THE CARE OF WOUNDS A GUIDE FOR NURSES PDF





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Ebook Content :
Chapter 1 The Physiology of Wound Healing 1
1.1 Introduction 1
1.2 Definitions associated with wounds 1
1.3 The structure of the skin 2
1.3.1 Dermis 2
1.3.2 Epidermis 2
1.4 Wound healing 3
1.4.1 Inflammation 4
1.4.2 Reconstruction 6
1.4.3 Epithelialisation 8
1.4.4 Maturation 9
1.5 Impaired wound healing 9
1.5.1 Hypertrophic scars 9
1.5.2 Keloids 10
1.5.3 Contractures 10
1.5.4 Acute to chronic wounds 10
1.6 Conclusion 11
Chapter 2 The Management of Patients with Wounds 13
2.1 Introduction 13
2.2 Physical care 13
2.2.1 Nutrition 13
2.2.2 Infection 19
2.2.3 Smoking 23
2.2.4 Diabetes mellitus 25
2.2.5 They physical effects of stress 26
2.2.6 Pain 27
2.2.7 Sleeping 30
2.2.8 Hypothermia 32
2.2.9 Steroids 33
2.2.10 Radiotherapy 34
2.3 Psychological care 35
2.3.1 Anxiety 35
2.3.2 Motivation and education 37
2.3.3 Body image 39
2.3.4 Other psychological problems 41
2.4 Spiritual care 43
Chapter 3 General Principles of Wound Management 56
3.1 Introduction 56
3.2 Wound assessment 56
3.2.1 Wound classification 56
3.2.2 The position of the wound 57
3.2.3 The environment of care 58
3.2.4 M = measure 58
3.2.5 E = exudate 61
3.2.6 A = appearance 62
3.2.7 S = suffering 69
3.2.8 U = undermining 70
3.2.9 R = re-evaluate 70
3.2.10 E = edge 71
3.3 Managing wounds 72
3.3.1 Moist wound healing 72
3.3.2 Wound bed preparation 72
3.3.3 Pain management 76
3.4 Documentation 77
3.5 Evaluating the dressing 78
Chapter 4 Wound Management Products 83
4.1 Introduction 83
4.2 The development of dressings through the ages 83
4.2.1 Early days 83
4.2.2 The Dark Ages and early Middle Ages 85
4.2.3 Late Middle Ages and Renaissance 86
4.2.4 The seventeenth, eighteenth and early nineteenth centuries 87
4.2.5 Mid-nineteenth and early twentieth century developments 88
4.2.6 The British Pharmaceutical Codices 89
4.3 Traditional techniques 90
4.4 The use of lotions 91
4.4.1 Antiseptics 91
4.4.2 Antibiotics 95
4.4.3 Honey 96
4.4.4 Saline 0.9% 97
4.4.5 Tap water 97
4.5 Clinical effectiveness of wound management products 97
4.5.1 Providing an effective environment 97
4.5.2 The handling qualities of an effective wound
management product 98
4.6 Modern wound management products 99
4.7 Advanced technologies 105
4.7.1 Growth factors 105
4.7.2 Protease-modulating wound management products 105
4.7.3 Hyaluronan-based products 106
4.7.4 Hyperbaric oxygen 107
iv The Care of Wounds
4.7.5 Topical negative pressure 108
4.7.6 Tissue culture 110
4.7.7 Tissue engineering 110
4.8 Alternative therapies and wound management 112
Chapter 5 The Management of Patients with Chronic Wounds 121
5.1 Introduction 121
5.2 The prevention and management of pressure ulcers 121
5.2.1 The cost of pressure ulcers 122
5.2.2 The aetiology of pressure ulcers 123
5.2.3 Prevention of pressure ulcers 128
5.2.4 Management of pressure ulcers 138
5.3 The management of leg ulcers 143
5.3.1 The epidemiology of leg ulcers 144
5.3.2 The cost of leg ulcers 144
5.3.3 The causes of leg ulcers 145
5.3.4 Venous ulceration 145
5.3.5 Arterial ulcers 152
5.3.6 Ulcers of mixed aetiology 155
5.3.7 Malignant leg ulcers 156
5.3.8 Leg ulceration in rheumatoid arthritis 157
5.4 Diabetic foot ulcers 158
5.4.1 Aetiology 158
5.4.2 Prevention 159
5.4.3 Management 160
5.5 Fungating wounds 162
5.5.1 Aetiology and incidence 163
5.5.2 Management of fungating wounds 163
5.6 Lymphoedema 165
5.6.1 Lymphoedema management 166
5.7 Conclusion 168
Chapter 6 The Management of Patients with Acute Wounds 179
6.1 Introduction 179
6.2 The care of surgical wounds 179
6.2.1 Management of surgical wounds 179
6.2.2 Managing complications 186
6.3 Traumatic wounds 194
6.3.1 Minor traumatic wounds 194
6.3.2 The management of specific types of traumatic wounds 196
6.4 The burn injury 199
6.4.1 Aetiology 200
6.4.2 Incidence 201
6.4.3 The severity of the injury 201
6.4.4 Burn oedema 203
6.4.5 First aid treatment of burns 203
6.4.6 The management of burn injuries 205
Contents v
6.5 Radiation reactions 209
6.5.1 Aetiology 210
6.5.2 The classification of radiation reactions 210
6.5.3 Preventive skin care 210
6.5.4 Managing radiation reactions 211
6.5.5 Care of the patient 212
Chapter 7 Clinically Effective Wound Care 218
7.1 Introduction 218
7.2 Evidence-based practice and clinical effectiveness 218
7.3 Searching and appraising the literature 218
7.3.1 Appraising the literature on wound care 221
7.4 Developing clinical guidelines 222
7.4.1 Guidelines in wound care 222
7.5 The clinical audit cycle 224
7.5.1 Auditing clinical practice 224
7.5.2 Dissemination of audit findings 225
7.6 Conclusions 225
Chapter 8 The Organisation of Wound Management 228
8.1 Introduction 228
8.1 Managing wounds in the community 228
8.2.1 Nurse prescribing 228
8.2.2 Community leg ulcer clinics 229
8.3 Nurse specialists in wound care 230
8.4 The management of pressure-redistributing equipment 232
8.4.1 Equipment stores 232
8.4.2 Total bed management 232
8.5 Wound-healing centres 233
8.6 Conclusions 234
Index 236

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