Question

1. You are a nurse in a medical–surgical unit in a hospital caring for a 27-year-old professional football player who underwent surgery to repair a compound fracture of his femur. The surgery went smoothly and you are responsible for his postoperative care after he returns from PACU. (Learning Objectives #1 & #2)

a. What is his skin’s role in preventing infection before surgery?

b. Describe how you would expect his wound to heal.

c. Indicate factors that could affect the healing of his surgical wound.

d. For which complications would you monitor his wound?

e. Outline signs and symptoms that might indicate his wound is infected. In what time frame might they appear?

Answer 1

a )

Skin is a part of the first line of defense in fighting infection. They help to protect us against invading pathogens. You have beneficial bacteria growing on your skin, in your bowel, and other places in the body (such as the mouth and the gut) that stop other harmful bacteria from taking over.

b )

He is a healthy person so I think his wounds will heal within a period of 2 to 4 weeks

Wound healing is a complex physiological process that is regulated by many different cell types, growth factors, cytokines, and chemokines. Most of all, it is the body's inherent way of responding to injury for survival. During the healing process, cells such as inflammatory cells, platelets, endothelial cells, fibroblasts, and keratinocytes undergo distinct preprogrammed changes in their gene expression and/or phenotype. In consequence, the wound environment progresses toward homeostasis through stages involving inflammation, new tissue formation, and, finally, tissue remodeling, that is, the classical phases of wound healing.3 The wound-healing program is an intricate interplay between several cell types involving various forms of intercellular signaling

c )  Factors that could affect wound healing include

• Desiccation. A moist environment allows wounds to heal faster and less painfully than a dry environment, in which cells typically dehydrate and die. This causes a scab or crust to form over the wound site, which impedes healing. If the wound is kept hydrated with a moisture-retentive dressing, epidermal cell migration is enhanced, encouraging epithelialization.

• Infection or abnormal bacterial presence. If an infection is present, as evidenced by purulent drainage or exudate, induration, erythema, or fever

• Maceration. Urinary and fecal incontinence can alter the skin's integrity. Proper skincare is essential for successful skin and wound management.

• Necrosis. Dead, devitalized (necrotic) tissue can delay healing. Slough and eschar are the 2 types of necrotic tissue that may appear in a wound. Slough is moist, loose, stringy necrotic tissue that is typically yellow. Eschar, which appears as dry, thick, leathery tissue, maybe black. In most cases, necrotic tissue must be removed before repair and healing can occur.

• Pressure. When the pressure at the wound site is excessive or sustained, the blood supply to the capillary network may be disrupted. This impedes blood flow to the surrounding tissue and delays healing.

• Trauma and edema. Wounds heal slowly-and may not heal at all-in an environment in which they are repeatedly traumatized or deprived of local blood supply by edema.

d )

Two common complications of surgical wounds are infections and wound dehiscence. As such, the following signs should be looked out for in the post-operative wound review: fever, hematoma, seroma, separation of wound edges, and purulent discharge from the wound.

e )

• Pus or drainage.
• Bad smell coming from the wound.
• Fever chills.
• Hot to touch.
• Redness.
• Pain or sore to touch.