Chronic wounds and pain Flashcards
What are the four types of chronic wounds
Foot ulcers
Leg ulcers
Malignant wounds
Pressure injuries
Wound clinical manifestations
HEALTHY WOUND (NOT CHRONIC)
- pink / beefy red
- decreasing / clear serous exudate
- warm, pink, normal surrounding skin
- no associated pain
- no infection
CHRONIC WOUND
- pale, greyish, avascular looking, lack of healthy granulation tissue
- infection - purulent exudate, oedema / redness around wound, foul odour
- non-viable wound tissue (slough / necrosis)
- no decrease in wound size over time
- Recurrent wound breakdown
- Pain associated with wound
What does a wound assessment consist of?
HEIDI
H- hx (health hx and wound hx)
E- examination
I - Investigations eg. swab, biopsy, blood sample
D - diagnosis and management plan
I - indicators of wound progression - ongoing ax and documentation
When examining wound, consider following:
- wound location
- wound hx
- clinical appearance
- underlying cause / contributing factors
- wound dimensions - size, depth, breadth
- wound edges and surrounding skin
- presence of infection
- pain
Foot ulcers
- Commonly caused by diabetes + PVD - persistent hyperglycaemia can damage nerves and feet and decrease blood supply to feet, PVD can also restrict blood and o2 supply to extremities
- NEUROPATHIC CHRONIC WOUND - when foot ulcer caused by nerve damage only, blood supply and pulses intact
- Nerve damage results in decreased sensation in feet and abnormal walking pattern, increased risk of ulcers
- Unawareness that feet have been injured, delayed treatment and progression to more serious wound
- NEUROISCHAEMIC CHRONIC WOUND - where foot ulcer caused by nerve damage and ischaemia
Leg ulcer
- VENOUS LEG ULCER - impaired venous circulation
- ARTERIAL LEG ULCER - impaired arterial blood supply
- MIXED VENOUS / ARTERIAL LEG ULCER - impairment of both arterial and venous circulation
- NEUROPATHIC LEG ULCER - loss of protective sensation
Malignant wounds
- Lesions resulting from cx cells which infiltrate skin and blood / lymph vessels, leading to necrosis
- Classified as either primary lesion or fungating / uncreative wound that occurs when cx growing under the skin breaks through
- May manifest as cavity, open wound, nodule / nodular growth
- May present with odour, pruritis, exudate, bleeding and pain
- Primary goal of care is to manage symptoms
Pressure injuries
- Localised injury to skin and underlying tissue that occurs when pressure, force or friction to skin and underlying tissue impairs blood and lymph flow
- Result is ischaemia, necrosis, ulceration
- May manifest as small superficial lesion / deep wound extending to underlying structures
- Usually occurs over bony prominences, but may occur on any area of skin exposed to pressure, force or friction
Assessing pain
- Health hx and pain hx
- PQRSTU (palliating / precipitating factors, quality, region / radiation, severity, timing, understanding / client interventions used)
- Physiological response to pain
- Examination of specific area of pain - inspection, auscultation, palpation
- Verbal and nonverbal responses to pain or examination
- Response to meds / other interventions
Nurses role in pain management
- Health education related to proper body mechanics and manual handling, stress management and relaxation techniques, appropriate therapy and med management
- Pain ax and pain medication administration
- Evaluate response to treatment and advocate for additional / alternative pain relief if necessary
- Identify risk factors for chronic pain and modify
- Promote self management (exercise, relaxation, distraction, sleep, nutrition)
What are the 5 factors of chronic pain?
Is ongoing
Is complex
Is not a linear process
Interferes with QoL
Impacts mental wellbeing
Is considered a chronic condition in its own right