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Please answer all questions in the 3 case studies and general questions. Case study Case Study Scenario 1 – Burn Injury: Carol Mitchell, aged 64 was admitted to the burns unit after sustaining burns to the front and back of her left lower leg and foot. Carol had been cooking in her kitchen, when she accidently knocked a saucepan full of hot oil over herself. Carol’s husband drove her to the nearest medical centre where Carol’s burn was treated and then she was transported by ambulance to the hospital for further assessment. 15595171 / Bork / shutterstock.com In the emergency room, Carol was conscious and in evident distress. Her admission notes were: areas of variable depth of injury over her posterior lower leg and foot only; dark pink discoloration with sluggish capillary refill, blistering is evident; an area on her inner left ankle has an area of blotchy red/white with sluggish to absent capillary refill, patient is complaining of pain on her lower leg, but states that her ankle is somewhat pain free. After consultation with the Burns team, the burns are to be surgically debrided and a small skin graft will be applied to her inner ankle injury. Case Study 1 – Short answer questions: word count and referencing stated where required Read each question carefully and ensure you answer each part. 1. The wound healing process commences when any damage to the skin has occurred. Once the skin is impaired and a wound is created the healing process begins. This is a dynamic and complex process. It consists of four stages Match the stage with the physiological and biochemical processes haemostasis – stage 1 inflammation phase – stage 2 proliferation or reconstruction phase – stage 3 maturation phase – stage 4 Stage Physiological and Biochemical Processes During this phase tissue is temporarily replaced and the area is cleaned up by macrophages which digest the dead bacteria and debris. New blood capillaries are developed and granulation tissue (mainly collagen) is laid down. As granulation tissue continues to be laid the epithelium thickens to 4 to 5 layers forming the epidermis. The wound contracts and becomes smaller. This stage can take from 2 to 24 days Process of the wound being closed by clotting. Starts when blood leaks out of the body. The first step is when blood vessels constrict to restrict the blood flow. Next, platelets stick together in order to seal the break in the wall of the blood vessel. Finally, coagulation occurs and reinforces the platelet plug with threads of fibrin which are like a molecular binding agent, this stage happens very quickly Vasodilation of surrounding tissues occurs due to the release of histamine and other vasoactive chemicals. This increases blood flow to the surrounding areas which leads erythema, swelling, heat and pain. White blood cells descend into the area as a defense response. This phase lasts approximately three days The wound and surrounding tissue is gradually remodeled and the collagen cells laid down are strengthened. This stage can last from 24 days to approximately one year. During this stage the wound is still at risk and should be protected. 2a. Skin Assessment – outline the steps of the skin assessment for Carol’s burn that would be carried out immediately on admission to the emergency department. 2b. Part of the assessment (here is a clue for the above question) is burn size. Using the burn chart (below), tick the correct estimate of the size of Carol’s burn using the information in the scenario Burn percentage 20% approx. Burn percentage 9% approx. Burn percentage 27% approx. Burn percentage 0.7% approx. 224297740 / stihii / shutterstock.com 2c. When a patient suffers a burn injury it is important to classify the wound. Provide a description for each of the classifications in the table below. Classification Description Superficial Partial thickness Full thickness State which one would most likely apply to Carol’s area of her burn around her inner left ankle and give a rationale for your choice 2d. When undertaking a wound assessment, the main purpose is to optimise the healing process and to produce a baseline status against which the healing process can be measured Outline four (4) aspects you may consider when conducting a holistic wound assessment. Provide a reason for each of your choices. 3a. As stated in the case study, Carol is complaining of pain Which of the following strategies may be utilised to provide comfort to Carol? (There is more than one) Provide pain relief Provide distraction therapy Elevate Carol’s foot above heart level Ensure bed comfort Assess stress / anxiety levels and look at reducing these Inform Carol that pain is a normal aspect of a burn and there is not much that can be done to reduce all pain 3b. Describe an appropriate pain assessment tool and then explain why it is important to reduce pain levels in patient with wounds? 4. It was noted in the case study for Carol that she required “surgical debridement” to her burns Explain what surgical wound debridement is and why is it done? 5. Describe how the skin heals with the assistance of a skin graft. 6. When assessing a patient’s wound discuss 2 common problems / complications you may encounter Case study Case Study Scenario 2 – Pressure Ulcer: John James is an 82-year-old male who has been a resident in the high care ward of a local aged care facility for the past 2 years. His mobility has been decreasing since admission and he now requires 2 hourly turns when in bed and is reliant on a hoist and wheelchair. John is incontinent of both urine and faeces and has a poor dietary intake. John’s skin is paper thin and the pressure ulcer on his sacrum, below has increased in diameter by 2cms over the last 2 weeks. John was recently transferred into your hospital ward with chronic bronchitis. 417970330 / Elena Kitch / shutterstock.com Case Study 2 – Short answer questions: word count and referencing stated where required Read each question carefully and ensure you answer each part. 1a. You have been asked to attend to the dressing of John’s wound. What would be a suitable dressing to use on John’s wound? 1b. Explain the goal of this treatment as per Q1a – what are you trying to achieve by maintaining a moist wound environment 1c. Explain whether John required a primary or secondary dressing, or both, and provide a rationale for your choice 2a. Most infections agents are micro-organisms, these include: – (choose one answer) Bacteria, viruses, Soil, protozoa and prions Bacteria, Candida, fungi, protozoa and prions Bacteria, viruses, fungi, protozoa and prions Bacteria, viruses, fungi, protozoa and dust 2b. Match the common fungal infections with their major reservoir Common fungal infection: Candida albicans, Aspergillus organisms Common fungal infection Major reservoir Soil, dust, mouth, skin, colon, genital tract Mouth, skin, colon, genital tract 2c. Match the common viral infections with their major reservoir Common viral infections Viral infection, Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus (HIV), Herpes simplex virus (type I) Common viral infection Major reservoir Reservoir Faeces Blood and body fluids Blood Blood, semen, vaginal secretions (also isolated in saliva, tears, urine and breast milk, but not proved to be sources of transmission) Lesions of mouth or skin, saliva, genitalia plus herpes zoster (shingles) or viral warts or herpangina (oral ulcers) 2d. On the picture below, place an X on each of the areas that pressure sores can develop (if your computer doesn’t allow you to do this, you may write the answers underneath). 132726884 / Anna Rassadnikova / shutterstock.com Discuss 4 pressure relieving devices that may be used for John either in hospital or when he goes back to the aged care facility (Word Count Range: 25 – 50 words, reference) Pressure relieving devices 3. Match the Ulcer type with their specific characteristic Ulcer type: Venous ulcers, Diabetic ulcers, Arterial ulcers, Pressure ulcer: Ulcer type Characteristic Caused by ischemia; related to the presence of arterial occlusive disease; symptoms include pain and tissue loss Local losses of epidermis and various levels of dermis and subcutaneous tissue, occurring over or near the malleoli at the distal lower extremities; caused by edema and other sequalae of impaired venous return. : Caused by trauma or pressure secondary to neuropathy or vascular disease related to diabetes mellitus. Caused by pressure which destroys soft tissue 4. As John is quite elderly and his mobility has decreased, outline 3 risk assessments you can do, and using your research state 2 common risk assessment tools used in Australia 5. There are four stages of pressure ulcer formation and each stage has its noted characteristics. Match the stage with the presentation. Stage: Stage 1, stage 2, stage 3, stage 4. Stage Presentation pressure injuries present as shiny or dry shallow ulcers without any bruising present Pressure injuries are the most severe and represent full-thickness tissue loss with exposed bone, tendon or muscle pressure injuries present as areas of persistent, non-blanch able redness when compared with the surrounding skin Pressure injuries represent full-thickness skin loss. Subcutaneous fat may be visible, but bone, tendons or muscle are not exposed. Give a rationale to support which stage you think John’s pressure ulcer is at 6. When the nurse is assessing Johns wound, he/she documents what it looks like using a variety of methods. Choose from the following words and fill in the blanks with words that match them to the sentences. Probe, marking pen, wound tracing, a ruler, written consent, transparent acetate grid, clinical wound photography, wound measurement. ………………………………. provides the most accurate and objective means of assessment and evaluation of wound treatments. ………………………………. can be used to provide an accurate measurement of the length and width of a wound Assessment of the depth or length of a wound can be performed using a ……………………………………………………………………………………………………………….. Using a two-dimensional method, such as by tracing the margins of the wound, can be assessed using a ……………………………………………. and ……………………………………………………….. It is essential that ………………………………………………. is obtained from the patient/relative or carer prior to taking photographs 7. Johns doctor has ordered a Doppler ultrasound, explain what this means and how it is performed? 8. Identify and discuss 2 effects on wound healing in regards to complex and challenging wounds Factor Effect on wound healing 9. Many factors affect the wound-healing process. Therefore, wound management strategies must be tailored to meet the individual holistic needs of the patient, their wound and their environment. Tick the sentence that best outlines the principles of wound management Assess and correct cause of tissue damage Assess wound history and characteristics Ensure adequate tissue perfusion Wound-bed preparation Wound cleansing Wound-cleansing solutions and techniques All of the above Case study

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