Chronic wounds and pain

Question 1

What are the four types of chronic wounds

Answer 1

Foot ulcers
Leg ulcers
Malignant wounds
Pressure injuries

Question 2

Wound clinical manifestations

Answer 2

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

Question 3

What does a wound assessment consist of?

Answer 3

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

Question 4

Foot ulcers

Answer 4

• 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

Question 5

Leg ulcer

Answer 5

• 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

Question 6

Malignant wounds

Answer 6

• 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

Question 7

Pressure injuries

Answer 7

• 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

Question 8

Assessing pain

Answer 8

• 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

Question 9

Nurses role in pain management

Answer 9

• 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)

Question 10

What are the 5 factors of chronic pain?

Answer 10

Is ongoing
Is complex
Is not a linear process
Interferes with QoL
Impacts mental wellbeing
Is considered a chronic condition in its own right