skin care
Wound Care
Patient was instructed on the optimization of wound environment. Adequate nutrition and hydration, remove nonviable tissue, maintain moisture balance, protect the wound and peri-wound skin, eliminate or minimize pain, cleanse, prevent and manage infection, control odor.
Patient was instructed on adequate nutrition and hydration to minimize wound development. Encourage protein, calorie-dense foods and fluids (unless contraindicated), monitor intake, weight and skin turgor, assess and address impairments in dentition and swallowing.
Patient was instructed on traumatic wounds. Contusions are caused by more extensive tissue trauma after severe blunt or blast trauma. The overlying skin may seem to be intact but later become non-viable. Extensive contusion may lead to infection.
Patient was instructed on factors that may contribute to chronic wounds is old age. The skin of older people is more easily damaged, and older cells do not proliferate as fast and may not have an adequate response to stress in terms of gene up regulation of stress related proteins. In older cells, stress response genes are over expressed when the cell is not stressed, but when it is, the expression of these proteins is not regulated by as much as in younger cells.
Instructed patient about some signs and symptoms of pressure ulcers, such as, skin tissue that feels firm or boggy, local redness, warmth, tenderness or swelling.
Instructed patient DO NOT massage the skin near or on the ulcer. This can cause more damage. DO NOT use donut-shaped or ring-shaped cushions. They reduce blood flow to the area, which may cause sores.
Instructed patient in position and reposition every hour to prevent skin breakdown.
Instructed in wound care as ordered by MD such as proper storage of dressing supplies, proper handwashing technique and removal of dressing, proper storage of dressing supplies, cleansing of wound as specifically ordered by MD, proper application of ointments, powders, solutions, etc, if ordered by MD, proper application of specific dressing change if ordered by MD, return demonstration of complete dressing change technique; more than one teaching may be needed.
Instructed in proper handwashing before and after wound care or touching wound site to prevent spread of infection.
Instructed in materials used in wound care. However, even with proper treatment, a wound infection may occur. Check the wound daily for signs of infection like increased drainage or bleeding from the wound that won’t stop with direct pressure, redness in or around the wound, foul odor or pus coming from the wound, increased swelling around the wound and ever above 101.0°F or shaking chills.