Case Study One
Identification of the Care that Mr Jones will require in relation to the safe management and promotion of wound healing
This essay will focus on the holistic care of Mr Jones, with particular attention to the management of his wound. The points that will be discussed and analysed are the role of the skin, wound assessment, the nutritional status of Mr Jones and the problem of his obesity. Added to this, an analytical discussion of the involvement of the multi-disciplinary team, the way that Mr Jones’ wound should be managed including the problem of infection and pain plus the suitable dressings, which could be used. Lastly, health promotion for Mr Jones will be addressed.
It is important that the role and functions of the skin are identified in order to realise the importance of appropriate wound care. The skin is the largest organ in the body (Worley 2004), and has an array of functions. According to Gunnewicht and Dunford (2004), there are seven main functions that the skin performs. These are the regulation of body temperature, protection, sensation, excretion, immunity, blood reservoir, and finally synthesis of vitamin D. Gunnewicht and Dunford (2004) mention that the skin is the body’s first line of defence against infection. It provides a physical barrier to protect from bacterial invasion.
Mr Jones’ wound is a surgical wound so it can be classified as mechanical because it was caused by a laparotomy performed 10 days earlier. Mechanical wounds can be caused by either surgery, friction or shearing. Other types of mechanical wounds could be bites, penetrating wounds and lacerations. (Dougherty and Lister, 2004) According to Gunnewicht and Dunford (2004), most surgical wounds heal by primary intention, which means that the wound will heal from the skin downwards, the edges are brought together in direct opposition and are closed using sutures or clips. In Mr Jones’ case, his wound will have to heal by secondary intention because it is not suitable to be resutured due to his obesity problem. Gunnewicht and Dunford (2004) state that wounds that are left to heal by secondary intention heal from the bottom upwards; the wound is not closed but left to heal by granulation.
“Accurate wound assessment forms the basis of any clinical decision making and is a sound investment in time. Effective wound management depends on the appropriate selections of dressings and treatments, which can only be determined by a thorough and knowledgeable wound assessment” (Gunnewicht and Dunford 2004 pp6). It is important that when nurses are faced with a new patient who has a wound, that it is assessed within the context of the history, investigation results, and overall medical status of the patient. The assessment should focus on the “whole patient and not just the hole in the patient” (Gray and Cooper 2005 pp1). This statement is supported by Fletcher cited in Hoban (2005) who maintains that holistic care is essential in wound management and that the wound should be looked at last and the patient first. However, it is noted that this rarely happens in practice because of factors such as nurses particularly liking a certain wound care product and tending to use it a lot of the time without properly assessing the wound, the availability of wound care products, and the tendency to get caught up in just the wound that the patient has instead of looking at the patient as a whole (Gunnewicht and Dunford 2005).
The nutritional status of Mr Jones is of great importance to consider concerning the healing of his wound. The case study mentions that Mr Jones is obese with a weight of 120 Kilograms and a height of 5 feet and 8 inches tall. This would mean that his body mass index is 40, which is classified by the World Health Organisation as just into grade 3 obesity. According to Williams and Young (1998), it is a common myth that nutritional supplements will only aid healing if the patient is underweight. It is an extremely...
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