This essay will discuss nutrition and the effects it has on wound management, and what impact communication skills have on patient’s health. I will include some information about my experience of wound management, while working along side my mentor in a rehabilitation unit, for a patient who was admitted with multiple scleroses (M.S), the patient is wheel chair bound and had a pressure sore which developed into a sacral sinus wound (grade 4).
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In accordance with the Nursing and Midwifery Council (2008), Guidelines on Confidentiality, I will refer to the patient as Ben, who is 72 years old. Ben’s wound had caused extensive destruction of his tissues and damaged to his muscle and supporting structures. A swab was taken and reports confirmed that his wound had been infected with (Methicillin-resistant Staphylococcus aureus) MRSA. Flanagan(2000) states that age reduced mobility, malnutrition, incontinence, skin integrity, friction, moisture, and pain. It can lead to skin breakdown and wound developing.
Ben’s observation were taken regularly, he had a supra pubic catheter, which was monitored on regular basis to minimize the risk of infection, Ben’s bowel motion was also assessed; it was made sure that the wound would not be contaminated with overflow of bowel. His over all conditions were monitored every day but his dressing were not changed every day. The nurse, my mentor, was using a local wound assessment chart for managing his wound. The chart was used for the assessment of his wound and every time it was updated after changing the dressing. All changes and appearance of the wound were noted down in the chart. Progress in daily assessment and plan of care were noted down in the chart to carry out regular reassessment of his wound.
According to Eunis and Menesis (2000), the excess of exudates within the wound can also inhibit healing, control of exudates is therefore essential. This is usually achieved by selecting a dressing of the appropriate absorbency. The nurse selected an Aqua Cell Silver dressing to use for Ben’s wound, as his wound was infected with MRSA. (Methicillin Resistant Staphylococcus Aureus). British National Formulary (2006) says that “aqua cell silver is an appropriate dressing for infected wounds”.
Gunnewicht and Bun (2004) described that if the wound is clean, healthy, granulating and happy; it does not require cleaning because the wound exudate itself has beneficial bactericidal properties, which may be inappropriateely removed. The general strategy of my mentor, in the cleansing of Ben’s wound was based on providing minimal necessary intervention. She was using normal saline to clean the wound. Griffiths et al (2001) stated that the solution should be of a non- irritant and free of bacteria. Normal saline is the most commonly used wound cleaner, it is best to use the solution at body temperature.
We identified and addressed the nutritional needs of Ben. This was of a puree diet and the supervision of his meal times, to aid optimum recovery. A dietition was envolved in Ben’s nutritional needs. It is obvious that nutrition plays a crucial role in wound healing. All patients with wounds should have appropriate nutritional assessment. If a patient’s nutritional status is compromised, and they are unlikely to meet their requirements, recovery will be delayed. Boon (1998) said that “a good nutritional assessment involves the multidisciplinary approach including medical, nursing and dietretic staff”.
Ben was kept on a food chart which was updated everyday after each meal. The correct quantities of Ben’s intake were entered on the chart. If we examine the importance of nutrients, we would know that they have key roles in the healing process, such as, protein depletion can affect the rate of wound healing because it is required for the granulation of tissues, carbohydrates are also a part of healing process, cellular activity is fuelled by adenosine triphosphate (ATP), which is derived from glucose, providing the energy for the inflammatory response to occur. If carbohydrates are not sufficient, the body breaks down proteins to provide glucose for cellular activity. Therefore, carbohydrates are required as well as proteins. Ben was given fruit yougurt or pudding after every meal, mash potato and meat were the regular part of his diet along with some mashed vegitables. Fats and vitamins have a key role in cell membrane structure and function, certain fatty acids are essential as they cannot be synthesised in sufficient amounts, so must be provided by diet.
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Williams and leaper (2000) states that B complex vitamins are co-factors or co-enzymes in a number of matabolic functions involved in wound healing, particularly in the energy release from carbohydrates. The doctor had prescribed 30mg of zinc per day for six weeks, along with multivitaminal tablets. According to Grey and Cooper (2001) vitamin C has an important role in collagen synthesis in the formation of bonds between strands of collagen fibre, while vitamin K is involved in the formation of thrombin. Deficiency of vitamin K (in the presence of wound) can lead to haematoma. Vitamin A supports the proliferation of epithelial cells. Minerals like zinc, iron and copper play a vital role in wound healing. Zinc is required for protein synthesis and also has an inhibitory effect on bacterial growth; it is envolved in the immune response. Long term of zinc supplimentation must be accompained by
copper supplimantation to prevent zinc induced copper deficiency. The deficiency of copper and iron delay wound healing.Perkins (2000), defined that the ideal way to meet requirements of nutritional needs, is by consuming adequate intake of normal food.
My mentor and I were spending time with Ben, explaining and educating him about the process of his wound healing and the importance of medication, nursing interventions and nutrition. I felt that Ben needed support and care for his treatment. According to Quality and Safety in Health Care (2008) Communication looks easy when it is done well, it requires engagement, empathy, and ability to listen and respond, and it requires time.
To conclude: I feel that wound care requires multi skills and broad spectrum of knowledge because nurses are the first one to take responsibilities of wound care. Bens wound care management and assessment provided me with opportunities, which enabled me to improve my knowledge and understanding of wound care. I feel I have improved my confidence about the wound management.
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An important part of wound management is realising the potential dangers of wound infection. Wound infection and presence of pathogens in the skin and body are primarily responsible for delayed wound healing although host immune response and local environmental factors such as tissue necrosis, hypoxia and ischemia impair immune cell activity.
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