CHAPTER 29 Wounds and Wound Management
I. GENERAL STRATEGY
A. Assessment
1. Primary and secondary assessment/resuscitation (see Chapters 1 and 31)
2) Past medical history
3) Psychological, social, and environmental factors
1) Complete blood count (CBC) with differential: if wound infection present, determine leukocytosis, anemia, thrombocytopenia
3) Coagulation profile: if bleeding is uncontrolled evaluate for coagulation abnormalities especially if deep wound excision required
C. Planning and Implementation/Interventions
F. Age-Related Considerations
3) Major heat loss can occur in young children left unclothed for a period of time because of their large body surface area
1) It is important to develop and maintain a relationship with the family, along with the child, because security for most children comes from parents
4) Child maltreatment should always be considered because surface trauma is often associated with, or is the most evident sign of, nonaccidental injuries in children
5) Poor tolerance for cold as result of peripheral vascular changes and diminished thermoregulatory ability
II. SPECIFIC WOUND MANAGEMENT EMERGENCIES
A. Lacerations
2. Analysis: differential nursing diagnoses/collaborative problems
3. Planning and implementation/interventions
9) Assist with hospital admission if extensive débridement, irrigation, or repair required, or other injuries present
3) Wound care instructions: keep wound and dressing clean and dry; keep covered for the first 48 hours
4. Expected outcomes/evaluation (see Appendix B)
Table 29-2 SUTURE REMOVAL TIME GUIDELINES
| Wound Location | Removal Times |
|---|---|
| Face | 3–5 days |
| Scalp | 5–8 days |
| Neck | 3–5 days |
| Chest | 7–10 days |
| Abdomen | 7–10 days |
| Back | 10–12 days |
| Upper extremity | |
| Nonjoint surface | 7–10 days |
| Joint surface | 10–12 days |
| Lower extremity | |
| Thigh | 7–10 days |
| Knee | 12–14 days |
| Lower leg | 7–10 days |
| Foot | 7–10 days |
