Wound Healing Process: Factors and Postoperative Nursing Care Contributions

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Introduction

The process of wound healing reflects significant variables of the patient and care providers. A wound can be a source of infection to the patient, and that is why wound healing is of concern to nurses caring for patients. Many factors determine wound healing including premedication and other underlying diseases such as rheumatoid arthritis, and diabetes among others. Although patients’ factors influence wound healing, nurses play a significant role in the wound healing process. The proceeding paragraphs discuss the factors that contribute to the wound healing process and the contributions of nurses in postoperative patient care.

Information for postoperative wounds

Adequate knowledge of the healing process of postoperative wounds gives nurses an upper hand in the management of postoperative wounds. The wound healing process is multifactorial, involving a highly complex chain of interdependent and interacting events (Julie, 2006, p. 51). Thus, holistic assessment of a patient may show elements that may impair the natural healing process.

Nurses must know those factors that may determine wound healing because it will determine what wound care product and medication s/he prescribes. The nurses should not rely entirely on research evidence relating to the success of diverse dressing because it downplays the influence on the healing process of environmental, social, or systematic factors (Bale & Jones, 2006, p. 254). Thus, information on environmental, social, and systemic status is crucial in the assessment of postoperative wounds.

Furthermore, factors can negatively influence the postoperative wound healing process. Julie affirms that these factors may be intrinsic or extrinsic (2006, p. 64). Intrinsic factors include age, disease process, rheumatoid arthritis, diabetes, jaundice, renal disease, and psychological status. The nature of the patient occupation can influence his or her healing process significantly.

Nurses role in consent for general anesthesia

Patients have the right to information regarding/her treatment. Thus, patients are entitled to information about the risks related to general anesthesia as a component of their informed consent. Nurses provide the opportunity to achieve this objective.

Nurses have a greater role in evaluating whether or not consent is informed. When a nursing professional sees a patient’s signature for a surgical procedure, s/he is not accountable to provide the details of the procedure (Sakaguchi & Maeda, 2005, p. 316). Instead, he or she acts as a patient’s representative to safeguard the patient’s dignity, to detect any anxieties, and to establish the patient’s level of understanding and approval of care to be delivered.

All patients will have a distinct and unique reaction depending on their individuality, cognitive ability, emotions, and educational status. Thus, when a patient can restate the information that anaesthesiologists or anesthetists had passed on him/her, it will verify that s/he has acquired sufficient information and has appreciated it. In this regard, the health care legislation obliges the nurse to testify any doubts concerning the patient’s comprehending of what the anesthetist has communicated. In addition, the health legislature requires nurses to report any issues about patients’ ability to make decisions.

Vitals signs

The most essential signs in most medical procedures include temperature, blood pressure, respiratory rate and effort, pulse/heart rate. Nurses measure and assess the vital signs of the patient to gain information that points to the health or ill health of the patient.

Vital signs data can be influenced by a medical procedure including surgery and anesthesia. This explains why nurses always must measure, assess, and record temperature, respiration, pulse, and blood pressure before infusing the foremost unit of blood; subsequent 15 minutes following the beginning of every unit; and at the end of infusion (Bolland, Brennan, Chippendale, Long, McCabe, & Houghton, 2007, p. 6). Blood transfusion must always follow surgery because of loss of blood.

When an adverse outcome occurs in a patient that has undergone surgery, such as thick yellow exudates in Sophie’s situation, assessing and measuring vital signs will help indicate the underlying disease process. Indeed, if an adverse effect results, nurses should measure and document vital signs frequently (McClelland, 2007, p. 32). For instance, temperature increases may indicate pyretic infection of the patient. Vital signs data help alert nurses when the medical procedures exacerbate an underlying health condition, so that he or they may take swift measures to address the problem.

Wound assessment

Wound assessment is a prominent medical responsibility for nurses in most health care contexts. Medical policymakers designed this practice to describe wound status at one point in time (Maylor, 2006, p. 444). The purpose of wound assessment connects to dressing assortment and in giving documentary proof of care. Correct wound assessment is critical to the appropriate and practical planning and implementation of interventions and goals for patient healing.

Nursing priorities in wound assessment

There are various nursing priorities in postoperative wound assessment. Priority concern measuring wound. The nurse can measure the dimension of Sophie’s wound including the length, width, and depth using a disinfected ruler or by tracing on a proprietary measuring grid. By comparing wound measurements taken at a different point in time, a nurse can know whether the wound is healing or worsening.

Second, concerns checking for any normal signs of healing. Inflammation characterized by increased redness around the wound, and high temperatures in the local wound area are an indication of the healing process. An understanding of the wound healing process and stages is necessary for effective wound assessment and subsequent treatment. The stage of healing determines the change in treatment and dressing (Torrance & Serginson, 1997, p 180). Wound assessment enables the nurse to determine setbacks and priorities for wound treatment.

The third priority involves identifying the type of wound. The necrotic wound appears as a thick grey, brown, black, slough, or hard dark scab. The presence of an increased amount of exudates that may have an offensive smell characterizes such a wound. Priority in such wounds involves removal of the necrotic slough, while treatment will be the focus towards debridement. Sophie’s wound is not such type of wound.

On the other hand, redness about the wound, offensive exudates, pain, localized hyperthermia, and cellulitis, characterizes an infected wound. Sophie’s case is more of an infected wound because it discharges pus. These wound characteristics indicate healing impairment or infection consistent with her underlying disease condition and use of prednisone.

Fourth, exudates characteristics are a powerful indicator of healing or infections. Normally, wound exudates support healing and maintain a moist wound surrounding. Exudates facilitate diffusion of healing factors and cells move across the wound bed. In addition, it supports cell proliferation, supplies nutrients, and boosts autolysis of necrotic tissue (World Union of Wound Healing Societies [WUWHS], 2007). However, over or underproduction of exudates may negatively influence healing. In Sophie’s case, the yellow discharge (pus) is an indication that the wound is infected. The nurse in charge will focus on fighting infection and sustaining drainage of the wound. The attending nurse should monitor Sophie for signs of systematic infection, and perform a wound swab to diagnose the bacteria involved so that he or she makes appropriate prescriptions. The nurse must rule out penicillin as an antibacterial agent.

Aseptic technique

Aseptic technique refers to a set of practices that reduce the introduction of pathogens to patients during postoperative care. Medics classify aseptic into general asepsis and surgical asepsis. General asepsis relates to patient care interventions outsides the confinement of the operating room, while surgical asepsis relates to those interventions intended to prevent infection of the surgical site. Thus, the purpose of aseptic techniques is to minimize threats of postoperative infections as well as to reduce the exposure of health practitioners to microbial infections.

Aseptic technique in wound dressing

Knowledge of how dressing materials work is indispensable in making the right product choices based on individual patients’ demands. On top of fluid handling potential, the dressing choice should facilitate a wound environment that favors healing, prevents additional problems, and satisfies the patient’s demands (Dowsett, 2008, p. 39). Nurses can ensure that dressings are not a source of infection by applying the aseptic technique in dressing wounds.

Identify the material that has been used for dressing. Low-adherent dressings or semi-permeable film dressing are favorable if the site is prone to cross-contamination common to wounds in the perineal or groin area (Oldfield & Burton, 2009, p. 85). A nurse attending to Sophie’s wound should prefer semi-permeable postoperative dressing because they provide bacteria- and waterproof barrier.

The goal of the aseptic technique is to protect wounds from microbial contamination. Main sources of microbial infection include care providers’ hands, surfaces, and health equipment. The major principles of the aseptic technique are maintaining asepsis, minimal exposure of the wound, and employing appropriate procedures. To achieve this objective, nurses must give priority to certain factors.

The priority involves patient preparation. The nurse explains the dressing procedure to Sophie to obtain consent and cooperation. Then the nurse draws screens about her bed and maintains sufficient light. In addition, she or he clears the bed area; switches off fans, and so forth. The nurse adjusts bedclothes to allow easy access to the wound site, while s/he pays attention to maintaining warmth and Sophie’s dignity. Further, the nurse should assess the patient’s comfort, before administering analgesics and allow time to take effect.

The second priority is nurse preparation for dressing. She or he should consult the care plan to know the type of dressing needed and frequency of change (Nicol, Payne, & Edwards, 2008, 2). The nurse must observe basic hygiene including tying hair back, washing and drying hands properly, and wearing an apron and protective clothing.

The third priority is the preparation of equipment including dressing trolley, dressing pack, and syringe for wetting the wound, cleansing liquid, and fresh dressing. Alcohol hand-rub facilities are also noteworthy. The nurse cleans the trolley and another necessary surface. The nurse gathers the equipment; verifies the sterility and expiry time of each piece of equipment and liquids.

Causative factors of wound breakdown

Concerning Sophie Smith, her wound breakdown can be attributed to two factors. First, Sophie suffers from rheumatoid arthritis whose disease process impairs wound healing. Prednisone is an anti-inflammatory agent. Because the wound healing process involves inflammatory reactions, prednisone impairs wound healing. With this information, the nurse may incorporate interventions that compensate for the disease effects, especially nutritional status into Sophie’s postoperative wound management plan and implementation. In addition, the nurse will rule out the prophylactic use of penicillin for preventing infection.

Conclusion

Wound healing is a complex process that involves overlap and interplay of many factors. Patient factors are the most prominent elements in the wound healing process. Patient medical history and lifestyle information determine the plan of wound treatment.

Reference list

Bale, S., & Jones, V. (2006). Wound Care Nursin: A patient-centered approach (2ed.). London: Mosby Elsevier.

Bolland, R., Brennan, E., Chippendale, M., Long, L., McCabe, A., & Houghton, J. (2007). Standards for assessing, measuring and monitoring vital signs in infants, children and young peopel. Royal colllege of Nursing , 1-13.

Dowsett, C. (2008). Managing wound exudate: role of Versiva® XC™ gelling foam dressing. Br J Nurs , 17(8), S38-S42.

Julie, M. (2006 ). Woundcare: assessment and principles of healing. Practice Nurse , 32(8); 62-66.

Maylor, M. E. (2006). Establishing nurses’ preferences in wound assessment: a concept. Journal of Clinical Nursing 15, 444–450 , 444-450.

McClelland, D. L. (2007). Handbook of transfusion medicine. London: UK TRansfusion andn Blood Tissue Transplant Services.

Nicol, M., Payne, A., & Edwards, D. (2008). Aseptic dressing technique. London : Barts and The London.

Oldfield, A., & Burton, F. (2009). Surgical wounds: Why do they Dehisce? Wound Essentials , 84-89.

Sakaguchi, M., & Maeda, S. (2005). Informed consent for anesthesia: survey of current practices in Japan. Journal of Aneshtesia , 19, 315-319.

Torrance, C., & Serginson, E. (1997). Surgical nursing. Philadelphia: lippincott and Willkins.

World Union of Wound Healing Societies (WUWHS). (2007). Principles of best practice: Wound exudate and the role of dressings. London: MEP Ltd.

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