Essay Example on Elderly Wound Care: Diagnosis Is Key for Healing

Introduction

As an individual age, the likelihood of getting wound infections and the progression of an acute wound into a chronic wound is usually high. This is due to several confounding factors that come into play as the individual ages. Among these factors, or probably notable, is the decreased immunity in the individual. As such, elderly individuals are more probable victims to delayed wound healing and complicated wound infections.

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As such, the diagnosis of wounds in elders is paramount for a nurse since the healing process and management of the wound entirely depends on the diagnosis. Over the past years, the diagnostic methods have evolved considerably, embracing the constantly changing microbes and also to keep pace with the fast-changing technology. Hence the following methods and criteria are the most common.

Swabs

This is undoubtedly the most common practice. The wound material collected by the swab is then taken for culture (Gardner et al., 2016).

Biopsies

In this case, a portion of the wound is derived and taken for lab investigations. The method is more quantitative than swabs, but recent research indicates that biopsies reduce the rate of the wound healing process.

Fine Needle Aspirates

This is probably the most recent and innovative method. In this case, a Needle is used to take the Aspirate from the wound. The method has minimal effect on the condition and the wound healing process (Yazdanpanah, Nasiri, & Adarvishi, 2017). The above diagnostic methods are mainly laboratory-based. Nonetheless, an inspection of the wound can yet be an important tool in wound diagnosis (Symbas, DiOrio, Tyras, Ware, & Hatcher, 2013). The following Markers can be looked out for.

Skin Color

ii) Wound Size. This includes the length and width of the wound

iii) Edges of the wound. Bulging edges indicate a chronic wound.

The Difference between Colonization and Infection

Colonization and infection are two important aspects that should be understood for appropriate wound care by nurses. In both, there is preens of proliferating bacteria but what differs is the host defense reaction and the effects to the healing process. In colonization, there are preens of bacteria but no host response. Colonization has been shown to have no effects on the wound healing process. On the other side, infection, there are bacteria with a host response also coming into play. Unlike colonization, infection impedes the wound healing process (Olaechea et al., 2014).

Diabetic Foot Ulcer

Older adults are more prone to developing diabetes than the younger generation. As such, they, therefore, become regular victims of diabetic foot ulcers. Diabetic Foot ulcer affects approximately 16 Percent of Diabetic patients with a bigger portion of being elderly individuals. The ulcer is usually open and most often than not located at the sole-bottom of the foot. This increases the risk of infection. At times, the ulcer might be painless due to the individual developing peripheral neuropathy due to the high blood sugar levels which damages peripheral nerves. This makes it hard to treat the ulcer since the patient will notice it when the situation has detreated, and infection has already set in. The wound can be Ischemic or Neuropathic (Hilton et al., 2014). Neuropathic is usually warm with no change in skin color, while Ischemic is cold with altered skin color. Alternatively, cues that can be used for early detection include drainage in socks, redness over the wound, swelling, and occasionally an odor. In some cases, there may be exposed portions of a tendon and eroded edges of the wound (Young, Breddy, Veves, & Boulton, 2014).

Management of Diabetic Foot Ulcer

The management of a diabetic foot is a dynamic procedure that puts into consideration the vascular and neurologic status of the patient and also the wound itself. Neurologic status can be tested by identifying whether the patient is neuropathic or not (Yazdanpannah,2015). The vascular state of the wound is important since it determines the healing rate. Vascularity can be assessed by taking pulses on different sites of the foot and noting the disparities. A measure of capillary filling, which can be done on the big toe, is also essential in assessing for vascularity of the foot (Steed, Donohoe, Webster, & Lindsley, 2016).

Treatment Objectives

• Reduce bacterial load
• Reduce and manage exudates
• Reduce odor

Treatment Approaches

Debridement

This involves the removal of necrotic tissue from the wound. Foreign bodies in the wound can also be removed during the process of debridement. Debridement helps to reduce the risk of infection to the wound and also reduces pressure on the wound (Harper, Young, & Merriman, 2012).

Antibiotic Therapy

This aims at eliminating the causing bacteria. Methicillin-resistant staphylococcal aureus is a common occurrence and hence appropriate and more potent antibiotic such as Ceftaroline (Armstrong, Lavery, & Diabetic Foot Study Consortium, 2015).

Total Contact Casting

This is a type of cast specially designed to reduce the pressure applied on foot. A reduction in foot pressure plays a significant role in speeding up the healing process. (Brem & Tomic-Canic, 2016).

Negative Pressure Wound Therapy

In this case, by creating negative pressure, the equipment is able to remove tissue debris and excess fluids from the wound (Frykberg, 2012).

Mode of Dressing

The dressing should be able to absorb the exudates, fluid from the wound (Dumville, Soares, O'meara, & Cullum, 2012). Foam and alginate dressings are suitable in this case. The dressing should not be too tight so as to allow for aeration of the wound. Frequent changing of the dressing is required for assessment of the progress of the wound. Silver containing dressings are highly encouraged since they contain compounds that help speed up the healing process.

Contributing Factors to Diabetic Foot Ulcer

Poor Circulation

High friction and pressure on the affected area

Patients who are alcoholics have a higher risk (Nelson et al., 2016).

iv) Cigarette smoking

v)Peripheral Vascular Disease

vi)Old Age

vii) History of recent foot amputations and ulceration (Eriksson, 2012).

Prevention

Advice patient to practice good hyperglycemic control. High blood sugar levels alleviate the condition(Ledoux,2015)

If the patient is a smoker, advice on cessation of the same. Smoking increases the risk of developing diabetic foot ulcers (Beaudry, 2016).

The patient can also adopt the use of diabetic socks (Wiersema, Vilmann, Giovannini, Chang, & Wiersema,, 2015).

Regular inspection of the foot (Dumville, Deshpande, O'Meara, & Speak, 2013).

It is avoiding strenuous activities that apply exceeding pressure on the foot (Rickard et al., 2014).

References

Armstrong, D. G., Lavery, L. A., & Diabetic Foot Study Consortium. (2015). Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomized controlled trial. The Lancet, 366(9498), 1704-1710.

Beaudry, S. A. (2016). U.S. Patent No. 7,008,392. Washington, DC: U.S. Patent and Trademark Office.

Brem, H., & Tomic-Canic, M. (2007). Cellular and molecular basis of wound healing in diabetes. The Journal of Clinical Investigation, 117(5), 1219-1222.

Dumville, J. C., Soares, M. O., O'meara, S., & Cullum, N. (2012). A systematic review and mixed treatment comparison: dressings to heal diabetic foot ulcers. Diabetologia, 55(7), 1902-1910.

Dumville, J. C., Deshpande, S., O'Meara, S., & Speak, K. (2013). Hydrocolloid dressings for healing diabetic foot ulcers. Cochrane Database of Systematic Reviews, (8).

Eriksson, E. (2012). U.S. Patent No. 5,152,757. Washington, DC: U.S. Patent and Trademark Office.

Frykberg, R. G. (2012). Diabetic foot ulcers: pathogenesis and management. American family physician, 66(9), 1655-1662.

Gardner, S. E., Frantz, R. A., Saltzman, C. L., Hillis, S. L., Park, H., & Scherubel, M. (2016). Diagnostic validity of three swab techniques for identifying chronic wound infection. Wound Repair and Regeneration, 14(5), 548-557.

Harper, P., Young, L., & Merriman, E. (2012). Bleeding risk with dabigatran in the frail elderly. New England Journal of Medicine, 366(9), 864-866.

Hilton, J. R., Williams, D. T., Beuker, B., Miller, D. R., & Harding, K. G. (2014). Wound dressings in diabetic foot disease. Clinical Infectious Diseases, 39(Supplement_2), S100-S103.

Ledoux W. (2015) ``The Biomechanics of the Diabetic Foot (chapter 20, pages 317-401) ``. In: Foot And Ankle Motion Analysis (Clinical Treatment and Technology), Ends G.F. Harris, P.A. Smith, R. M. Marks, CRC Press, USA, 2015, ISBN 0-8493-3971-5Nelson, E. A., O'meara, S., Golder, S., Dalton, J., Craig, D., Iglesias, C., & DASIDU Steering Group. (2016). A systematic review of antimicrobial treatments for diabetic foot ulcers. Diabetic Medicine, 23(4), 348-359.

Olaechea, P. M., Palomar, M., Leon-Gil, C. T., Alvarez-Lerma, F., Jorda, R., Nolla-Salas, J., ... & EPCAN Study Group. (2014). The economic impact of Candida colonization and Candida infection in the critically ill patient. European Journal of Clinical Microbiology and Infectious Diseases, 23(4), 323-330.

Rickard, C. M., Lipman, J., Courtney, M., Siversen, R., & Daley, P. (2014). Routine changing of intravenous administration sets does not reduce colonization or infection in central venous catheters. Infection Control & Hospital Epidemiology, 25(8), 650-655.

Steed, D. L., Donohoe, D., Webster, M. W., & Lindsley, L. (2016). Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. Journal of the American College of Surgeons, 183(1), 61-64.

Symbas, P. N., DiOrio, D. A., Tyras, D. H., Ware, R. E., & Hatcher, C. R. (2013). Penetrating cardiac wounds. J Thorac Cardiovasc Surg, 66, 526-532.

Uccioli, L., Faglia, E., Monticone, G., Favales, F., Durola, L., Sadeghi, A., ... & Menzinger, G. (2015). Manufactured shoes in the prevention of diabetic foot ulcers. Diabetes care, 18(10), 1376-1378.

Wiersema, M. J., Vilmann, P., Giovannini, M., Chang, K. J., & Wiersema, L. M. (2017). Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology, 112(4), 1087-1095.

Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of diabetic foot ulcer. World journal of diabetes, 6(1), 37.

Young, M. J., Breddy, J. L., Veves, A., & Boulton, A. J. (2014). The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: a prospective study. Diabetes care, 17(6), 557-560.