P. 1
8

8

Ratings: (0)|Views: 11|Likes:
Published by Riska Hermita
mata
mata

More info:

Published by: Riska Hermita on Dec 28, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

04/04/2015

pdf

text

original

 
 
WOUND CARE GUIDELINES
March 2008
 
BOLTON PRIMARY CARE NHS TRUST & BOLTON HOSPITALS NHS TRUST 
WOUND CARE GUIDELINES
 CONTENTS
A
 
INTRODUCTION.................................................................................................................................................2
 
B:1 PRESSURE ULCER CLASSIFICATION AND MANAGEMENT GUIDELINES............................................5
 
B:1 PRESSURE ULCER CLASSIFICATION AND MANAGEMENT GUIDELINES (
CONTINUED
).......................6
 
B:2 P
RESSURE
U
LCERS
: D
RESSING SELECTION
.............................................................................................................7
 
C: 1
 
LEG ULCERS: THE FACTS (AETIOLOGY).....................................................................................................8
 
C2
 
L
EG
U
LCERS
:
 
D
RESSING
S
ELECTION
.......................................................................................................................9
 
D:
 
DIABETIC FOOT ULCERS...............................................................................................................................10
 
E: W
OUND
I
 NFECTION
..................................................................................................................................................11
 
F: W
OUND
B
ED
P
REPARATION
& D
RESSING
S
ELECTION
..............................................................................................12
 
G: M
INOR
W
OUNDS
 – D
RESSING
S
ELECTION
..............................................................................................................13
 
H: CELLULITIS..........................................................................................................................................................14
 
I: WOUND COMPLICATIONS:...............................................................................................................................15
 
I:1 – O
VERGRANULATION
............................................................................................................................................15
 
I:2 - H
YPERTROPHIC
/ K 
ELOID SCARS
..........................................................................................................................15
 
I: 3 - F
UNGATING WOUNDS
...........................................................................................................................................16
 
J: WOUND CLASSIFICATION................................................................................................................................17
 
 
MECHANISMS OF WOUND HEALING.........................................................................................................18
 
L
 
WOUND ASSESSMENT...................................................................................................................................18
 
Wound Bed.....................................................................................................................................…...19 Wound Measurement............................................................................................................................19
 
 Exudate.................................................................................................................................................19
 
 Infection................................................................................................................................................20
 
Pain……………….................................................................................................................................20
 
Surrounding Skin..................................................................................................................................21
 
M
 
FACTORS DELAYING WOUND HEALING...................................................................................................21
 
 N
 
 NUTRITIONAL ASPECTS OF WOUND HEALING.......................................................................................23
 
O
 
WOUND MANAGEMENT................................................................................................................................26
 
i.
 
Wound Cleansing...................................................................................................................................26 
 
ii.
 
Choice of Dressings..............................................................................................................................27 
 
P:
 
F
ORMULARY OF
P
RODUCT
G
ROUPS
W
ITH
ECOMMENDATIONS FOR
U
SE
............................................................29
 
REFERENCES……………………………………………………………………………………………………….31
 
APPENDICES:............................................................................................................................................................35
 
1.
 
Clinical Evidence Grading Criteria......................................................................................................35
 
2.
 
Wound Care Assessment Tool...............................................................................................................35
 
1
 
Nurswc001Review Date: March 2010
 
 A INTRODUCTION
The wound care guidelines have been developed by clinicians who are treating patients with wounds. They reflect current research and evidence based expert opinion. The guidelines are intended for use as a resource for wound management and should be available to all medical,nursing and therapist caring for patients with wounds in Bolton Primary Care NHS Trust and Bolton Hospitals NHS Trust,Bolton Hospice and The Beaumont Hospital. Evidence based recommendations are included and a formulary of wound care products is included to promote rational  prescribing. These guidelines have been produced for use by any member of the healthcare team.They are not intended as a substitute for professional judgement but are in support of the practitioner making an informed decision relating to the management of the patient,in accordance with individual professional competence. The guidelines have been developed incorporating available evidence of best practice. Where evidence of best practice is not available, expert opinion has been sought and consensus agreement between the multi-professional team has been reached. Acknowledgement to the patients who are part of the leg ulcer service who gave valuable comments and advice on leg ulcer management. They will be reviewed annually and updated every two years. Comments from users of the guidelines are welcomed.
Authors:
Jacqui Ashton – Consultant Nurse – Tissue Viability  Nicky Morton – Tissue Viability Specialist Nurse Susan Beswick – Podiatrist – Bolton Hospitals NHS Trust Vivienne Barker – Tissue Viability Podiatrist – Bolton PCT Freda Blackburn – Sister – Beaumont Hospital Carolyn Wright – Dietetics Manager – Bolton Hospitals NHS Trust Lisa Turner – Pharmacist – Bolton Hospitals NHS Trust Kathryn Morton – Dietitian – Bolton PCT Andrea Jennings – District Nurse
2
 
Nurswc001Review Date: March 2010

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->