Nursing and Health Breakdown: Pre-Operative Case Study

(Sussman and Bates-Jensen, 2007)

Assessment data is reported to enable the clear communication among clinicians about the wound and in making the provision for "continuity in the plan of care" as well as allowing for "evaluation of treatment modalities." (Sussman and Bates-Jensen, 2007) Wounds that are classified as red, yellow and black are those that require examination of deep tissue involvement. (Sussman and Bates-Jensen, 2007) The wound must be monitored during the healing process since monitoring provides the means of "checking the wound on a regular and frequent basis for "signs and symptoms that should trigger a full reassessment, such as increased wound exudate or bruising of the adjacent or periwound skin. Included in monitoring is the "gross evaluation for signs and symptoms of wound complications, such as erthema (change in color) or periwound skin and pus, which is indicative of infection." (Sussman and Bates-Jensen, 2007) Included as well should be inclusive of progress toward healing of the wound including granulation tissue growth (red color) and reepithelization (new skin)." (Sussman and Bates-Jensen, 2007)

Aseptic Technique of Wound Care

The Aseptic Technique of wound care is the method by which microbial contamination is prevented during invasive procedures or care of breaches in the skin's integrity." (ICNA, 2003, cited in: Calderdale and Huddersfield, NHS Foundation Trust, 2008) There are two types of aseptic techniques which are reported as being: (1) medical and (2) surgical in nature. (Calderdale and Huddersfield, NHS Foundation Trust, 2008) The aim of the medical aseptic technique is the reduction of the number of organisms as well as the prevention of the spread of the organisms in the hospital ward and other areas of treatment in the hospital. The surgical aseptic technique is reported to be a "…strict process" that is inclusive of procedures geared toward the elimination of micro-organisms from an area" by nurses as well as other health care workers. (Calderdale and Huddersfield, NHS Foundation Trust, 2008)

There are various causative factors in wound breakdown or the spread of infection. These are reported to include those of: (1) infectious agents (bacteria, viruses, fungi, or parasites); (2) a reservoir that supports the infectious agent allowing it to survive and multiply; (3) a portal of entry that allows the infectious agent to leave the reservoir; (3) a mode of spread (direct and indirect contact or via airborne droplets); (4) a portal of entry; and (5) a susceptible host. (Calderdale and Huddersfield, NHS Foundation Trust, 2008) The means for spread of infection are stated to be those of: (1) direct contact; (2) indirect contact; and (3) Dust particles or droplet nuclei suspended in the atmosphere." (Calderdale and Huddersfield, NHS Foundation Trust, 2008)

Nursing Intervention

Nursing intervention includes patient assessment. Patient assessment is stated to include giving consideration to (1) social/environmental factors;

(2) Psychological factors;

(3) Previous experiences with dressings and wounds; and (4) Patient expectations. (Wound Academy Expert Forum, 2007)

Because this patient presented with a wound that is obviously infected the nurse will be required to notify the surgeon so that the surgeon can examine the wound and prescribe proper medications. The nurse will follow-up with the patient on a regular basis to monitor the wound's healing progress.

Summary and Conclusion

This work has related the information collected by the nurse during the preoperative assessment and the importance of collecting baseline data and the ethical and legal requirements that the nurse must ensure are met. This work has additionally explained the aseptic technique of wound care and the nursing intervention in the event the surgical wound develops infection.

References

Aseptic Technique (2008) Aseptic Technique. Section G. NHS Foundation Trust. Online available at: http://www.cht.nhs.uk/fileadmin/departments/infection_control/policies/Section_G_-_Aseptic_Technique_Issue_2.pdf

Burney, R.E. et al. (1997) Core Outcomes Measures for Inguinal Hernia Repair. Journal of the American College of Surgeons. Vol. 185, Issue 6. Online available at: http://www.journalacs.org/article/S1072-7515%2897%2900108-7/abstract

Issues in Wound Care: Appropriate Use of Dressings. Report from a Wound Academy Expert Forum. Sponsored by the Molnlycke Health Care Wound Academy. September 2007. Online available at: http://www.molnlycke.com/Global/Wound_Care_Products/UK/Wound%20Academy/IssuesAppropriateusefinalSept07.pdf

Khan, Y. And Fitzgerald, P. And Walton, M. (1997) Assessment of the postoperative visit after routine inguinal hernia repair: A prospective randomized trial. Journal of Pediatric Surgery. Vol. 32, Issue 6. June 1997. Online available at: http://www.jpedsurg.org/article/S0022-3468%2897%2990644-8/abstract

Pudner, Rosemary (2005) Nursing the Surgical Patient. Elsevier Health Sciences 2005.

Sussman, Carrie and Bates-Jensen, Barbara M. (2007) Wound Care: A Collaborative Practice Manual. Point Lippincott Williams and Wilkins Series. 2007. Accessed online available at: http://books.google.com/books?id=CnOCWkSZ3BoC&dq=wound+care:+purpose+of+assessment&source=gbs_navlinks_s.....