Student Nurses Guide to Care of the Incision Part 2

In part 1 of our series on care of the incision we covered types of dressings and some basic care for your patient's wounds and proper removal of the initial dressing. In this article we will cover irrigations, some basic wound terminology (Please also see our article on wound terminology) and complications of wound healing.

Irrigation is the act of cleaning a wound with a solution by introducing the solution directing onto or into the wound with a syringe, shower, whirlpool or a syringe and catheter. This technique can be used either using a sterile or non sterile technique depending on the physicians or surgeons desires. To avoid fluid retention you should place your patient on their side this will encourage the flow of irrigate to move away from the wound. Irrigations promote wound healing by removing debris from the wound, loosening and/or removing any eschar and decreasing bacteria counts. Basic wound irrigation include cleansing the wound in a direction from the least contaminated area to the most contaminated area.

Complications of wound healing can happen under even the best circumstances so it's best for the nurse to have a basic understanding of certain types of complications and known how to properly deal with these complications as they arise. Impaired wound healing will require the nurse to accurately observe the wound and deal with ongoing interventions.

Wound bleeding may indicate a deeper problem, for example a dislodged clot, a slipped suture, trauma to blood vessels or tissue, or coagulation problem.

Dehiscence is when the wound layers separate, the patient may express that something has given away. Dehiscence can happen when the patient coughs, sneezes or vomits. If dehiscence occurs the nurse should place a sterile dressing over the area until a physician can properly evaluate the wound site.

Evisceration is when the abdominal organs protrude through an opened incision. If your patient experiences an evisceration it is mandatory that your patient remain in bed and any contents from the abdomen should be covered with a warm, sterile saline soaked dressing. The nurse should notify the surgeon immediately as this is a medical emergency that will require surgical repair.

Wound infection is when a surgical wound has become contaminated. The CDC has labeled a wound as infected when it contains purulent drainage. Your patient that's wound may be infected may display a fever, tenderness at wound site, pain at the wound site, an elevated WBC count, and possible edema. Depending on the pathogen in the wound the purulent drainage will have an odor but its color may be brown, yellow, or green.