WOUND
E. SONJO
OBJECTIVES
• SPECIFIC OBJECTIVES
BY the end of the lesson students should be able
to:
Define a wound
Describe wound classification
Describe the types of wounds
Explain the reasons for wound dressing
Demonstrate skills in wound dressing
DEFINITION
• A wound is a break in the skin integrity
• It can be intentional or unintentional, open or
closed.
Groups of wounds
There are two groups
Intentional and unintentional
1. INTENTIONAL WOUND /SURGICAL
• It is planned
• The wound has clean edges
• There is controlled bleeding
• Follows aseptic procedure
UNINTENTIONAL
• The wound is unplanned
• It has jagged/raged edges
• Uncontrolled bleeding
• Unsterile e.g. Gunshot or stab wound, burns
Groups cont………………
OPEN WOUND
• There is a break in skin integrity
• May bleed with tissue damage
• Increased in infection risk
CLOSED WOUND
• There is no break in the skin integrity but soft
tissue present
• May have intentional injury and bleeeding
TYPES OF WOUNDS
1. INCISED WOUND
• It is an open wound where a clean cut is
made with sharp instrument e.g. A surgical
wound made by a surgeon
2. CONTUSED WOUND
It is a closed wound that occur as a result of a
blow from a blunt object
• It is characterised by considerable injury of
soft tissues, haemorrhage and swelling
3.LACERATED WOUND
It is an open wound with jagged ragged irregular
edges with torn tissues e.g. Injuries like cuts
from glass, barbed wire
• 4.PUNCTURED WOUND
It is a wound made when a sharp instrument
penetrates the skin and the underlying tissues
It can be intentional or unintentional. e.g.
gunshot
5. ABRASION WOUND
It is superficial open wound of the skin in which
the outer layers are scraped off through
friction.
WOUND DRESSING
• It is the process of cleaning and covering the
wound
REASONS FOR WOUND DRESSING
• To keep the wound clean
• To lessen the spread of microorganisms
• To hasten tissue healing
• To absorb or localise drainage of the wound
• To prevent mechanical injury to the wound
• To immobilise the wound so that further
trauma does not occur (supporting the injured
part)
• To maintain pressure so that excessive
bleeding is avoided.
TYPES OF WOUND DRESSING
1. OPEN DRESSING.
This is where a dressing is not applied.
The method is mainly used in burns
ADVATAGES
-Helps wound to dry
Does not provide conducive environment for
micro organisms to grow
• No irritation on the wound caused by friction
when removing dressing
• DISADVANTAGES
• Risk of mechanical injury to the wound
• The wound would be scaring to the patient
2. CLOSED WOUND DRESSING
• Helps to absorb drainage
• Protect wound from microorganism
• Prevents mechanical injury to the wound
• Covers unpleasant disfigurement excessive
bleeding is avoided
• Assist in approximating wound edges .i.e
Restrict motion that tends to disrupt the
approximation of wound edges
• To immobilize the wound so that further
trauma does not occur
• Provide psychological comfort to the patient
Purpose for changing a dressing
• Protect the wound from trauma and external
contamination
• Provide an opportunity to assess the wound
• To provide a dry environment for wound
healing
Assessment before wound dressing
• Assess the location of the wound and degree
of pain
• Assess the presence of infection e.g
temperature. This will determine the type of
dressing and the solution to use
• Assess the dressing for drainage –observe
bedding and linen for drainage
• Assess the ability to cooperate during wound
dressing e.g. children
• NOTE: any patients allergies
• Review the nurses and doctors notes for
prescribed aseptic solutions for cleaning
REQUIREMENT EQUIPMENT
• TROLLEY WITH
• (a) Top shelf
-sterile dressing packs
i. Dressing forceps cotton and gauze swabs
ii. Towels
iii. Two pairs of dissecting forceps
iv. Kidney dish
v. Hand towel sterile gloves sterile cheattle forceps
vi. gallipot
• BOTTOM SHELF
• non sterile articles on a tray e.g bandage
• Pair of scissors
• Adhesive tape
• Bandages and topical drugs if required
• Antiseptic solutions as ordered
• Kidney dish for contaminated instruments
• Receiver for used towels
• disposable gloves
• Receiver for used swabs
NOTE :additional equipment
-drum with extra sterile swabs and gauze
-mackintosh
- Stitch removal pack
- Sterile dressing pack with sterile pins for
shortening the drain
• Sterile clip remover
PROCEDURE
PREPARATION
Wash dressing trolley with soap and water
Disinfect the top shelf
Place the sterile dressing pack/ stitch removal
pack on top
• Set the bottom shelf with equipment
• Wheel the trolley to the bed side
METHOD
1. Explain the procedure to the patient to gain
cooperation and consent
2. Screen the bed and close nearby window for privacy
3. Assist patient to lie in the most appropriate and
comfortable position considering the site of the
wound and the patient’s condition
For easy access and promotion of comfort
4.Expose the area to be dressed. For privacy and
dignity
5.Wash hands with soap and running water for
10-30 seconds and dry them, then put on
gloves to prevent cross infection
6.Lossen and remove outer dressing and discard
in the pedal bin in redness for dressing and
infection prevention
Cont…………………
7. Scrub hands vigorously with soap and water
for at least five minutes
8.Pick sterile towel and dry hands/ air dry
9.Put on sterile gloves
10.Ask assistant to open sterile pack and expose
sterile contents with cheattle forceps
11.Arrange the sterile equipment appropriately
12.Pour antiseptic solution into the galipot
13.Remove inner dressing using sterile dissecting
forceps and drop in the pedal bin
14. Discard the forceps into the kidney dish on the
bottom shelf
15.Place sterile towel appropriately around area
to be dressed.
16.Use dressing forceps and swabs dipped in an
antiseptic solution to clean the wound
17.Swab wound from inside out using each swab
only one stroke and discard . If infected clean
from clean to dirty area
18.Repeat until wound is clean
19.Remove any loose dead tissue
20.Dry wound with gauze swabs
21. Apply sterile dressing with forceps
22.Discard the forceps into kidney dish on bottom
shelf
23.Secure dressing with strapping
24. Leave patient comfortably
NOTE:
Squeeze any pus from wound
If the drain is present, clean it after the incision
Remove or shorten drain after cleaning drain
site
Dress patients with clean wounds first
• AFTER PROCEDURE
Remove the screens and open windows
Decontaminate, remove and discard gloves and
wash hands.
Wheel trolley to the treatment room
Put on surgically clean gloves
Decontaminate instruments, wash in soapy
water, rinse and dry
• Clean the trolley, disinfect it and keep in its
place
• Take towels to dirty linen container
• Decontaminate gloved hands, remove gloves
and wash hands
END OF PRESENTATION
