Wound Care Management presented by SN Dave from Sree Narayana Mission Home

1. WOUND CARE
MANAGEMENT
By: SN Dave

2. UNDERSTANDTHE ANATOMY AND PHYSIOLOGY OFTHE SKIN.
UNDERSTANDTHE PHASES OF WOUND HEALING.
IDENTIFYTHE FACTORS AFFECTING WOUND HEALING.
UNDERSTANDTHE DIFFERENTTYPES OF WOUND ASSESSMENT
TOOLS.
UNDERSTAND PROCESS OF WOUND ASSESSMENT
IDENTIFY AND UNDERSTANDTHE CORRECT SELECTION OF WOUND
PRODUCT MATERIALS
LEARNING OBJECTIVES:

3. THE LARGEST ORGAN OFTHE
BODY.
-ACCOUNTS FOR ABOUT 16%
OFTOTAL BODYWEIGHT.
-CONSIST OFTWO MAJOR
LAYERS.
EPIDERMIS &LDERMIS:
ANATOMY OF THE SKIN:

4. -THICKNESS IS BETWEEN 0.5
MM(EYELIDS)-4.0 MM (HEELS).
-CONTAINS FOUR MAJORTYPE OF
CELLS.(KERATINOCYTES, MELANOCYTES, LANGERHANS
CELL, MERKEL CELL)
-COMPRISED OF FIVE LAYERS.( STRATUM
CORNEUM, STRATUM LUCIDUM, STRATUM GRANULOSUM,
STRATUM SPINOSUM, AND STRATUM BASALE)
EPIDERMIS

5. 1. PROTECTION- PROTECTS AGAINST MECHANICAL ASSAULT, BACTERIAL AND VIRAL INVASION,
HYDRATION AND PROTECTION FROM UV RADIATION.
2. THERMOREGULATION- PROVIDE TEMPERATURE REGULATION, HEAT LOSS AND HEAT CONSERVATION.
3.SENSATION- RESPONDS TO TEMPERATURE, PAIN, TOUCH AND VIBRATION.
4. METABOLISM- CONVERT 7 DEHYDROCHOLESTEROL FOUND IN THE SKIN TO VIT D, WHICH PROMOTES
CALCIUM ABSORPTION IN G.I.
5. EXCRETION- EXCREATION OF UREA AND SODIUM THROUGH SWEATING.WATER AND ELECTROLYTES
LOSS FROM EXTERNAL ENVIRONMENT.
6.BODY IMAGE- IDENTIFICATION OF PERSON.
PHYSIOLOGY OF THE SKIN:

6. ANY DAMAGEWHICH CAUSES A BREAK INTHE
CONTINUITY OFTHE SKIN IS CONSIDEREDTO BE A
WOUND.
WHAT IS WOUND?

7. MECHANISM OF WOUND HEALING IS DEPENDENT UPON THE AFFECTED
TISSUE LAYERS.
1.PARTIAL THICKNESS WOUNDS -ARE THOSE INVOLVING ONLY PARTIAL LOSS OF SKIN
LAYER ( EPIDERMAL AND SUPERFICIAL DERMAL LAYER)
2.FULL THICKNESS WOUNDS- INVOLVES TOTAL LOSS OF SKIN LAYERS ( EPIDERMIS AND
DERMIS AND FREQUENTLY INVOLVES THE DEEPER TISSUES( SUBCUTANEOUS TISSUES,
MUSCLES AND BONES ) AS WELL.
TYPES OF WOUNDS:

8. WOUND
CLASSIFICATION:
A. Acute wound- wound that is sudden onset and short duration, healing
process is in a predictable and of short period. Move through the 4
phases of wound healing without difficulty.
B. Chronic wound- wounds fails to heal in a timely and orderly manner,
resulting in chronic and non healing wounds. Stuck in inflammatory
phase greater than 4 –6weeks.

9. CLASSIFICATION OF
WOUNDS: (AETIOLOGY)
AcuteWounds Chronic Wounds
TRAUMATIC
WOUNDS
SURGICAL WOUNDS
• ABRASION
• BURNS/ SCALDS
• BITES
• SKIN TEARS
• CRUSH INJURIES
• SURGICAL DEHISCENCE
WOUND
• DEBRIDEMENT
• SKIN GRAP/FLAP
• DONOR
• PRESSURE ULCER/ P.I.
• VENOUS ULCER
• ARTERIAL ULCER
• DIABETIC FOOT ULCER
• FUNGATING WOUNDS
• SINUS
AETIOLOGY

10.  PHASES OF WOUND HEALING:

11. FACTORS AFFECTING WOUND FACTORS AFFECTING WOUND
HEALING:
Intrinsic Factors: ExtrinsicFactors: OtherFactors:
●Age ●Mechanical Stress ●Systemic meds
● Health or Immune status ● Debris ●Alcohol
● Medical condition ● Temperature ●Smoking
● Obesity ●Desiccation / Maceration ●Pain
● Oedema ●Infection ●Psychological
● Nutritional status ●Pressure stress
● Chemical Stress ●Inappropriate
wound mx.

12. COMPLICATION OF THE
WOUNDS:
• Haemorrhage
• Infection
• Rupture (dehiscence)
• Immobility
• Contractures

13. LOOK AT THE “WHOLE "PATIENT
NOT THE HOLE.
Blood Supply Social Circumstance
Smoking Age
Sleep Medical condition
Mobility Drugs
Motivation Infection
Nutritional status Continence
Psychological status

14. PROCESS:
Start with
patient
assessment/
reassessment
Identify wound
aetiology
Perform wound
assessment
Wound
treatment/
evaluate
intervention
Is wound
healing/
Prevention
program
HEIDI TOOLHISTORY,EXAMINATION,INVESTIGATION,DIAGN
OSIS AND MX. PLAN, INDICATOR FOR EACH
PERSON

15. ASSESSMENT PROCESS: ADPIE
1. Undertake the assessment
a. Purpose
b. Patient history/wound history
c. Physical Assessment & Wound Assessment
2. Determine the diagnosis
a. Examination strategy
b. Consult or refer to other heath care professionals
c. Confirm a diagnosis (Aetiology)

16. 3. SET PLAN/GOALS FOR THERAPY:
A. SET GOALS AND CLINICAL OUTCOMES OF CARE
4. Implement appropriate interventions:
A. Determine appropriate interventions.
B. Refer to appropriate services.
C. Monitor and evaluate outcomes.

17. HISTORY:
1.Wound history(duration, location, character, size, odour,
wound dressing used.
2.Medical and surgical history
3.Drug history
4.Social background
5.Nutritional Status
6.Psychological status
7.Occupational status
8.Education level

18. EXAMINATION:
1. Wound examination : duration , location , size, wound bed,
exudate and odour
2. Wound exam tool
3. Pain (severity, duration and location)
4. Surrounding skin
5. Skin colour, temperature, moisture and turgor
6. Oedema
7. Scars, calluses and lesions
8. Nutrition

19. INVESTIGATION:
Wound swab
Wound biopsy
Pulse assessment
Capillary refill
Ankle- brachial Pressure index(ABPI);Toe- Brachial pressure
index (TBPI)
Sensation testing (vibration perception assessment)
X-ray

20. DIAGNOSIS:
Diagnostic test which you may consider;
1. Laboratory value( ex. albumin)
2. Microbiology (bacterial swab culture)
3. Wound Biopsies
4. Diagnostic imaging ( x-ray for ex. Osteomyelitis)
5. Vascular Studies

21. INDICATORS:
1.Wound aetiology
2.Wound progress
3.Peri wound skin
4.Changes in blood test

22. WOUND ASSESSMENT:

23. TYPES OF WOUND ASSESSMENT TOOLS
1.ASSESSMENTS TOOL
2. TIME TOOL
3. MEAsURE TOOL

24. ASSESSMENT TOOL:
1.ASSESSMENTS TOOL
A- anatomical location, Age of wound
S- size, Shape
S- sinus tract, Tunnelling, Undermining
E- exudate
S- sepsis (including odour)
S- surrounding skin
M-maceration
E-edge, Epithelialization
N-necrotic tissue
T- tissue bed, Tenderness (pain)
S- status- changes in condition, improvement

25. ASSESSMENT TOOL:
2. TIME TOOL
T-tissue: viable or non viable.
I- infection/ Inflammation
M-moisture imbalance ( maceration or desiccation)
E- edge of wound

26. WOUND ASSESSMENT
TOOL:
3. MEAsURE TOOL
M- measure (length x width and depth)
E- exudate ( type, colour, consistency, quantity and odour)
A- appearance- wound bed ( granulation, biofilm, friable tissue,
hyper granulation, slough, eschar, epithelialization.
S-suffering- (pain intensity)
U- undermining- (tunnelling, sinus)
R-re-evaluation- duration of dressing change, thorough
reassessment.
E- edge (condition of peri wound.)

27. MEASUREMENTS:
• Ruler –based linear method (head to toe)-using the body as face of an imaginary
clock.
The greatest length and the greatest width perpendicular to the greatest length
-face is always at 12 o’clock
-the feet are always at 6 o'clock
The heels are always at 12 o’clock
-the toes are always at 6 o’clock
• 3 d measurement
• Visitrak

28. Type Color Consistency Significance
Bloody Red Thin watery Indicate new blood
vessel growth or
disruption of blood
vessels
Hemoserous Light red to pink Thin watery Normal during
inflammatory and
proliferative phase.
Serous Clear, light color Thin watery Normal during
inflammatory and
proliferative phase.
Haemopurulent Cloudy, yellow or tan Thin watery First sign of impending
wound infection
Purulent/ Pus Yellow, tan to green Thick, Opaque Signals wound infection
EXUDATE: QUALITY

29. Type Definition
None No exudate
Small (scant) Exudate fully controlled. Non absorptive dressing may
be used, wear time up to 7 days.
Moderate Exudate controlled
Absorptive dressing may be required, wear time 2-3
days
Large (copious) Uncontrolled exudates.
Absorptive dressing required, dressing may be
overwhelmed in <1 day . Ex. Venous ulcer and deep
burn degree wounds.
EXUDATES: QUANTITY

30. Type Description
Strong Odour is evident on entering room (2-3 meters form
patient) Intact dressing
Moderate Odour is evident on entering room (2-3 meters form
patient). Dressing is removed
Slight Evident at close to the patient when dressing is
removed.
No odour No evident even at the patient bedside with
dressing removed.
EXUDATES: ODOUR

31. Type Definition
Granulation Red firm. Vascularized tissues has a granular
appearance
Friable tissues Brittle or fragile, easily damage tissues, agranular,
indicate high bacterial load.
Biofilm Poly microbial community, more often with slimy glue-
like substance
Hypergranulation/overgranulation Excess of granulation tissues beyond the amount
required to replace the tissue deficirt.
APPEARANCE:

32. Type Definition
Slough Soft, moist, avascular
May be white, yellow, tan or grey green in colour.
Loose or firmly adherent.
Eschar Black, soft and wet or hard and dry necrotic tissues due
to inadequate blood supply.
Loose or firmly adherent.
Epithelialization Pink or red skin migrating from wound margin.
Process of epidermal resurfacing (Sussman,2007)
APPEARANCE:

33. SUFFERING:
Pain intensity, duration , location, frequency
Used of pain assessment tool such as:
1. Modified Wong-Bakers / Face pain rating scale
2. Verbal Numerical Scale
3. Behavioural Pain Scale
4. PAINAD and Abbey Tool (Dementia)

34. UNDERMINING:
Indicates the loss of tissue underneath an intact
skin surface
Probe or cotton tipped applicator are used for
assessment.
Recording based on the clock system.
Head
12
ocloc
k
9
o’clock
3
o’clock
6
o’clock

35. UNDERMINING: SINUS TRACK VS.
TUNNELLING
Is narrow and quite long , seems to have a
destination.
Sinus tract and tunnels are often used
interchangeably.

36. RE- EVALUATION:
Monitor wound parameters at every
dressing changes
Thorough re-assessment every 1-4
weeks or depending on the schedules
dressing change.

37. EDGES:
 Condition of edge.
 Peri wound skin (includes the skin with in 4 cm of the wound edges (Sussman,2007))
1. Epithelializing/Epithelized
2. Rolled wound edges
3. Callus
4. Bruise
5. Excoriation
6. Induration
7. Inflammation
8. Maceration
9. Tape –skin tearing

38. WOUND
DEBRIDEMENT:
Wound
Debridement
CSWDSurgical
Larval
Mechanical
Enzymatic
Autolytic

39. WOUND CLEANSING :
The ideal wound cleansing solution :
• Non toxic to viable tissues.
• Effective in the presence of organic materials such as blood, slough or
necrotic tissues.
• Able to reduce the number of microorganism.
• Hypoallergenic and does not cause sensitivity reaction.
• Readily available, cost effective and stable.

40. WOUND CLEANSING SOLUTIONS:
1. Tap water- for home environment is acceptable.
2. Normal Saline 0.9%- is the safest cleansing agent because it does not interfere with wound healing.
3. Distilled water- for irrigation- out patient clinics.
4. Povidone-iodine- Effective against gram positive and negative bacteria and other organism.
5. Potassium Permanganate- is an oxidising agent with disinfectant, deodorizing and astringent properties.
6. Alcohol 70%- hard surface disinfection and skin antisepsis.
7. Dermacyn Solution- indicated for chronic wound, DFU, VU, post surgical and infected wound.
8. Chlorhexidine- antiseptic solution against gram positive and negative bacteria.
9. Protosan solution- cleansing, moisturizing and decontamination of acute, chronic wounds,superficial and
partial thickness burns. Useful in the removal of biofilm.

41. CLEANSING SOLUTION:

42. WOUND PRODUCTS:
1. Maintain a warm moist environment
2. Control exudates, control infection
3. Non traumatic on removal of dressing
4. Aids in debridement of necrotic or sloughy tissues
5. Cost effective

43. WOUND DRESSING PRODUCTS:
1.Wound contact layer- Jelonet , Urgotul , Mepitel 1.
2.Transparent film- usually waterproof and air permeable, covering
blisters, retention of primary dressing not recommended with fragile skin and
infected wounds.
E.g. Tegadernm , Opsite
3. Hydrocolloids Dressing- contains hydrocolloid material (sodium
carboxymethycellulose-NaCMC and gelatin) that reacts with wound exudate
forming a gel like covering. Break down of the product my produce a residue
of varying colours and possible foul odour. E.g. Duoderm Extra Thin, Comfeel
Dressing

44. WOUND DRESSING PRODUCTS:
4. Hydrogel- Contain certain level of hydrocolloids in liquid base. Create a
moist environment to dry, necrotic, sloughy or granulating wounds. E. g. Duoderm
gel.
5. Calcium Alginates- Made from woven or non woven fibers that derives
from brown seaweeds. Used on moderate to heavy exudative wound and packing of
cavity wounds. E.g. Kaltostat ,Biatain , Algisite Ag.
6. Hydrofiber (Aquacel)- is primary wound dressing products from
sodium carboxy-methylcellulose. Forms unique gelling action that absorb and locks in
exudates and bacteria.
7.NaCl Impregnated Dressing- Made of absorbent, non woven
impregnated viscose, polyester with NaCl. Stimulates wound cleansing by absorbing
exudate, bacteria and necrotic material from the wound .Do not direct contact with
exposed bone or tendon or dry and low exudative cavity wounds. E.g. Mesalt

45. WOUND DRESSING PRODUCTS:
8. Foam Dressing-Consist of a hydrophobic polyurethane foam. Provide a
moist environment for wound healing and thermal insulation. Used for
wounds with minimal to heavy exudates. E.g. Allevyn, Biatian Ag, Mepilex
and Mepilex Ag.
9. Iodine Dressing- anti microbial dressing effective against broad
spectrum of wound pathogens inc. MRSA, viral, fungal and Acid fast bacteria.
Not to use in large wounds or exceed 150 g /week and 3 months in single
course. E.g. Iodosorb oint/powder, Inadine dressing.
10. Silver Dressing- anti microbial properties against broad spectrum of
organism including MRSA and VRE. Silver ions actions activated on contact
with exudates. E.g. Aquacel Ag, Algisite Ag, Biatain, Alginate Ag, Mepilex Ag,
Acticoat.

46. WOUND DRESSING MANAGEMENT:
Over Granulation- granulation tissue which grows above the level of the
surrounding skin, Preventing epithelial cells from growing across the wound.
Treatment Aims: To suppress overgrowing tissue by controlling excessive exudates and
destruction of the hyper granulation tissue.
Treatment Options: Clean : Hypertonic impregnated gauze dressing or highly absorbent
foam. E.g. Mesalt , Biatain
Colonised/ Infected: Antimicrobial and highly absorbent dressing- E.g. Iodosorb powder,
mesalt ,Biatain Ag.
Other consideration: Do not apply moisture retentive dressing E.g. Film or Silicon foam or
hydrofiber dressing

47. WOUND DRESSING MANAGEMENT:
Moist Slough- viscous yellow layer that is moist and partial or loosely
adherent to wound bed.
Treatment Aims: To remove all derbris and slough tissue, to promote autolysis by
rehydration of necrotic tissue.
Treatment Options: Remove loosely detached slough tissue.
Superficial: Hydrocolloids or moist hydorfiber dressing: E.g. Comfeel. Duoderm
extra, Moistened Aquacel.
Cavity: Algisite or Hydrofiber/ Hydrogeland moisture retentive dressing: E.g.
Kaltostat, Aquacel,Duoderm gel and fil or foam dressing.
Other consideration: Refer wound nurse for conservative debridement.

48. WOUND DRESSING MANAGEMENT:
Dry Slough- viscous yellow layer that is dry and sloughy adherent to wound bed.
Treatment Aims: To rehydrate adherent slough tissue and promote autolysis.
Treatment Options: Hydrocolloids or moist Hydrofiber dressing. E.g. Comfeel dressing/ Duo derm extra
thin, Duoderm gel.
Note: Film or foam as a secondary dressing when hydrogel is applied.
Other consideration: Take caution of skin maceration when hydrogel is applied to superficial or shallow
wound.

49. WOUND DRESSING
MANAGEMENT:
Necrotic / Eschar- necrosis is the death of a living tissue due to inadequate blood
supply. This tissue is often black/brown in colour and leathery in texture.
Treatment Aims: To rehydrate the eschar and reduce the risk of infection.
Treatment Options:Hydrocolloidsor hydrogel or combination of hydrogel and hydrocolloid dressing. E.g.
Comfeel , Duoderm extra thin and duoderm gel.
Note: Film or foam as a secondary dressing when hydrogel is applied
Other consideration: Do not rehydrate dry gangrene or ischaemic foot eschar.

50. WOUND DRESSING MANAGEMENT:
Necrotic (gangrene ) Digits- necrosis due to lack of blood supply to
foot/ toes.
Treatment Aims: To prevent infection and to aid in auto- amputation of digits
Treatment Option:
Dry gangrene: anti microbial cleansing and dry dressing or leave exposed. E.g. Methylated Spirit 70% or
Povidone Iodine 10%
Wet gangrene:Anti microbial and alginate dressing:E.g. Methylated Spirit 70% or Povidone Iodine
10%,Iodosorb powder + kaltostat dressing.
Other consideration: Do not apply retentive dressing E.g. Film or foam dressing, Seek vascular and
orthopaedic doctors opinion. Check for hypersensitivity to antimicrobial agents.

51. WOUND DRESSING MANAGEMENT:
Partial thickness burn- Scalded or fire burn involving dermal layers.
Treatment Aims: To prevent infection and to promote healing by maintaining a warm moist environment.
Treatment Option: Low and non adherent antimicrobial foam or wound contact of film dressing. E.g.
Urgotol Ag, mepilex Ag, Mepilex or Opsite Dressing.
Other consideration: Assess for history of hypersensitivity to antimicrobial agent.

52. WOUND DRESSING MANAGEMENT:
Biofilm- are complex microbial communities containing bacteria and
fungi that attaches firmly to a living or non living surface.
Treatment Aims: To reduce the biofilm and biofilm formation.
Treatment option: Regular debridement and antimicrobial dressing. E.g. Inadine ,
Urgotol Ag, Sesorb Ag, Iodosorb powder.
Note: Avoid moisture retentive dressing E.g. Fil or silicone foam.
Other consideration: Assess for history of hypersensitivity to antimicrobial agent.

53. WOUND DRESSING MANAGEMENT:
Critical colonised or Infected wound:
Critical colonization-multiplication of bacteria causing a delay in wound healing.
Infection- multiplication of bacteria causing disruption in wound healing and damage of wound tissue.
Treatment Aims: To reduce bio burden, treat infection manage exudate and odour.
Treatment option: Anti microbial dressing.
Superficial:Inadine, Iodosorb powder, Mesalt, Urgotol Ag, Aquacel Ag.
Cavity: Inadine, Iodosorb powder, Mesalt, Aquacel Ag, Seasorb Ag.
Other consideration: assess for history of hypersensitivity to antimicrobial agent. Refer to doctor when
there is spreading of inflammation or no improvement. Avoid moisture retentive dressing E.g. film and
foam.

54. WOUND DRESSING MANAGEMENT:
Friable tissue- Brittle or fragile tissue, easily damage agranular tissue that bleed easily
often indicate high bacterial load.
Treatment Aims: To reduce bio burden, treat infection and manage exudates.
Treatment option: High Absorbent Anti microbial dressing. E.g.Mesalt, Iodosorb powder and mesalt,
Seasorb Ag
Note: Avoid moisture retentive dressing E.g. Fil or silicone foam.
Other consideration:Assess for history of hypersensitivity to antimicrobial agent. Refer to doctor when
there is spreading of inflammation or no improvement. Avoid moisture retentive dressing E.g. film and
foam.

55. WOUND DRESSING MANAGEMENT:
Granulation-during the proliferative phase of healing, this is the bright red tissue
formed from new capillary loops which are red moist and moist in appearance.
Treatment Aims: To promote and protect angiogenesis by maintaining a warm moist environment;.
Treatment Options:
Superficial:Low/ non adherent wound contact layer or foam dressing: E.g. Urgotul, Mepitel, Mepilex.
Shallow : Algisite or Hydrofiber or hydrogel dressing: E.g. Kaltostat, Aquacel, Duoderm gel
Cavity: Algisite or Hydrofiber dressing: E.g. Kaltostat , Aquacel.
Other consideration: Do not apply film dressing on moderate and heavy exudating wound.

56. WOUND DRESSING MANAGEMENT:
Epithelialisation-The final stage of wound healing where epidermal cells migrate
across the across the surface of the wound. These cells are pink/ white in colour at the wound edges or
over granulation tissues.
Treatment Aims: To protect and promote new tissues growth by maintaining a moist environment.
Treatment Options: Low/ non adherent wound contact layer or hydrocolloid: Urgotul, Mepilex, Mepilex lite,
Melolin, Duoderm Extra thin.
Other consideration: New form Tissue is only 60-80% as strong as origin. Failure to protect may result in
reopening of wound.

57. CASE STUDY: BIOGRAPHIC DATA
NAME: Mr. Singh
GENDER: Male
BIRTH DATE/ AGE: 29/07/1952 (62 years old)
RACE: Singaporean- Indian
OCCUPATION:
MOBILITY STATUS: Bed bound (maximum assistance)
DIET: On soft/ minced diet with 2 scoop propass/day- (OVO-VEGETARIAN)
BMI: 16.9
MEDICAL HISTORY/SURGICAL H/O,CHRONIC D’SES/ALLERGIES:
Epilepsy, Neurosyphilis, SIADH, Neurogenic bladder on long term IDC, Hx. Of klebsiella Pneumonia, Hx. Of
Alcohol Dependence, Dementia, Depression, Adrenal Insufficiency (HTN).

58. CASE STUDY: FAMILY & SOCIAL HISTORY
Resident is a divorced in 2003, He has one sister and 4 younger
brothers residing in London.
Has two daughters and a son but has estranged relationship with the
patient
Eldest sister is the only supportive person for the resident and has
been appointed as a committee of person for pt. or spoke person but
financially unstable.
H/O chronic alcoholic drinker.

59. CASE STUDY: MEDICATION
Drug Allergy: Phenytoin
Tab. Phenobarbitone 30 mg BD
Tab. Paracetamol 1 gm. QDS/PRN
Tab. Hydrocortisone 10 mg OM, 5 mg. ON
Tab Senna 15 mg. ON
Cap Omeprazole 40 mg OM
Tab Folic Acid 5 mg. OM

60. CASE STUDY:
First photo: (after hospital discharge) PRESSURE INJURY- UNSTAGEABLE
Location: posterior area of lt. iliac crest.
Measurement: 4 cm ( L )x 3 cm (W) (unstageable wound)
Wound description: Necrotic fibrous tissue/ slough
peri-wound: erythema and discoloration
Exudates: Scanty amount of serous drainage
Odour: Absence
Dressing: Duo derm CGF
Dressing change: Every 3 days/ PRN
Pain: 3/10
Main Goal: debridement of slough, maintaining moist environment, provide clean wound for granulation tissue.

61. CASE STUDY: INTERVENTIONS
1. Strictly two hourly turning and wound review.
2. Skin care ( moisturizer and barrier creams)
3. Nutrition ( referral to dietician for extra nutritional support)- trial of impact
powder
4. Mechanical support ( air mattresses, paramount bed)
5. Hydration
6. Passive mobilization (bed bound)- referral to physiotherapy and occupational
therapy.
7. Routine medication review.
8. Financial concerns: referral to MSW for subsidized medications

62. WOUND HEALING PROGRESS:

63. END
Thanks……