Every nurse is sure to encounter caring for a patient with a wound – whether a surgical wound or an open wound from some type of injury.
Wounds are classified as either open (involving a break in the skin) or closed (involving internal damage to body tissue).
There are 5 different types of open wounds, classified according to their cause:
1. Abrasion – occurs when skin rubs or scrapes a rough or hard surface, such as in road rash – not usually a lot of bleeding, but it needs to be scrubbed & cleaned to avoid infection.
2. Incision – a cut made by a clean, sharp instrument, such as a knife or razor blade in surgery, or a glass splinter. A deep incision can damage tendons, ligaments, & muscles and will bleed a 3. lot & quickly.
4. Laceration – an irregular deep cut or tearing of the skin caused by blunt trauma, such as an accident with tools or machinery – the bleeding is rapid & extensive.
5. Puncture – a small hole caused by a long, pointy object, such as a nail, needle, or bullet – it may not bleed much but can be deep enough to damage internal organs.
6. Avulsion – a partial or complete tearing away of skin & tissue – these usually occur during violent accidents & bleed heavily & rapidly.
The main complication of an open wound is the risk of infection. Risks for infection are increased by certain conditions, including:
– Chronic illnesses, such as diabetes, cancer, kidney, or lung diseases
– Weakened immune system
– Certain medications, such as steroids or chemotherapy
– Elderly patients
– Wound caused by a dirty or contaminated object
– Foreign objects stuck in the wound
– Wound caused by a human or animal bite
– Large, deep wounds or one with jagged edges
– Emergency surgery, abdominal surgery, or surgery lasting more than 2 hrs
– Poor wound care hygiene
Signs & symptoms of infection in a wound include:
– Redness & swelling – should diminish over time during the initial phases of wound healing – If it does not decrease, and red streaks are seen in the skin around the wound or progressing away from wound, an infection is likely present.
– Throbbing pain or tenderness in wound area – pain should gradually subside as the body heals – a sudden or increased pain may be a sign of infection.
– Area may be warm or hot to the touch.
– Purulent discharge (pus) collected beneath the skin or draining from the wound – a small amount of clear or slightly yellow-colored fluid can be expected from a surgical wound, but if the fluid is cloudy, green, or foul smelling, this indicates an infection.
– Dizziness or a fast heartbeat.
– Generalized chills or malaise.
– Fever over 100.4F >4 hours – signs of a localized systemic infection.
– Leukocytosis (elevated WBC)
Complications from a wound infection:
– Cellulitis, an infection of the skin is caused by bacteria entering the body via the wound & spreading to deeper tissues beneath the skin.
– Tetanus, or lockjaw, is an infection with the bacterium Clostridium tetani, which produces toxins that interfere with muscle contractions, causing severe muscle spasms.
– Necrotizing subcutaneous infection (necrotizing fasciitis) is a severe infection that causes necrosis of the innermost layer of skin and can lead to gangrene, the death of tissue caused by critically insufficient blood supply.
– Gas gangrene, a type of wet (infected) gangrene caused by the bacteria Clostridium, produces gas within tissues. It spreads to healthy tissue quickly and can cause necrosis, sepsis, toxemia, and shock.
Prevention of wound infections:
– Teach the surgical patient to stop smoking 4-6 weeks before surgery. If they cannot quit, there is absolutely no smoking for 12 hours before surgery.
– The patient should shower before the operation, using antiseptic soap recommended by the doctor and avoid shaving the skin area where the operation will occur.
– Following surgery, the patient should avoid touching the incision site & clean it according to their doctor’s instructions.
– Educate on the importance of handwashing for the patient, visitors, and all caregivers.
– Encourage high-energy nutrition & pain relief
Wound infections can be treated in the following ways:
– Wound cleaning with soap and water will wash away bacteria.
– Incision & drainage of the infected wound will release pus or pressure built up under the skin – some wounds require insertion of a drainage tube to drain body fluid that may accumulate and become a source of infection.
– Debridement involves the removal of necrotic tissue to promote wound healing – otherwise, dead skin inhibits the development of healthy new tissue & makes the area more susceptible to infection.
– Wet or dry dressings may be used for debridement of a wound and to reduce opportunities for bacteria to enter wounds or spread to another wound.
– Antibiotics help fight wound infections caused by bacteria.