Complex wound management: a case study

Mr. G.'s situation was challenging, because it did not readily conform to the management techniques currently available and required consideration of psychosocial and other physical factors. To meet individual patient needs, nurses must be creative in finding solutions to unusual problems. By focusing on the short-term goals for wound management and the goals for family-centered home care as a guide to interventions, adaptations were made to fit this patient's needs.     

Larval therapy in wound management: a review

Debridement is an essential component of wound care as the presence of devitalised tissue can impede the healing process. Larval therapy has been used for the debridement of wounds for several hundred years. A plethora of literature is available on larval therapy, but many authors acknowledge the paucity of large-scale clinical trials supporting its effectiveness. While the exact mechanism of larval therapy remains unknown, it encompasses three processes: debridement, disinfection and promotion of healing. This literature review discusses the applications, benefits and disadvantages of larval therapy as well as the processes involved. The literature reviewed suggests that further comprehensive research into the mechanisms involved in larval therapy is required to ensure that it may be used to best medical advantage.     

Sternal wound management: a case study. Nursing grand rounds

The complication of mediastinitis has important implications for nurses. This article describes the case of a man who developed a sternal wound infection following coronary artery bypass surgery. Nursing care is discussed and is summarized in care plans for the diagnoses Ineffective Breathing Pattern, Impaired Skin Integrity, and Ineffective Coping. Expert nursing care resulted in hospital discharge approximately two months after admission.     

A case study in evidence-based wound management

On the first of July 1998, Frank Dobson, the then Secretary of State for Health, revealed the consultation document 'A First Class Service' (Department of Health (DoH), 1998). This article describes a wound management case study which showed how a first class service was provided for a patient with very severe pressure ulcers and complex medical problems. A multiprofessional approach to her complex and challenging problems was maintained. Evidence-based guidelines for the prevention and management of pressure damage were followed, supported by modern researched-based wound management and pressure relief. In addition, risk management strategies were observed, and provided the basis for planning and evaluating her individualized care.     

The disease process of spinal cord injuries: a case study reflecting holistic nursing management.

There are more than 10,000 cases of traumatic spinal cord injuries each year in the United States. The systemic injuries, along with nursing care, will be presented in this article.     

Shave therapy for chronic venous ulcers: a guideline for surgical management and postoperative wound care.

This article presents a practice-oriented concept in the treatment of chronic venous ulcers with accompanying lipodermatosclerosis by shave therapy. Besides the indication for shave therapy, we focus on the operative technique and important therapy during postoperative convalescence time.     

Methods of wound debridement: a case study

Wound debridement is the process of removing foreign material and dead or damaged tissue from a wound. It can speed up the healing process and reduce the risk of infection. There are various methods and each has its advantages and disadvantages. This article presents a case study to discuss the value of debriding wounds and the various options available.     

基因和干细胞疗法修复慢性难愈创伤的研究与应用

背景：许多疾病和因素都会使伤口久治不愈或延迟愈合,基因疗法和干细胞疗法为慢性难愈创伤的治疗提供了新的技术途径。目的：针对基因疗法和干细胞疗法用于治疗慢性难愈创伤的研究作一综述。方法：以＂gene therapy,stem cell therapy和chronic wound＂为检索词,检索Medline数据库（1980/2010-12）,文献检索语种限制为英语。将近年发表的针对性强的文章纳入研究范围,同一领域的文献则选择近期发表或权威杂志的文章。排除与基因疗法和干细胞疗法相关性不强、陈旧的文献。结合自身的研究经验和纳入排除标准,对查阅到的最新研究成果详细分析并加以总结概括。结果与结论：初次检索到267篇文献,严格按照纳入标准,最终将33篇文献纳入研究。基因疗法和干细胞疗法都是新的治疗方法,其相关理论和技术已经成熟,为慢性难愈创伤的治疗提供了新的技术途径,它们的有效运用有望给慢性难愈创伤带来突破性的治疗效果。     

Eight 'Cs' of caring: a holistic framework for nursing terminally ill patients

This introductory paper describes how nurses can incorporate eight caring elements into nursing care for terminally ill patients. These caring elements can be described as: Compassion, Competence, Confidence, Conscience, Commitment, Courage, Culture and Communication. The Eight Cs of caring are comprised of Simone Roach's five Cs plus three further Cs. According to Roach (1993), who developed the Five Cs (Compassion, Competence, Confidence, Conscience and Commitment), knowledge, skills and experience make caring unique. Here, I extend Roach's work by proposing three further Cs (Courage, Culture and Communication). The paper takes as its framework the concept of holistic care, which encompasses physical, psychological, emotional, spiritual and cultural aspects. Examples are provided as to how the Eight Cs may be applied. Literature from various nursing scholars is included to support the discussion throughout.     

Managing and caring for a patient with a complicated wound

The patient discussed in this care study is a 91-year-old woman admitted to hospital from her own home. She presented with reduced mobility, constipation, increased confusion and reduced oral intake. Her history included small vessel disease and a stroke. On admissions she also had a number of grade two pressure ulcers on her buttocks. The surrounding skin appeared macerated and the patient complained of pain when the skin was cleaned after she was incontinent of both urine and faeces. It was expected that the wound would be fast healing, as it was superficial, but the healing rate proved otherwise. This article will focus on incontinence management as well as ways of aiding in healing a pressure ulcer where skin is macerated and the patient has many risk factors.     

Evidence-based case management in a high-risk pregnancy: a case study

This article examines the case management needs of a pregnant woman confined to bed after preterm premature rupture of membranes. Through the period when she is confined to bed, interventions and outcomes are determined on the basis of evidence-based guidelines. By examining this case study, it is anticipated that best practices can be determined for women in similar situations.     

Prontosan wound irrigation and gel: management of chronic wounds

Chronic wounds present a challenge that is costly in terms of quality of life to the patient and in financial terms for the NHS. Several factors contribute to the development of a chronic wound, in particular the influence of bacteria as a biofilm within the wound environment. Irrigating a wound with normal saline has long been advocated as the most appropriate method of wound irrigation but biofilms are now known to be resistant to this method of cleansing. A small (10 patient) evaluation of the use of Prontosan in patients whose duration of chronic wounds exceeded 1 year has demonstrated that Prontosan wound irrigation and Prontosan gel are an appropriate alternative for cleaning, moistening and decontaminating encrusted, contaminated and chronic skin wounds, and can have a dramatic influence of the quality of life for such patients. This article discusses the cause of chronicity within a wound and discusses in depth three of the ten patients in the evaluation.     

Stroke: holistic care and management

Stroke can have a devastating effect on a patient's life and that of his or her family. This article discusses the causes and effects of stroke and outlines the role of the nurse in the rehabilitation of a patient after stroke with reference to the National Clinical Guidelines for Stroke (RCP 2002).