Types of Wounds

When you consider the manner in which the skin or tissue is broken, there are six general kinds of
wounds:   abrasions,   incisions,   lacerations, punctures,   avulsions,   and   amputations.   Many wounds,
of  course,  are  combinations  of  two  or more  of  these  basic  types.

ABRASIONS.–

Abrasions  are  made  when  the skin  is  rubbed  or  scraped  off.  Rope  burns,  floor burns, and skinned
knees or elbows are common examples  of  abrasions.  This  kind  of  wound  can become  infected  quite
easily  because  dirt  and germs are usually embedded in the tissues.

INCISIONS.–

Incisions,  commonly  called CUTS,  are  wounds  made  by  sharp  cutting  instruments  such  as  knives,
razors,  and  broken glass. Incisions tend to bleed freely because the blood vessels are cut cleanly and
without ragged edges. There is little damage to the surrounding tissues. Of all classes of wounds,
incisions are the least likely to become infected, since the free flow of blood washes out many of the
microorganisms (germs) that cause  infection.

LACERATIONS.–

These wounds are torn, rather than cut. They have ragged, irregular edges and masses of torn issue
underneath.  These wounds are usually made by blunt, rather than sharp, objects.  A wound made by a
dull knife, for instance, is more likely to be a laceration than an incision. Bomb fragments often cause
laceration.  Many  of  the  wounds  caused  by  accidents with  machinery  are  lacerations;  they  are
often complicated  by  crushing  of  the  tissues  as  well. Lacerations are frequently contaminated with
dirt, grease, or other material that is ground into the tissue; they are therefore very likely  to  become
infected.

PUNCTURES.–

Punctures are caused by objects that penetrate into the tissues while leaving a small surface opening.
Wounds made by nails, needles, wire, and bullets are usually punctures. As  a  rule,  small  puncture
wounds  do  not  bleed freely;  however,  large  puncture  wounds  may  cause severe internal bleeding.
The possibility of infection is great in all puncture wounds, especially if the penetrating object has
tetanus bacteria on it. To prevent anaerobic infections, primary closures are not made  in  the  case  of
puncture  wounds.

AVULSIONS.–

  An avulsion is the tearing away of tissue from a body part. Bleeding is usually heavy. In certain
situations, the torn tissue may be surgically reattached. It can be saved for medical  evaluation  by
wrapping  it  in  a  sterile dressing  and  placing  it  in  a  cool  container,  and rushing  it,  along  with  the
victim,  to  a  medical facility.  Do  not  allow  the  avulsed  portion  to  freeze and  do  not  immerse  it  in
water  or  saline.

AMPUTATIONS.–  

A  traumatic  amputation is  the  nonsurgical  removal  of  the  limb  from  the body. Bleeding is heavy
and requires a tourniquet, which will be discussed later, to stop the flow. Shock is certain to develop in
these cases. As with avulsed  tissue,  wrap  the  limb  in  sterile  dressings, place  it  in  a  cool  container,
and  transport  it  to the hospital with the victim. Do not allow the limb to  be  in  direct  contact  with
ice,  and  do  not  immerse  it  in  water  or  saline.  The limb can often be successfully reattached.
Acute Appendicitis: Introduction
Acute appendicitis is a rapidly progressing inflammation of a small part of the large
intestine called the appendix. Acute appendicitis is a medical emergency that generally
requires prompt removal of the appendix to prevent life-threatening complications, such
as ruptured appendix and peritonitis.

Acute appendicitis can occur when a piece of food, stool or object becomes trapped in
the appendix. Acute appendicitis can also happen after a gastrointestinal infection.
A tumor may also cause acute appendicitis in rare cases. Sometimes the cause of
acute appendicitis isn't known.
Any of these conditions result in the abnormal growth of bacteria, swelling and
inflammation of the appendix. The appendix then fills with pus, resulting in the typical
symptoms of acute appendicitis. Symptoms of acute appendicitis include abdominal
pain in the right lower area of the abdomen, fever, nausea, vomiting and loss of
appetite. However, not all people with acute appendicitis will experience typical
symptoms. Acute appendicitis can also lead to serious complications, especially if left
untreated. For more details on symptoms and complications, refer to symptoms of acute
appendicitis.
Acute appendicitis is a very common condition and a frequent cause of emergency
surgery. Acute appendicitis can occur in any age group or population. However, it most
often occurs in teens and young adults. It is rare in children under two years of age.
Making a diagnosis of acute appendicitis begins with taking a
thorough medical history, including symptoms, and completing a physical examination.
Examination of the abdomen frequently reveals severe pain and tenderness in the right
lower area of the abdomen. This area is where the appendix is located and is
called McBurney's point.
Diagnostic testing includes a blood test called a complete blood count with
differential (CBC). A CBC can determine if there is a rise in the number of certain types
of white blood cells, which indicates that an inflammatory and/or infectious process,
such as acute appendicitis, is occurring in the body.
More specific diagnostic imaging tests may include an abdominal ultrasound and/or
abdominal CT scan, which may reveal the inflamed appendix. These imaging tests are
not always conclusive, and in some cases, a surgery called a diagnostic laparoscopy
may be needed to look inside the abdomen and make the diagnosis. Other tests, such
as urinalysis, are also done to rule out other common diseases and conditions that have
similar symptoms, such as a kidney stone.
OBJECTIVES:
After 8 hours of duty at NMMC, surgical ward. I will be able to:

 Join the pre and post conference.

 Join the endorsement of the patient.
 Check vital signs in the right time.
 Do bedside care.
 Perform procedure to my patient.
 Administer medicine.
 Formulate nurse’s notes.
 Compute the I and O of my patient.

GOALS:
After 16 hours of duty at NMMC, surgical ward. I will be able to:

 Perform appropriate procedure to my patient.

 Do effective bedside care to my patient.
 Successfully administer medication to my patient with the ten rights of my patient.
 Educate my patient and give some health teachings regarding to his condition.
 Do my independent intervention to my patient.
 Evaluate my patient if my intervention is effective or not.
 Pass all my requirements.
DAILY PLAN OF ACTIVITIES:

 2:30 – join the pre-conference and endorsement of

patients.
 3:00 – check vital signs of my patient and regulate IV.
 3:30 – check any medication of my patient that will be
administered at 4 o’clock and ready the medication.
 4:00 – administer medication if there is medication for 4
pm.
 4:30 – do bedside care and do some health teachings to
my patient.
 5:00 – regulate IV fluid and check vital signs if needed or
check I and O of the patient.
 5:30 – formulate sample nurses notes.
 6:00 – ready medication if there is medicine to be
administered at six pm.
 6:30 – do bedside care.
 7:00 – check vital signs, finalize nurses notes, regulate
IV fluid, check the I and O of the patient.
 7:30 – check for any medication to be administered at 8
pm.
 8:00 – administer medication at 8 pm.
 8:30 – plot all the vital signs, do nurses notes, record the
I and O of the patient.
 9-11 pm – always stay at patient’s side to have a
continuous care.