Running head: STERILE DRESSING Critical Thinking Application with Sterile Dressing Changes One of the best methods of reducing infection in patients with any type of wound is sterile technique with dressing change. Heavy colonization of infected sites is a risk factor for infections associated with any type of wound but mostly for wounds that penetrate deeper into the skin. Sterile site dressing is advocated to protect the open wound from contamination because it will come in to direct contact with the wound, and sterility is required in order to execute the application of the dressing successfully.
The nursing process is an important principle to use when examining, treating, and maintaining any type of wound or applying wound dressings. The five steps: assessment, diagnosis, planning, implementation, and evaluation are all applied during the process. Critical thinking about the method, the purpose, and understanding why procedural guidelines must be followed is key to keeping your patients safe and free from infection. The first step of the nursing process is to thoroughly assess your patient.
Baseline and continual assessment data provide important information about the client’s skin integrity, mobility, nutritional status, and wound condition. Nurses must carefully examine the wound stability, its appearance, drainage, and the patient’s pain level. It is essential to identify what makes the dressing change more stressful for patients, if there is constant background pain and what helps in reducing the pain patients may have experienced during previous dressing changes (Hollinworth, 2005).
The nurse should inspect the surface of the skin, inspect the wound for any signs of healing or worsening, and also obtain client’s temperature, heart rate, and white blood cells count to see if there is any infection. The next step is to use the assessment data gathered to indicate an actual or risk diagnosis that will direct supportive and preventative care. Patients with wounds are at greater risk for infection, impaired skin integrity, impaired tissue perfusion, and acute or chronic pain.
By establishing the most accurate diagnosis, the nurse can then set goals and outcomes of how to treat and maintain the wound, as well as the appropriate technique to apply a sterile dressing. Planning involves setting goals and establishing outcomes both the nurse and patient should accomplish within a reasonable amount of time. One of the nurse’s goals is to apply a clean dressing using sterile technique to prevent any infection or contamination of the wound. Sterile technique requires the nurse to plan ahead and be prepared before she walks into the patient’s room to change the dressing.
The nurse should be equipped with the necessary materials which include a sterile dressing change package, sterile gloves, normal saline, extra cotton swabs, and tape. Once the nurse is sterile, she/he cannot touch anything outside the sterile field, so she/he needs to plan and set up accordingly. The nurse also needs to plan how she/he can make the patient the most comfortable during the process. Implementation is where the nurse uses his/her knowledge and actual technique to apply the dressing.
Hand hygiene is the most important thing a nurse should do and the most effective way of avoiding infection. After reviewing orders, the client should be positioned comfortably and the nurse should set up his/her sterile field. Once the wound has been cleaned, the nurse must re-apply sterile gloves, assess the appearance of the wound and measure it by length, width and depth. This allows the nurse to keep track of the healing progression and see if the wound is on the right track or if something is causing it to become infected.
Two types of dressings can be used, dry and moist. Dry dressings provide protection and absorption of wound drainage. Moist dressings are used to provide moisture of the wound, especially if there is granulation tissue forming but still allow the excess drainage to be picked up and adhere to any debris. “By fostering a moist wound environment that promotes epidermal migration, dressings permit healing from the bottom and sides of the wound rather than allowing an overlying crust to develop” (Bouchard, 2005).
Perform sterile dressing changes as ordered, less than or excessive changes can affect the healing process and increase the risk for infection. There are also implications for infection control and delayed healing due to repeated wound exposure, and an increased risk of epidermal damage and irritant contact dermatitis by repeatedly removing adhesive products (Hollinworth, 2005). The wound should be packed with enough gauze to cover the open wound but it should not be packed in too tightly because that obstructs air getting to the tissues.
Once the wound has been packed, a few dry pieces of gauze should be placed over the open wound followed by the abdominal pad. The area around the skin should be dry because moist skin can lead to breakdown and further skin complications. The last step of the process is to clearly label the dressing so that when other nurses and healthcare professional come to assess the client, they will know when and by whom the dressing was last changed by. The nurse should be explaining what he/she is doing as the application goes on, and teach the patient why sterile technique is necessary.
By teaching, the nurse is informing the patient how he/she can be more involved in their own care and the importance of keeping their wound clean because it can lead to further and more dangerous problems. The final step of the nursing process is to evaluate the patient’s condition and response to the dressing change treatment and to measure whether the interventions were effective. Clients with impaired skin integrity need ongoing assessment and planning to find ways to keep the skin in the best condition possible.
Proper sterile technique should be evaluated to determining if any new or unseen drainage or irritation becomes present after the intervention. It is important to involve the patient in the entire process, but especially the evaluation to determine whether the treatment was helpful or not. The patient’s pain level, comfort, and understanding of the procedure also need to be evaluated. Sterile technique is very important when it comes to dressing changes because the patient is overly susceptible to infection due to the breakdown of their first line of defense.
An ideal wound dressing is one that is sterile, breathable, and encourages a moist healing environment. Another general consideration in wound care management is prophylaxis (Bouchard, 2005). Using any ointments or topical agents that help prevent microbial growth will help ensure the patient’s wound is, for the most part, safe from infection. The nurse must understand all aspects of the activity which include the purpose of changing the dressing, why sterile technique must be used, how to deal with any unpredicted outcomes, and how to keep the patient in the best condition possible.
Critical thinking involves understanding what was initially assessed, why the findings were what they were, and whether any other factors contributed to the situation such as nutrition, position, or neurologic impairment of the patient. Sterile dressing change is a nursing responsibility, and using the nursing process as well as critically thinking can lead to a positive patient outcome. References Bouchard, M. (2005). Sideline care of abrasions and lacerations: preparation is key. Physician & Sports Medicine, 33(2), 21-29. Hollinworth, H. (2005). The management of patients’ pain in wound care. Nursing Standard, 20(7), 65-73.