Healing
drainage. ➤ Review the major complications of wound healing. ➤ Explain the factors involved in the development of pressure injury. ➤ Use the Braden scale to assess risk for pressure injury. ➤ Assess and categorize pressure injuries based on the staging system. ➤ Provide nursing care that limits the risk of pressure injury development. Have the patient stay in bed with the knees bent to minimize strain on the incision. ■ Do not put a binder on the patient. ■ Notify the surgeon and ready the patient for surgery (see Chapter 36 for care of the surgical patient). Fistulas found in wounds. ➤ Discuss when and how to use absorbent dressings, alginate dressings, collagen dressings, gauze dressings, transparent films, hydrocolloids, hydrogels, and foam and antimicrobial dressings. ➤ Describe guidelines to follow when applying heat or cold therapy. ➤ Demonstrate bandage and binder application. William Harmon is a 78-year-old man who fell and frac- tured his left hip 3 days ago.After being admitted to the hospital, he underwent an open reduction and internal fixation (ORIF) of the left hip.Today is his second postop- erative day. He is unable to roll or pull himself up in the bed. Mr. Harmon’s weight on admission was 140 lb (63.64 kg). His height is 73 in (185.42 cm). His family reports that he has been steadily losing weight. He expresses little interest in eating and says he has suffered depression since his wife died last year. A fistula is an abnormal passage connecting two body cavities or a cavity and the skin. Fistulas often result from infection or debris left in the wound. Fistulas can occur after bowel surgery, especially in compromised patients. It can also occur spontaneously and is associ- ated with certain diseases, such as inflammatory bowel disease (IBD) and cancer (McNichol et al., 2021). An abscess forms, which breaks down surrounding tissue and creates the abnormal passageway. Chronic drain- age from the fistula may lead to skin breakdown and delayed wound healing. The most common sites of fis- tula formation are the gastrointestinal and genitouri- nary tracts. Figure 32-9 illustrates a fistula between the rectum and vagina. A large dressing covers the incision on Mr. Harmon’s left hip. During your assessment, you loosen the dressing and see that the staples are intact at the incision site, and there is a min- imal amount of sero- sanguineous drainage on the bandage. As you Meet Your Patient
common in the gastrointestinal and genitourinary tracts.
STUDENT RESOURCES The questions and exercises in this book allow you to practice the kind of thinking you will use as a full-spectrum nurse. Critical-thinking questions usually have more than one right answer, so we do not provide “correct” answers for these features. Try to answer these questions yourself. It is more important to develop your nursing judgment than to just cover content. You will learn more by discussing the questions with your peers. If you are still unsure, see the Davis Advantage chapter resources for suggested responses.
Two types of case studies illustrate key points and bring concepts to life, connecting what students read to what they will see and do in practice. As a nurse, you will care for many patients who have wounds or who are at risk for skin break- down. The remainder of the chapter explains how to 2 to 4 weeks may be considered chronic. A pressure injury is a type of chronic wound. To learn about pres- sure injuries, see the Example Client Condition: Pres- sure Injury and Figures 32-10 and 32-11. Practical Knowledge knowing how Key Concepts Skin integrity Wound Wound healing Related Concepts See the Concept Map on Davis Advantage. Example Client
Build a solid foundation with either text
To explore learning resources for this chapter,
Go to www.DavisAdvantage.com and find:
Answers and Suggested Responses for all questions in this chapter Concept Map Knowledge Map References and Bibliography
Condition Pressure injury
(Continued)
1 Caring for the Williams Family Kayla Robinson, Stanley and Nadine Williams’ 3-year-old grandchild, fell at the neighborhood playground. She has abrasions on her knees, a deep puncture wound on her left hand, and a laceration on her scalp. Mr. and Mrs.Williams bring her to the clinic for assessment. She is crying loudly and moving all extremities. No treatment has been given. 6/22/23 4:52 PM Mobility and activity Sensation
Time and pressure
4797_Ch32_001-036.indd 1
Knowledge Check 32-5 ■ Describe four types of wound closures. ■ Identify five types of wound complications. ■ Describe three signs of internal hemorrhage. ■ Compare dehiscence and evisceration.
Pressure injury
Intrinsic factors
• Nutrition • Age
Tissue tolerance
Think Like a Nurse 32-2: Clinical Judgment in Action
• Circulation • Underlying
health status
658 Recall the case of Mr. Harmon (Meet Your Patient).What form of wound healing (primary, secondary, or tertiary) is he undergoing? How long would you expect it to take before his wounds heal?
Think Like a Nurse: Clinical Judgment in Action questions put students in the nurse’s role to begin developing their clinical judgment skills from day one. Extrinsic factors
• Friction • Shearing •Moisture
4798_Ch32_658-704.indd 658 CHRONIC WOUNDS A chronic wound is one that has not healed within the expected time frame. Wounds that do not heal within
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FIGURE 32-10 Several factors contribute to the development of a pressure injury.
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