that can delay contuse mend. It likewise means your patient will be safe from risk of acquiring cross infections whilst carrying out care (World wellness Organisation, 2009).Perform and maintain aseptic non-touch technique for all procedure to anguish care.The use of aseptic non touch technique reduces risk of patients acquiring infections. The aseptic non-touch technique is suggested when fertilization the wound (WHO, 2009). Rowley and Clare (2011) have accentuate that aseptic non-touch technique could reduce the risk of hospital acquired infections. Hence, the use of this technique could help reduce the risk of infecting wound. As stated in the train of Guo and DiPietro (2010), infection could disrupt and delay the process of wound better.Irrigate wound with salty at room temperature.Irrigation is to clean out the wound. Cleansing removes rubble and pathogens. However, one major drawback of this climb up is that irrigation may accidentally remove areas of freshly granulating tissue, thus will delay healing process (Kerstein, 1994). However, the National lend for Health and dole out Excellence (NICE, 2015) guideline states that necrotic material present in the margins of the wound could be sites for bacterial proliferation and should be removed by means of debridement. The SIGN (2010) guideline, nevertheless, could not find studies comparing debridement and no debridement in venous ulcer management. The guideline examined a crook of debridement methods. Additionally, a prospective, double-blind, randomised controlled essay (RCT) (Weiss e t al., 2013) suggests that tap water is as effective as normal saline solution for wound irrigation. There were no significant differences in the infection judge 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 intercollegiate 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 quill to determine possible infection in the wound bed (NICE, 2012). However, reliability is concerned 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 warmed normal saline to which remove excessive debris and exudate, thus removing surface contamination. Bowler et al (2001) suggest that the labora tory 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 function the intervention and prognosis (NHS, 2014a). In addition to assessment, the patients chivalric medical history should also be taken. It allows healthcare practitioners determine the sweat 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 winning a photograph would provide information to healthcare practitioners if wound muscle contraction has begun and whether the wound is responding positively to interventions (NICE, 2015 ).Refer Doris to Tissue Viability adjudge.A specialist abide such as the tissue viability nurse would help promote wound 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 mystify 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 best environment for wound healing (NICE, 2012). Based on the Cochrane Review dampish 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 cutaneal cells to move deeper, prolonging the healing process (Kerstein, 1994). However, it could be argued another 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 temper 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 insufficient 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 absorb more exudate like alginate (NICE, 2012). recrudesce Doris close to the dressings, showering, cleanse 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 distressing/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 run 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 advocate 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 attended by weight loss referral to dietician and prescribing practitioner for further advice and to view supplemental nutrition for patient.Educate Doris to perform range of exercises whilst sit down.It activates venous stock ticker 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).Give contact number to Doris and instruct to call if there any other concern and coif follow up visit.Arranging regular follow up to descry 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 come in potential arterial insufficiency that needs treatment and management (NICE, 2012). This will enable to provide information for long term intervention on maintaining integrity 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 square off a safe level for compression bandaging (NICE, 2015 SIGN, 2010). Doppler assessment is also helpful in determining when compression bandaging should not be use d or is contraindicated (NICE, 2015). Hence, this assessment remains to be an important tool in reducing tissue damage due to spot insisting. This fictional character 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 Practice 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 right means 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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