Why is wound care important in nursing
How does the wound care work?
The term wound care includes the cleaning, closing and care of open wounds. Such wounds can be both acute injuries (such as cuts) and chronic wounds (such as pressure sores in bedridden patients).
Wounds that have existed for more than two to three weeks are called chronic.
Primary and secondary wound care
Doctors differentiate between primary and secondary wound care:
Tour of the paramedic station at the Oktoberfest
First aid with the balloonA permanent building has stood on Munich's Theresienwiese since 2006. During the Oktoberfest, the paramedic station of the Bavarian Red Cross (BRK) is housed here. 140 volunteer doctors, paramedics and helpers work there on a Saturday evening. Everything is tightly organized, like in the emergency room of a clinic. A balloon with a red cross that hovers over the building shows the way.
Operations managementAnyone who dials 112 at the Oktoberfest will be connected to the operations management of the BRK station from the control center in Munich. The team there then passes on to the helpers what kind of emergency it is and where exactly the patient is on the festival site.
receptionIf you only need a plaster or a headache pill, you will find help at reception. This service is mainly used by people who work at the Oktoberfest - that's over 10,000 people.
Carry instead of an ambulanceAt Oktoberfest, first aiders do not drive to the patient by ambulance, but come with specially equipped stretchers. The stretcher crew is at least four: one of them runs away with a radio and looks for the right place, a doctor or paramedic is in charge of medical management and two other helpers push the stretcher. The yellow cover shields the patient to protect him from gawkers.
Sighting areaIn the inspection area of the medical station, an experienced emergency doctor assesses how badly the patient is injured on the stretcher and assigns one of the categories green, yellow or red. Thanks to an electronic registration system, the doctor knows which treatment places are still available and assigns them to the patient. A total of 20 people can be cared for lying down in the BRK station during normal operation.
The surveillance roomPatients who were struck down by the beer are brought here. The carriers are very low in case someone rolls out. When it rains, alcoholics often arrive in the surveillance room dripping wet - there is dry laundry for them. Heat blowers ensure that the patients do not get too cold. Each individual is assigned a helper who immediately notices if someone is worse off. Most of them leave the station on their own two feet.
treatmentThe treatment in the paramedic station is comparable to the emergency room in a hospital. In one of the six treatment cubicles, the patient is interviewed (anamnesis), possibly stabilized and prepared for transport to the hospital. A surgeon treats smaller wounds in the operating theater. For example, a cut wound can be sewn.
Shock roomPatients with real vital dysfunctions, such as a heart attack or an open hernia, are stabilized in the emergency room. Then an ambulance with an ambulance takes them to the clinic. Fortunately, such emergencies rarely occur at Oktoberfest - the shock room in the BRK station is the least occupied.
Primary wound care
This means that the wound is closed within the first six hours after the injury. Sometimes a plaster or tissue adhesive is sufficient for this, for example in the case of wounds on areas of the skin that are not subject to mechanical stress. In other cases, the wound must be closed with sutures or staples.
Secondary wound care
In some cases, primary wound care is not possible. This applies, for example, if a wound is inflamed (infected) or if it is a chronic wound, for example pressure ulcers (decubitus) or diabetic foot. If such a wound were closed directly, the pathogens present in it could easily multiply and cause a serious infection.
Therefore, such an injury initially remains open and is cleaned regularly. Only when the wound is clean (usually after several days, but sometimes not until weeks) is it closed with a suture.
Wound care: moist or dry
With dry wound treatment, open wounds are covered with a sterile, dry wound pad. In the case of poorly healing wounds and burns, on the other hand, it makes more sense to use special pads that keep the wound area moist. These moist wound care (moist wound treatment) is also called modern wound care because specially manufactured materials that have been newly developed in recent years are used for this.
You can read more about the different dressings and their use in the article Wound Care: Wound Dressings.
The beginning of every wound care is the initial care of the wound. It is important for further treatment and good wound healing.
In the case of smaller wounds in particular, first aid can also be provided by a layperson, for example by the patient himself or by the parents (for children with small wounds). A medicine cabinet or an emergency kit should be available in every household and car with the following content:
- mild disinfectant, suitable for open wounds / mucous membranes
- sterile swabs and compresses
- commercial plasters and fixing plasters
- Gauze bandages and bandages
When it comes to providing first aid to a bleeding wound, the first thing to do is Hemostasis. You can stop weaker bleeding by applying several sterile compresses to the wound and then wrapping the wound with a gauze bandage with light pressure.
If the bleeding is heavier, after the first wraps of the gauze bandage you should also place a bandage pack over the wound and wrap the rest of the gauze bandage tightly around it (pressure bandage). The extra pressure can compress the blood vessels. It is also advisable to elevate the affected part of the body. If the bleeding still cannot be stopped, you must call a doctor immediately!
In the past, when there was heavy bleeding from arterial blood vessels in the arms and legs, it was recommended that the extremity be tied to stop the bleeding. However, there is a risk that the tied limb will be completely cut off from the blood supply - this can lead to tissue death. In the worst case, the affected leg or arm must then be amputated!
Therefore, the tying of wounds is now only recommended if there is a threat of life-threatening blood loss. In addition, if possible, it should only be performed by healthcare professionals.
In situations in which surgical hemostasis is difficult (e.g. in military medicine), tying continues to be of great importance.
If the injury is superficial, primary wound care is indicated. This can usually be done by the family doctor or pediatrician:
First, the doctor examines the wound in detail. Among other things, he checks how deep the injury is. Then he starts cleaning the wound: To do this, he uses, for example, saline solution for coarse dirt and then a mild disinfectant that does not burn as strongly. So that the wound can heal well, he now brings the wound edges together with cling plasters or special tissue glue. If the clean wound edges are next to each other, the injury can heal well.
If the doctor determines that the wound is a deep, complex injury during the wound assessment, he will proceed as follows for the primary wound care:
- First, he must clean and disinfect the wound, as is indicated for superficial injuries.
- Then he can close the wound: Sometimes a special tissue adhesive is sufficient. In other cases, he will have to stitch the wound or use a special stapler to staple the wound. So that the patient does not experience any pain, the doctor injects a local anesthetic near the wound beforehand.
- If the wound is bleeding profusely, the doctor often places a drainage before the wound is closed: Wound fluid and blood are sucked out of the wound area through a thin plastic tube using negative pressure. The drain is then removed a few days later.
Chronic or inflamed wound
An inflamed wound, like a chronic wound, requires secondary wound care. This is how a potentially life-threatening wound infection can be prevented:
The doctor first cleans the wound with saline and then rinses it out. He uses an antiseptic solution for this wound irrigation. Usually there is also a so-called Debridement: The doctor cuts out infected or damaged tissue from the edge of the wound and from the depth of the wound. This prevents wound infection and stimulates the remaining tissue to heal.
The final wound closure only takes place when there is no (longer) infection and the newly formed tissue looks healthy.
If a wound was bandaged during initial treatment, the dressing should be changed after 24 to 48 hours at the earliest. In the case of chronic or inflamed wounds, this should be done by a doctor or nursing staff. You can lend a hand yourself for smaller wounds. You can find out what you should pay attention to in the article Wound Care: Dressing Change
Wound and healing ointments
There are different ointments that can support wound healing. For example, some contain the active ingredient dexpanthenol. It promotes the renewal of the skin layer and provides moisture. You can read more about ointments for wound care and their correct application in the article Wound Care: Wound and Healing Ointment.
After wound care
After treating the wound, you should pay attention to a few points so as not to disrupt the healing process:
- After treating the wound, make sure that the wound is not soiled and does not come into contact with water. You can stick a special waterproof plaster on for showering.
- You must not use commercially available soaps for wound care.
- If your wound has been sutured, you should see your general practitioner or treating doctor after ten to twelve days to have the stitches pulled. If it is a wound on the face, you can have the sutures removed as early as the fourth to sixth day.
Wound care: maggot therapy
In the case of poorly healing wounds, doctors sometimes rely on the help of maggots: fly larvae are introduced into the wound. The maggots that hatch from it eat dead cells and can thus promote wound healing. You can read more about this form of therapy in the article Wound Care: Maggot Therapy.
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