multidimensional care 1

SIM DAY 2

(Skin Integrity, Providing Wound Care to a Patient with a Venous Stasis Ulcer-Josephine Morrow)

Post-SIM Activity

Nursing Care Plan

Article review: Please locate a peer reviewed articled published within the past 5 years that pertains to skin integrity issues. Include a one half-one page discussion of the article and how it relates to patient care.

As the human skin begins to age, its structure undergoes a range of significant changes (Desai, 1997). A combination of extrinsic and intrinsic factors leads to a loss of the structural integrity and physiological function of the skin (Thomason and Hardman, 2009). The former include long-standing exposure to ultraviolet radiation from sunlight or environmental damage (Farage et al, 2008), while the latter include changes in cellular function, proteins, and growth factors, which result in epidermal and dermal changes (Gosain and DiPietro, 2004). Skin aging is associated with increased susceptibility to a wide range of age-related conditions including chronic wounds and pressure ulcers (Farage et al, 2008; Chang et al, 2013). 

     With advancing age, medical conditions and other factors that adversely affect wound healing become more prevalent (Gosain and DiPietro, 2004). Comorbidities such as diabetes, peripheral arterial disease, and venous insufficiency complicate wound healing and impair or delay healing of chronic wounds (Thomas, 2001; Wicke et al, 2009).

Patient skin color is normal, skin temperature is warm, to touch aging, skin feels moist and very thin,  due to sweat, no broken areas, and no skin tear. It is generally accepted that wound healing becomes impaired or delayed as individuals age. Evidence has demonstrated the effects of older age on the epidermis and dermis, the main one being the changes in the DEJ that lead to changes in skin integrity and increase the susceptibility of the epidermis to injury.

Reference

Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healing. British Journal of Community Nursing, 24(Sup3), S28–S33. https://doi.org/10.12968/bjcn.2019.24.Sup3.S28

Patient education: Complete in a narrative format exactly how you would educate a patient on wounds (pressure or vascular) this can include, but is not limited to- medication, possible complications associated with wounds, nutrition, activity. Include 4 narrated sentences.

Detecting risk factors preoperatively, classifying patient’s risk and using a multidisciplinary approach, all are of great importance to determine the appropriateness of the surgical procedure, designing a tailored education session for the patient on the risk of possible complications, and last but not least, determining an effective plan for expected postoperative complications.

1. Wash your hands with soap and water.

2. Clean wound with soap and water. You may do this in the shower. Do not soak in a bathtub or go swimming.

3. Dry wound gently with a clean towel.

4. Apply antibiotic ointment to wound.

5. Apply a dry, clean bandage.

References

Almuhanna, M. T., & Alnadwi, M. E. (2018). Epidemiology, Bacteriology and Risk Factors of Surgical Wound Infections: A Systematic Review. Egyptian Journal of Hospital Medicine, 70(4), 625–629. https://doi.org/10.12816/0043815