For community clinical this week I went to the wound care clinic at TRMC.

I saw about

five patients with wounds that varied greatly in size, shape, and condition. One patient that I saw

had a very rectangular shaped abscess on his left leg that when undressed, had a foul odor. This

patient also had compartment syndrome around the wound site which was the first time I had

observed that syndrome. The worst wound that I saw came from an elderly patient with a stage

four pressure ulcer on her coccyx. The “entry point” of the wound was about the size of a fist

with undermining that allowed about a 12” by 6” foam to fit inside. I believe I may have been

able to the patients coccyx bone. Another patient had multiple sclerosis which greatly limited her

movement and confined her to an electric chair. Because she is not able to move much she had

multiple pressure ulcers on the bottom of her legs and buttocks with some tunneling. Her wounds

were packed with gauze coated in Santyl which helps break down and remove dead tissue. On

the other hand, the “best” wound that I saw was a patient with a small abscess on her left buttock

that had a lot of calace tissue and was nearly healed. Some of the wounds I saw were covered

with a foam called promogran prisma which promotes healing and inhibits bacterial growth.

Other than wounds I was shown the hyperbarics chambers and taught about them.

One objective that is relatable to this clinical is to apply educational theory, principles,

and strategies when teaching individuals and families. The elderly patient which had the worst

wound was brought to the hospital by two other younger ladies which seemed to be family. The

doctor educated the two family members about how an abscess like this would even form. She

explained that sitting or laying on a spot for too long can obstruct blood flow, and start to create

a pressure ulcer. She went on to explain that pressure ulcers start as an irritable, red discoloration

of the skin and progress to deep wounds. All of this information seemed to almost be new to the

two family members. Finally the doctor explained to turn and reposition the patient frequently to
avoid forming new pressure ulcers and to help the stage four one heal. The doctor also explained

why she was packing the wound the way she was, and why they suctioned the wound and how to

care for it.

Another objective that is relatable to this clinical is examining health related issues that

impact the individual client and their family. Wounds depending on the location and severity can

greatly impact people. For one patient that was cared for, he was told that he would have to stand

up while doing his arts and crafts rather than sit down. Some individuals were responsible for

wrapping their own leg while at home and applying prismas or other medicines. For family,

(especially with the stage four pressure ulcer) could be responsible for turning their family

member or caring for the wound at home. Wounds like these can affect activities of daily living,

if you cannot use a certain leg or if you can’t sit in one spot for too long.

I learned a lot this week at the wound clinic. I already understood pressure ulcers, but

what I did learn about them was how they might be treated once they reached the stages that they

did. I didn’t know that suctioning could be used to not only pull drainage out, but to decompress

the wound to promote faster healing. With a stage four pressure ulcer I wouldn’t even know

where to begin the healing process, but now I do. I also learned a lot about the hyperbarics

chambers that are sometimes used to promote wound healing. I learned about the procedure of

actually getting a patient into or out of the machines, and all the safety measures that must be put

into place. I learned that these chambers can be especially useful in healing radiation injuries,

infections, burns, skin grafts, and diabetes related injuries.