Surgery cut as emergency cases peak

The Launceston General Hospital has been forced to delay some elective surgery cases to cope with a surge in emergency patients. Extra staff are being put on and the hospital has been forced to find space in the hallways. About 25 patients in the emergency department currently need beds the hospital can not provide. Northern Area Health Service CEO, John Kirwan, says four elective procedure have been cancelled and there could be more to come. A surge in seasonal illnesses such as asthma and other respiratory diseases is partly responsible. Mr Kirwan says patients are remaining at the hospital longer "If it does continue to escalate, which is why we've taken this action, then we may have to cancel more elective surgery as we get closer to the weekend." "What's occurred is that we're not getting the discharges out of the hospital and that gives us the bed block." "We have had up to 25 patients in the emergency department that require admission, that have finished their emergency episodes of care and treatment that need to be admitted. "That's the problem we're now facing." People needing medical attention are being urged to see their GP first, unless it is an emergency.

REACTION: As technology rises, different diseases rise too and most people affected are the rural areas. In some areas like Philippines, they usually encounter these situations during rainy seasons, because of the increase number of cases in dengue. E.R department and Pediatric Ward department are the busiest one during this season, because many patients were admitted including massive accidents such as vehicular accidents. Unfortunately, reality speaking, many hospitals in the Philippines cannot afford to render the service needed its not because they lack of care but because of scarcity of health care facilities such as rooms and hospital beds in the areas and because of these, some patients were given delayed services and some Hospitals tries to maximized the available source they have just to provide all the care that is needed for every patients who is in need. Theory:

The Nursing Theory that best relates to this article is the theory of Virginia Henderson, which is the 14 Basic Needs, according to Virginia Henderson, the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge According to this theory, a patient should at least received the basic needs they needed, such as food, enough sleep and rest, proper hygiene etc. The Hospitals may have lack some medical facilities but they shouldnt take for granted the basic needs of their patients. They should always bear to their minds that no matter what the situation is, they should always have the tender, love and care for their patients.

Incision care refers to a series of procedures and precautions related to closing a wound or surgical incision; protecting the cut or injured tissues from contamination or infection; and caring properly for the new skin that forms during the healing process. Incision care begins in the hospital or outpatient clinic and is continued by the patient during recovery at home .

Purpose
There are several reasons for caring properly for an incision or wound. These include:
y y y y

lowering the risk of postoperative complications, particularly infection avoiding unnecessary pain or discomfort minimizing scarring preventing blood loss

Description
Types of wound or incision closure

Proper care of an incision begins with knowing what material or technique the surgeon used to close the cut. There are four major types of closure used in Canada and the United States as of 2003.
SURGICAL SUTURES. Sutures, or stitches, are the oldest method still in use to close an incision.

The surgeon uses a sterilized thread, which may be made of natural materials (silk or catgut) or synthetic fibers, to stitch the edges of the cut together with a special curved needle. There are two major types of sutures, absorbable and nonabsorbable. Absorbable sutures are gradually broken down in the body, usually within two months. Absorbable sutures do not have to be removed. They are used most commonly to close the deeper layers of tissue in a large incision or in such areas as the mouth. Nonabsorbable sutures are not broken down in the body and must be

removed after the incision has healed. They are used most often to close the outer layers of skin or superficial cuts. Sutures have several disadvantages. Because they are made of materials that are foreign to the body, they must be carefully sterilized and the skin around the incision cleansed with Betadine or a similar antiseptic to minimize the risk of infection. Suturing also requires more time than newer methods of closure. If the patient is not under general anesthesia, the surgeon must first apply or inject a local anesthetic before suturing. Lastly, there is a higher risk of scarring with sutures, particularly if the surgeon puts too much tension on the thread while stitching or selects thread that is too thick for the specific procedure.

-------------------

Surgical incisions require care in order to heal quickly and completely without becoming infected. Closed surgical incisions require the same care whether they were closed with sutures, staples, steri-strips or surgical glue. Open incisions, or incisions that are left open for the surgeon to close at a later time, require very different care from the standard closed incision. If you have had surgery and your incision is still healing, plan on showering at least once a day if you are able. A shower is an ideal way to clean your incision and remove soap residue without softening the incision to the point of weakness. If you cannot shower, it is best to take a sponge bath rather than bathe for the first few weeks if you cannot bathe without soaking your incision for an extended period of time.

Surgical wound care - open

An incision is a "cut" through the skin that is made during surgery. It also called a "surgical wound." Some incisions are small, and others are very long. The size of the incision will depend on the kind of surgery you had. Do not wear tight clothing that rubs against the incision while it is healing. Sometimes, a surgical wound will break open (wound dehiscence). This may happen along the entire cut or just part of it. Your doctor may decide not to close it again with sutures, or stitches. If your doctor does not close your wound again with sutures, you will need to learn how to care for it at home, since it may take time to heal. The wound will heal from the bottom to the top. The dressings help to soak up any drainage and to keep the skin from closing before the wound underneath fills in.

Proper Handwashing
It is important to clean your hands before you change your dressings. You make use an alcoholbased cleaner like Purell, or you may wash your hands using these steps:

y y y y y

Take all jewelry off your hands. Wet your hands, pointing them down under warm running water. Add soap and wash your hands for 15 to 30 seconds (sing "Happy Birthday" or the "Alphabet Song" 1 time through). Clean under your nails also. Rinse well. Dry with a clean towel.

Removing the Old Dressing

Your doctor will tell you how often to change your dressing. Be prepared before starting the dressing change:
y y y

Clean your hands before touching the dressing. Make sure you have all the supplies you will need handy. Have a clean work surface for all of the equipment you will need.

Remove the old dressing:

y y y y y

Carefully loosen the tape. Use a clean (not sterile) medical glove to grab the old dressing and pull it off. If the dressing sticks to the wound, get it wet and try again. Put the old dressing in a plastic bag and set it aside. Clean your hands again after you take off the old dressing.

Caring for the Wound

You may use a gauze pad or soft cloth to clean the skin around your wound:
y y y y

Use a normal saline solution (salt water) or mild soapy water. Soak the gauze or cloth in the saline solution or soapy water, and gently dab or wipe the skin with it. Try to remove all drainage and any dried blood or other matter that may have built up on the skin. Do not use skin cleansers, alcohol, peroxide, iodine, or soaps with antibacterial chemicals. These can damage the wound tissue and slow your healing.

Your doctor may also ask you to irrigate, or wash out, your wound:
y y y

Fill a syringe with salt water or soapy water, whichever your health care provider recommends. Hold the syringe 1 to 6 inches away from the wound, and spray hard enough into the wound to wash away drainage and discharge. Use a soft, dry cloth to carefully pat the wound dry.

Do not put any lotion, cream, or herbal remedies on or around your wound without asking your doctor first.

Putting on the New Dressing

Place the clean dressing in the wound as your health care provider taught you to. You may be using a wet-to-dry dressing. See also: Wet to dry dressing changes Clean your hands when you are finished. Throw away all the old dressings and other used supplies in a waterproof plastic bag. Close it tightly, then double it before putting it in the trash. Wash any soiled laundry from the dressing change separately from other laundry. Ask your doctor if you need to add bleach to the wash water. Use a dressing only once. Never reuse it.

When to Call the Doctor

Call your doctor if:
y

You see any of these changes around the incision: o More redness o More pain o Swelling o Bleeding o The wound is larger or deeper o The wound looks dried out or dark The drainage coming from or around the incision: o Is increasing o Becomes thick, tan, green or yellow, or smells bad (pus) Your temperature is above 100 F for more than 4 hours.