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Case Study
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The use of polymeric membrane dressings for managment of a full-thickness/tunneling, dehisced surgical abdominal wound Laura Barnes, RN, MSN, WOCN, CWCN, APN-CNS Clinical Problem: A 34-year-old woman Gravida 1 Para 2 Cesarean Section presents with a dehisced abdominal wound. The patient has a history of obesity and diet controlled diabetes mellitus. Patient complained of abdominal wound pain. Nutritional support included protein in diet, vitamin c and zinc supplements. The abdominal full thickness wound measured 13 cm x 2 cm with a depth 4 cm and 3Ð4 cm tunneling present at 10Ð2 o'clock with 20% yellow slough tissue present. There was 80% granulation tissue noted in the wound bed and no signs of infection. Moderate amount of serosanguineous drainage noted. A WOC nurse was consulted for wound care. Previous wound care treatments during hospitalization included wet to dry dressings which were found unsuccessful. .Current Clinical Approach: The new wound care treatment was changed to a variety of polymeric membrane dressings. The polymeric membrane dressing was used as a primary dressing and packed into the depth and tunneling of the wound bed. Also, another variety of polymeric membrane dressing with island was used as a secondary dressing to cover the wound. The patient's spouse performed wound care/dressing changes every other day. Home Health Care assisted with monitoring wound care and observation of wound healing. Polymeric membrane dressing consist of a wound cleanser F-68 that eliminated the need for wound bed cleansing during dressing changes, the dressing facilitated autolytic debridement, reduced dressing changes and reduced patient discomfort. .Patient Outcome: The wound healed within 12 weeks from initiation until closure. .Conclusion: The different variety of polymeric membrane dressings were used as a primary and secondary dressing until wound closure. These dressings offered all the benefits provided by any category of wound care. .Behavioral Objectives:.1) Identify polymeric membrane dressings for autolytic debridement..2) Discuss polymeric membrane dressings for managing all depths of wounds including deep wounds and tunneling wounds..3) Identify problematic issues of abdominal dehisced wounds..4) Discuss using polymeric membrane dressings as a primary and secondary dressing..5) Discuss polymeric membrane dressing used to provide an optimal healing environment. Kim YJ, Lee SW, Hong SH. The effects of polymem on the wound healing. J Korean Soc Plast Reconstr Surg. 1999;109:1165Ð1172 Krasner D, Kennedy KL, Rolstad BS, Roma Aw. The ABC's of wound care dressings. Ostomy Wound Manage. 1993;39(8):66Ð86 Lee SK. A doctor's perspective on moist wound healing. The Remington Report. 2001;9(3):66Ð70 Ovington LG. Hanging wet to dry dressings out to dry. Home Health Care Nurs. 2001;19(8):477Ð483 Evans E. Nutritional Assessment in Chronic Wound Care. WOCN. 2005;32(5):317Ð320. |
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