James Fraser

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James Fraser

wound productrs

Hydrogels (Intrasite gel, Duoderm gel, Hydrosorb gel, Solugel, Curafil) - they consist of 70-90% water and are involved in autolytic debriding. This will allow the rehydration of the necrotic tissue as it will provide a moist environment.

Hydrocolloids (Duoderm, Comfeel, Activheal, Tegasorb, Hydrocoll and more) It allows the wound to clean and debride by autolysis during granulation and epithelialization

Wound management- James’ wife and the healthcare staff should assist with wound management for james

A: Assess patient, wellbeing and wound- checking the wound and its surroundings. Assess the patient's general health as he has recently come out of a Coronary Heart surgery and suffers from high cholesterol and ischaemic heart disease.

B: Bring in multidisciplinary team: such as occupational therapist, dietician, vascular team, pain team, podiatrists and potentially family carers to help his wife with wound dressings.

control or treat underlying causes and barriers to wound healing such as helping him consume a healthier diet considering his ischaemic heart condition. If this is not controlled, wound healing can be prolonged

decide on appropriate treatment: discussing treatment options with James and his wife such as surgically removing or biologically removing the necrotic tissue.

Goals of treatment-

As necrotic tissues must be removed due to their non viability, a treatment goal could be using topical medications such as gels to break down the necrotic tissue. Additionally necrotic tissues could be surgically removed too.

Treatment for physical factors-James can get treated for ischemic heart disease by taking medications such as nitrates, beta blockers, anticoagulants. He could also focus on consuming a healthier diet as he has high cholesterol. Check james’ environment of where he is sitting. As James cannot walk properly, regular checks for other pressure injuries should be done to prevent further consequences. As James’ ABPI is 0.7, it indicates mild obstruction, showing signs of moderate disease. Getting this checked will help James in the future.

Treatment for psychosocial factors- James may be given crutches to walk on or a wheelchair so he could get to see his friends, spend time with them during their poker nights and golf games. James could go to an occupational therapist which would provide help managing stress, providing company, help meet daily goals and help maintain skill

wound assessment

Tissue- The wound consists of 98% necrotic tissue and 2% of slough, indicating no blood flow to the site. inflammation /infection- The wound is not inflamed or infected. This is evident as there is no pain and swelling and there is no exudate or odour. Moisture- the wound is lacking moisture as it is dry and no infection is recognised Edges- Raised edges Surrounding skin- The surrounding skin is epithelial skin as it is pink. Stage of wound- Stage 3

Patient assessment

Psychosocial factors

Lack of insight of knowledge James’ wife was provided with multiple types of dressing supplies. Misunderstanding of the wound dressing, for example not cleaning the wound properly, loosely or tightly tying the methods could potentially cause infections

Isolation and reduced activities-prior to his surgery, James would gather with friends for poker nights and play golf with them 3 times a week. Due to his surgery and pressure injury, he would have to stay home to look after himself. Hence he would feel isolated without socialising with his friends. This could negatively impact James’ mental health and wellbeing, leading him feeling psychologically stressed. Stress decreases wound healing as the body cannot control the inflammatory response which is needed in wound healing

Interference with daily life- As James had the pressure injury, mobilisation must have been difficult causing him to stay home and not play golf with his friends. Due to immobility, the blood flow around the body may have decreased. This would have interfered with wound healing as the wound may not have gotten enough blood supply to heal.

Physical Assessment.

Age 68. As age increases the thickness of the skin decreases, becoming delicate and thinner. Resistance again shears and resistance forces decrease. As age increases, the dermis decreases. Hence a delay in wound healing is caused.

Suffers from ischaemic heart disease and high cholesterol. Ischaemic heart disease is when the heart is unable to receive sufficient blood and oxygen supply. Since there is a lack of blood supply in the body, the wound will also receive a lower amount of nutrients, prolonging wound healing

As James had a Coronary Artery Bypass Surgery, his mobility may have increased. This results in a reduced blood flow throughout the body, especially to the lower limb. As the pressure sore is located on the foot, the blood supply will be reduced, increasing the time required to heal.