Nurse Insights: What Are the Best Practices for Wound Care in Nursing?

Wound care is an essential aspect of nursing that requires careful assessment and management. In this article, we will explore the best practices for wound care in nursing, including initial assessment, wound dressing selection, the importance of moist wound healing, and infection prevention. Read on to discover insights that can help you promote efficient healing and patient comfort.

Nurse Insights

What Are the Best Practices for Wound Care in Nursing?

In our Nurse Insights series, experienced nurses offer an insider’s perspective on the nursing profession by addressing common questions, challenges, and triumphs of their careers.

Initial Assessment and Cleaning of the Wound

When attending to a wound as a nurse, your initial assessment plays an essential role in determining the appropriate treatment approach. The patient’s overall health, wound characteristics, and any signs of infection form key components in this evaluation.

Patient’s Overall Health

Before considering the wound itself, turn your attention to the patient’s general health. Are they presenting symptoms of shock or systemic infection? Do they have underlying conditions that may slow the healing process, like diabetes or circulatory diseases? Understanding the larger health context can inform the urgency, methods, and likely outcomes of wound care. It also helps you anticipate potential complications.

Wound Evaluation: Type and Depth

The nature of the wound also requires careful assessment, as different wounds require different treatments. Is it a superficial scrape, a deep laceration, or a puncture wound? Clean, shallow wounds may simply require cleansing and dressing. However, deeper wounds, burns, or punctures may necessitate sutures or specialized care.

Checking for Infection

Monitoring for signs of infection is critical. Look for inflammation, red streaks, purulent discharge, or an unusually warm touch around the wound. Fever, pain, or the patient feeling generally unwell are also potential signs of an infection. Early identification enables swift action to prevent the worsening of the infection.

By making a thorough initial assessment, you can make informed choices about appropriate wound management. This is integral in promoting a swift and unproblematic healing process, alleviating patient discomfort, and minimizing the risk of further health complications.

Wound Dressing Selection

When providing wound care, proper dressing selection is essential. Several types of wound dressings, including foams, alginates, and hydrocolloids, have their unique benefits depending on the wound’s characteristics.

Foam Dressings

Foam dressings are made of polyurethane and can be used on a wide range of wounds with moderate to heavy exudate (leakage). They maintain a moist environment that promotes healing and absorbs excess fluid, minimizing the risk of maceration surrounding skin tissue. Foam dressings can be used as primary dressings for wounds with depth and secondary dressings for packing deep wounds or cavities. They require less frequent changes than other types of dressings.

Alginate Dressings

Alginate dressings are derived from seaweed and are especially beneficial for wounds with significant exudate. They transform into a gel when in contact with wound fluid, aiding in the absorption of drainage. This type of dressing promotes autolytic debridement, making it ideal for wounds with necrotic tissue or slough. Keep in mind these dressings are not suitable for wounds that are dry or have minimal exudate.

Hydrocolloid Dressings

Hydrocolloid dressings contain gel-forming agents that form a protective layer over the wound, promoting a moist environment and facilitating the healing process. They’re effective for minor burns, superficial wounds, and pressure ulcers in the early stages. Hydrocolloid dressings are impermeable to bacteria and other external contaminants, which helps protect the wounds. However, they should not be used on infected wounds or those with high levels of exudate.

When choosing a dressing, consider the wound’s depth, exudate level, presence of necrotic tissue, and patient comfort. As an effective wound management practice, you should reassess the wound when changing the dressing to monitor the healing progression and decide whether a different dressing might be more suitable.

Keep in mind, despite the number of dressings available on the market, it’s your professional nursing judgment in combination with the individual patient’s needs that will determine the best course of action.

Importance of Moist Wound Healing

Maintaining a moist environment around a wound encourages quicker, natural healing. You might be inclined to let a wound dry out, immediately reaching for that air-permeable bandage or leaving it uncovered altogether. However, current research suggests that providing a hydrated atmosphere around an injury can actually promote faster cell growth and reduce the risk of infection. It’s a lot like tending to a fragile seedling; just as plants need moist soil to foster root development and boost plant growth, your skin cells need moisture to regenerate and mend the wounded area effectively.

Lower Infection Risk

Damp wound care tends to lead to a lower risk of bacterial infection. A moisture-balanced environment can trap and flush out harmful bacteria, preventing it from multiplying at the wound site. Moreover, most commonly used wound dressings are designed to absorb excess exudate, minimizing the possibility of infection-caused complications. You’ll find that an adequate barrier against external contaminants may also keep wound edges from drying and forming a scab, thereby reducing the chances of scar formation.

Reduced Pain and Inflammation

Newly formed granulation tissue, essential for wound closure, is often extremely sensitive. By keeping wounds moist, you also minimize patient discomfort. The hydration prevents bandages from sticking to the wound, reducing pain and stress during dressing changes. It also mitigates inflammation around the injury, reducing swelling and redness that are typically associated with open wounds.

Accelerated Healing

Moist wound healing enhances epithelialization, the process where your body forms new skin at the wound site. In this process, epithelial cells move across the wound bed in a moist environment, closing the wound quicker than dry healing. By keeping the wound moist, the body’s own healing mechanisms are supported, and the wound can close faster, reducing the risk of scarring.

Remember, achieving optimal wound healing involves a balance of moisture. Too little can lead to a dry wound environment, while too much could potentially increase the risk of infection and unnecessary wound complications. So it is always crucial to follow what you have been trained in regarding wound care, where moist treatment is often advised.

Changing and Disposing of Dressings

The first step in changing dressings is to ensure you have clean hands. Always properly wash your hands before you begin, using soap and warm water for at least 20 seconds. If soap and water aren’t available, use a hand sanitizer with at least 60% alcohol.

Next, gather your supplies. You’ll need new dressings, clean gloves, a bag for disposal, and possibly special cleansing solutions or ointments as prescribed by the doctor.

When removing the old dressing, carefully peel it away from the skin. Dispose of this in a small plastic bag to limit contamination. Once the old dressing has been removed, inspect the wound. Note any changes in appearance, smell, or patient discomfort, as these could indicate infection or other complications.

After this, perform hand hygiene and put on your clean gloves. If needed, clean around the wound using the prescribed solution following the wound cleaning protocols specific to the type of wound or injury. Often this is done by gently wiping in a circular motion, moving from the center of the wound outward.

Apply any prescribed ointments or medicated dressings. Then, apply the clean dressing to the wound. Secure it with the proper material, ensuring it’s tight enough to protect the wound but not so tight as to cut off circulation.

The frequency of changing dressings depends on the type of wound, its location, and how much it is draining. Generally, dressings should be changed at least once a day, but more frequent changes may be necessary for wounds that are draining heavily.

After handling dressings, it’s important to wash your hands again. If you’ve been changing dressings for someone else, it’s also recommended that you clean any areas where supplies were set down to prevent spreading germs.

Used dressings should be placed in a sealable plastic bag and disposed of in a trash can that’s out of reach of children and pets, not flushed down the toilet. This both promotes hygiene and prevents plumbing issues. However, you will always follow your agency’s policies and procedures for disposing of used dressings, which may include disposing of them in a biohazard bag.

Remember, if you notice any signs of infection when changing dressings, such as increased redness, swelling, warmth, or pus, it’s important to address this immediately. If this issue is not addressed, further complications can arise.

Pro Tip: Always have all your supplies prepared and within reach before you begin changing dressings to minimize the risk of contaminating the wound.

Administering Antibiotic Treatment When Necessary

In certain scenarios, an antibiotic treatment may be required, particularly when a bacteria is causing an infection. Normally, a physician will direct you to administer antibiotic treatments, usually after laboratory testing has confirmed the presence of a bacterial infection.

Determining Administration Methods

For administering antibiotics, the method usually depends on the severity of the condition. For common infections, oral antibiotics suffice. For more severe infections, intravenous (IV) antibiotics in the hospital may be necessary. Always remember, as a healthcare provider, you must use a clean or sterile technique to apply these medications to minimize the risk of introducing more infections.

Understanding the Importance of Total Treatment Completion

It’s imperative to stress the importance of completing the entire prescribed antibiotic regimen, even if the patient feels better before the course is done. While it might be tempting to stop taking the antibiotics once the symptoms disappear, it’s crucial to remember that the treatment’s purpose is to eliminate the bacteria completely. If the patient quits prematurely, some bacteria may survive and re-infect them. It also significantly increases the chance of developing antibiotic-resistant bacteria, posing a broader public health concern.

Remember, the precise antibiotic, dosage, and duration will vary from patient to patient. Always ensure you are administering the correct medication to the right patient, at the right dose, via the suitable route, at the right time, and with the correct documentation. This is a principle known as the “5 Rights of Medication Administration” and is a critical aspect of responsible nursing practice.

Monitoring the Wound Healing Process

To monitor the wound healing process effectively, observe for both signs of improvement and potential complications. If the wound does not appear to be healing properly, specialized care may be needed.

Signs of Improvement

Healthy wound healing typically starts with redness and swelling around the wound as your body gears up to repair the damage. A good sign is if you notice the wound is getting smaller over time. It’s normal for a small amount of clear fluid to drain from the wound. Over time you should see new skin growing from the edges toward the center of the wound, eventually closing it completely.

Signs of Complications

In contrast, there are warning signs that might signal complications. You should be wary if the wound’s redness is spreading, the pain is increasing, or the wound has become hot to the touch, as this may suggest infection. A wound that’s becoming larger, deeper, or more filled with pus is also concerning. An odor from the wound or fever can also indicate that it’s time to contact the patient’s physician.

Look out for signs that the wound is not healing within the estimated time frames. Generally, minor wounds should start to heal within a few days, while more significant wounds may take weeks. It’s important to note, however, that health variables such as age, overall health, and condition of the wound can affect healing times.

Seeking Expert Intervention

If any of these red flags appear, or if the wound doesn’t seem to be healing properly, it’s time to seek expert intervention. Contact the patient’s physician, who may refer you to a wound care specialist. Don’t delay in seeking help; complications can sometimes escalate quickly, putting your patient’s overall health at risk.

Early intervention is crucial to prevent the wound from deteriorating or becoming infected. Professional wound care specialists have access to advanced therapies and treatments that can accelerate healing, reduce pain, and minimize scarring. Don’t hesitate to ask for help if you’re concerned about a wound, no matter how minor it may seem.