ME! Discussing wound management 7 22 Bunn; Discussing wound management ‘Asking for advice Describing wounds Taking part in Continuous Professional Development * Using a Wound Assessment Chart @ In pairs, discuss the following questions. 1 What is your experience of wound management? 2 What treatments are you familiar with? 3 What are some of the complications that can occur with wound healing? b In pairs, look at the picture and discuss the following questions. 1 What is the nurse doing? 2 Why is she wearing gloves? 3 What wound closures are you familiar with? € Clinical Nurse Specialists act as consultants in most large hospitals. They often work as part of a Health Team and assist ward staff when specialised knowledge is required. Some of the areas a Clinical Nurse Specialist will offer advice in are wound management, stoma care and renal dialysis: B31 Listen to a conversation between Sophie, a Clinical Nurse Specialist, and Ali, a Ward Nurse, and answer the followi 1g questions. 1 Why has Ali asked Sophie to come to the ward? 2 What kind of wound does Mr Jones have? 3 How long has he been in hospital this admission? Unit 3 Wound carei i d_ Put the following sentences in the correct order. C He had a Doppler test done last week. We sent a wound swab off, and we just got the results yesterday. Mr Jones is 68-year-old smoker with a long history of PVD. He's started on some IV antibiotics. Tio weeks ago he was admitted to this ward to have an assessment of his circulation and to monitor his wound management. He developed a venous ulcer on his right ankle after he tripped on some stairs His local doctor had a look at it and asked the District Nurses to come and dress the wound at home. eae @ P31 Listen again and check your answers. Match the medical terms and abbrevii ions (1-7) to their meanings (a~g). 1 NS microbes b ultrasound device which measures blood flow through oe arteries and veins 3 Doppler have episodes of pyrexia 4 bugs ¢ antibiotics which are given through a vein 5 spike a temperature Vacuum Assisted Closure; also pronounced vac 6 IVABs f Clinical Nurse Specialist 7 VAC 4 Peripheral Vascular Disease g B32 Listen to a conversat the following questions, n between Sophie, Ali and Mr Jones and answer 1 Why is Mr Jones's ulcer being reassessed? 2. What type of dressing are they going to use? 3 Why has this type of dressing been suggested? Communication focus: asking for advice @ Match the beginnings (1-5) to the endings (ae) to complete the questions. 41 Would you mind a that we change to? 2 What would you recommend —_b use? 3. What do you think © giving me some advice on his wound care management? 4 What do you suggest we 4 to try that instead of the dressing they/re using now? 5 Do you think it's a good idea e T should do with this ulcer? b Match the sentences in Exer¢ 1 e 2a to the most likely responses. Well, | think the first thing to do is to reassess the wound. 2 I'd like to use a VAC dressing on this wound. No, not at all, That's what I'm here for. Let me have a look at the wound and we'll see what the best option is. Yes, | think it'll help the wound heal faster. Unit 3 Wound care 23In pairs, practise asking for and giving advice on the treatment of Mr Jones’ ulcer. Student A, you are the Ward Nurse; Student B, you are the wound management Clinical Nurse Specialist. Swap roles and practise again. Share your knowledge In small groups, discuss the following questions and then feed back your group’s ideas to the class, * Do you have wound management Clinical Nurse Specialists in your country? * If not, how do you get advice on managing chronic wounds? GREE Medical focus: wound bed preparation 24 Describing wounds The progress of wound treatment is monitored and recorded in a Clinical Pathway or Integrated Care Pathway (ICP) document. A specialised wound chart describes the dimensions of the wound, the type of discharge from the wound and the presence or absence of infection. @_ In pairs, look at the pictures of wounds (a-d) and discuss the following questions. 1 How would you describe the wounds? 2 How would you manage them? Unit 3 Wound careb Match the medical terms (1-8) to their meanings (ah). 4 necrosis — a thick, dry, black necrotic tissue 2 eschar b drying out 3 desication € inflammation ofthe tissue under the skin, often caused by infection 4 inflammation 4 a small piece of material which i used to take samples of body Mids 5 swab € dead tissue which separates from healthy tissue after infection 6 slough F the removal of dead tissue 7 debridement 4g swelling caused by infection 8 cellulitis ——— hn death of cells and living tissue Underline the stressed syllable in words 1-8. In pairs, take turns to say a word and ask your partner to define it. @ Complete the following sentences using the words in the box and then match the sentences to the photos in Exercise 3a. cellulitis slough eschar inflammation swab eerosis desiccation debridement 1 Mrs Ximenes has an area of __vecvesis __, or dead tissue, on her left lower leg. There are blackened areas, or _____, on the upper wound. These areas will be surgically debrided tomorrow. photo: 2. Mr Edwards has _______ in the lower leg. The wound is showing signs of drying out, or____ ~ there is quite a lot of skin flaking off his leg. photo __ 3. The skin surrounding Mrs Heath's leg wound is red and warm to the touch. The ____is a sign of infection and was confirmed by a wound sent to the Pathology lab three days ago. photo 4 The yellowish _____, or dead fibrous tissue, on the inner part of Birad's wound will have to be softened before _____, or removal of the tissue, is possible. photo f In pairs, take turns to describe the wounds in Exercise 3a. Share your knowledge 1 Diabetic ulcers, also called neurotrophic ulcers, are usually found on the balls of the feet at the points of maximum pressure. What sorts of difficulties would the location of these ulcers cause? ‘What advice would you give diabetics about footwear? 3 What may occur as the consequence of diabetic ulcers? w Unit 3 Wound care 2526 Taking part in Continuous Professional Development (CPD) Continuous Professional Development is a major workplace focus for nurses and is @ requirement for continuing registration in some countries, It ensures that nurses keep up-to-date with current trends in clinical practice, such as Evidence-Based Practice (EBP} and risk management clinical governance. In pairs, discuss the following questions. ‘© What is your experience of Continuous Professional Development? * Are you familiar with sharing your knowledge through feedback sessions on the ward? If not, how do you share your knowledge with your colleagues? B33 You are attending a CPD training session given by a wound management Clinical Nurse Specialist, Mr John Simpkins, on wound bed preparation. Listen and tick the medical terms you hear (1-8). 2 the transplantation of skin from another part of the body to a wound which 1D) wellvascularised a sculan cannot heal on its own 2 D viable 'b excessive softness caused by too much moisture ¢ good blood circulation is achieved, and the tissues are supplied with oxygen and 3D) necrotic tissue ares 4 Chih bacterial toad long-term or ongoing 5 C1] exudate € a high level of infection carried by the tissues 5 1) maceration Foe or discharge from a wound 7 D chronic g able to grow or survive 8 shin grat dead tissue Match the medical terms above (1-8) to their meanings (ah). In pairs, take turns to say a word and ask your Partner to define it. 33 Listen again and complete the following handout using the words in the box. necrosis exudate dryness load balance inflammation steble base ‘SESSION HANDOUT ‘The aim of wound bed preparation is to prepare a (1) stable wound environment which results in wound healing. This is achieved by: a) restoring a well-vascularised wound bed, or (2) b) decreasing the high bacterial load by controlling (3) ©) creating moisture (4) or infection in the wound environment ‘The barriers to wound healing include: a) the presence of (5) = in other words, dead tissue b) high bacterial (6) ____, ora high level of infection carried by the tissues ©) imbalance of moisture levels: wounds with excessive (7) —~ that is, wounds which are too moist - and wounds which have excessive (8), or desiccation, will not heal properly Unit 3 Wound care[34 Listen to the second part of the training session and complete the rest of the handout using the words in the box. dressings graft debridement infection viable imbalance excessive reassess antibiotic desiccation reduced optimal fluid chronic well-vascularised advanced surgical ‘What is TIME? TIME is an acronym fora framework whan hel to identity tariers to healing in the wound bed and identties expected outcomes of treatment T 1 jm E Desorintion | Tissue is nt inflammation or Moisture Edge ofthe wound does (fg won | (]) ees ene | op eat ea lie Te tissues ofthe wound | is present. @——_____| The wound becomes a bed do not have sufficient |The high bacterial cad | exudate causes 4) | blood supply to survive. | prevents heating maceration, oF softening, | wound. of the wound edges. | (g9_____., | | or excessive dryness, sows healing | Ginical (2) Remove the infection and Hyarating j05) action [of necrotic tissue reduce the high bacterial ](t1) _______, | the wound ten a load which add moisture for | Consider ctferent | @ Antimicrobial dressings | dry wounds. management, e 9 skin procedure as well as, Negative pressure (ee (—_______| dressings, e.. vac replace the damaged skin medication ae used. | dressings, which remove | excess | (12) —___in | macerated wounds. Expected | Wound bed is a | The wound has an The edge ofthe wound outcome | (4) and inflammation around the |(13}________ nas (17) {has a good blood supply | wound | moisture balance or healed. Share your knowledge In small groups, discuss the following questions and then feed back your group's ideas to the class. © Do you follow the same process for wound bed preparation? © What are the advantages of following the wound bed preparation protocol? © Have you ever had any experience with skin grafts? IF so, what type? Unit 3 Wound care 20amma Charting and documentation: : Wound Assessment Chart 5 @ In pairs, discuss the following questions. 1 What is your experience of treating animal bites or wounds? 2 What complications can arise? 3 How can these complications be avoided? b P35 Gary Stephens has presented to Accident and Emergency with a severe dog bite wound. Listen to a conversation between Gary and two AGE nurses, Krisztina and Judy, and answer the following questions. 1 What kind of dog bites are a serious infection risk? 2 How will Gary's wound be treated? C35 The conversation contains several examples of asking for and giving advice. Listen again and match the requests (1~4) to the advice (ad). 1 Krisztina, what do you suggest I clean a Sure ... I like you to keep the dressing clean and dry and come to the wound with? Outpatients to have the dressing changed daily 2 Can you give me some advice on b Yes, that'd be a good idea. looking after this at home? ee 3 What should I do about the € Its best to flush it with lots of Normal Satine before you do the dressing antibiotics? 4 Youll be prescribed some antibiotics by the doctor a bit later, You'l get a 4 Should I get 2 medical certificate? script which you can take to the hospital pharmacy to be filled. d_ B36 Jennifer, the Ward Nurse, is handing over Gary Stephens to the afternoon shift. Listen to the handover and put the following stages described in the handover in the correct order. Ci Gary was started on IV antibiotics to clear up the infection in the wound, O He is in for a review by the Vascular Team on Monday, OO The wound was surgically debrided this morning. {U Gary Stephens sustained some deep puncture wounds in his left calf after a dog bite. He was treated in A&E and discharged home, 0 Gary returned to the ward with an antimicrobial dressing which will be re-dressed tomorrow. 1 The wound was reassessed yesterday. O The wound became infected and he has returned to hospital @ Match the medical terms (1-12) to their meanings (a~). 1 granulated 2 with yellowish fluid or blood serum 2 sloughy b adding moisture to something 3 macerated a dressing which does not stick to the wound 4 inflamed 4 contains dead tissue which falls off a wound during an infection 5 serous @ the dressing is sealed and cannot be lifted of for viewing 6 haemoserous f full of pus, a yellow or green discharge found in an infected wound 7 purulent g containing connective tissue found in heating wounds 8 odour h something which treats infective microorganisms 9 non-adhesive dressing (NAD) i softened because of excess moisture 10 antimicrobiat j yellowish fluid tinged with red blood cells 11 hydrating K ted and swollen because of infection 42 intact wound | smelt (usually unpleasant) 28 Unit 3 Wound caref Underline the stressed syllable in words 1-12 In pairs, take turns to say a word and ask your partner to define it. fh Look at the Wound Assessment Chart. In small groups, discuss your experience if you have used a chart like this before. rcazavoranosoran bv WOUND ASSESSMENT CHART a Suiname: Stephens i Given names: Gry SS — DOB: 501.1974 Sex Male Consultant _H. Perowne WOUND ASSESSMENT FORM z a Date ~__[ sane = Name Gary stephens Wound site a Wound des aranvsied | soughy [necrotic infected Frequency of dressing | bd tes daly 3 aly Ankbiotis no ves ora v Surrounding skin | healthy | dy maceied inflamed Bxudete ail smallamt | moderate heavy Exudete ype wa [serous haemoserous | purlent Odour present yes 0 Debridement vi curgial mechanical chemical (wet to dry essing) [Dressing products | nonadhesve desing NAD) " antimicrobial hydrating | Wound closure sutues ips open wound Comments For eview by Vascular Team on Mon Wound intact net desing nwo Find abbreviations in the Wound Assessment Chart with the following meanings. not applicable three times a day twice a day left intravenous 6 amount wsans D> 35 Listen again to the handover of Gary Stephens and underline the information you hear about his wound in the Wound Assessment Chart. k In pairs, practise handing over Gary Stephens. Student A, you are Jennifer; Student B, you are a nurse on the next shift. You can change the description of the wound using vocabulary from Exercise 5e. Swap roles and practise again. Unit 3 Wound care 29