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Background
Mr. Y was 45 years old and ex-Heroin addict. He was newly diagnosed of stage 4B diffuse large B cell lymphoma and had a right groin wound. The PetCT scan showed lymphoma involvement of right groin. Initial wound assessment revealed size 11x15cm , thick yellowish slough 75% and red tissue 25%, unstaging wound due to depth uncertain. There was a risk of the wound base in contact to the blood vessels which run along right femoral area. Surrounding skin was erytherm and exudate malodor. Wound swab culture results were heavy growth of Pseudomonas, Enterococci , Morganella morganii and Bacteroides species.
Nursing Management of the Wound
Initial aims of wound dressing were: 1) promoting patient comfort; 2) conservative approach for yellowish slough and 3) gentle wound cleansing. Therefore daily cleaning the wound with Chlorhesidime 0.05%, then rinsing with Normal Saline and packing by activated charcoal with sliver dressing (to absorb exudate, control odor and for antimicrobial effect) were performed. Repeated CT scan excluded the wound in contact with blood vessels. Dressing materials were revised to water base gel application and Alginate dressing packing for keeping moist facilitating slough autolysis and red tissue healing. Loose slough was trimmed repeatedly. When wound infection subsided, daily irrigation with Normal Saline was adopted. At sometime the depth of wound was6cm ! After 3 month, wound size decreased to 6x4cm with depth 1.5cm . (5 photos for the progress)
Holistic Considerations
Psycho-social care was addressed and Mr.Y was informed of wound progress and rationale of wound management. Mr.Y was also educated on high protein diet with nutritional supplement.
Conclusion
Appropriate and safe wound management was planned based on comprehensive assessment with risk identification. Wound management approach revised accordingly. Wound management focused on client as a whole rather than on the wound solely.
Mr. Y was 45 years old and ex-Heroin addict. He was newly diagnosed of stage 4B diffuse large B cell lymphoma and had a right groin wound. The PetCT scan showed lymphoma involvement of right groin. Initial wound assessment revealed size 11x
Nursing Management of the Wound
Initial aims of wound dressing were: 1) promoting patient comfort; 2) conservative approach for yellowish slough and 3) gentle wound cleansing. Therefore daily cleaning the wound with Chlorhesidime 0.05%, then rinsing with Normal Saline and packing by activated charcoal with sliver dressing (to absorb exudate, control odor and for antimicrobial effect) were performed. Repeated CT scan excluded the wound in contact with blood vessels. Dressing materials were revised to water base gel application and Alginate dressing packing for keeping moist facilitating slough autolysis and red tissue healing. Loose slough was trimmed repeatedly. When wound infection subsided, daily irrigation with Normal Saline was adopted. At sometime the depth of wound was
Holistic Considerations
Psycho-social care was addressed and Mr.Y was informed of wound progress and rationale of wound management. Mr.Y was also educated on high protein diet with nutritional supplement.
Conclusion
Appropriate and safe wound management was planned based on comprehensive assessment with risk identification. Wound management approach revised accordingly. Wound management focused on client as a whole rather than on the wound solely.