WOUND ASSESSMENT AND TREATMENT

Wound Assessment and Treatment

Wound Assessment and treatment

Introduction

Unresolved agony contrary sways wound healing and has an impact on value of life. Pain at wound dressing-related methods can be organised by a combination of accurate evaluation, apt getting dressed alternatives, accomplished wound management and individualized analgesic regimens. For therapeutic as well as humanitarian reasons it is vital that clinicians know how to assess, evaluate and manage pain. Having a basic understanding of pain physiology will help anyone involved in a wound dressing-related procedure to understand the patient's pain experience. It is fundamental to appreciate that pain from wounds is multidimensional, and the patient's psychosocial environment will influence and impact on the physiological experience of pain.

Understanding Types of Pain

There are two kinds of agony: nociceptive agony and neuropathic pain. Nociceptive pain may be defined as an appropriate physiological response to a painful stimulus. It may involve acute or chronic inflammation. Acute nociceptive pain occurs as a result of tissue damage and is usually time limited. Where wounds are slow to heal, the prolonged inflammatory response may cause heightened sensitivity in both the wound (primary hyperalgesia) and in the surrounding skin (secondary hyperalgesia). Neuropathic pain has been characterised as an unsuitable answer caused by a prime lesion or dysfunction in the tense system. Nerve damage is the commonest cause of the primary lesion, which may be due to trauma, infection, metabolic disorder or cancer. Neuropathic pain is a foremost factor in the development of chronic pain. It is often associated with altered or unpleasant sensations whereby any sensory stimulus such as light touch or pressure or changes in temperature can provoke intense pain (allodynia). The clinician must recognise that this requires specific pharmacological management and referral for assessment by a specialist who is able to diagnose (and treat) neuropathic pain.

Using a Layered Approach

The terms background, incident, procedural and operative can be used to describe the cause of pain. Whatever the cause of pain, the patient's experience will be influenced by his/her psychosocial environment.

Background pain is the pain felt at rest, when no wound manipulation is taking place. It may be continuous (eg like a toothache) or intermittent (eg like cramp or night-time pain). Background pain is related to the underlying cause of the wound, local wound factors (eg ischaemia, infection and maceration) and other related pathologies (eg diabetic neuropathy, peripheral vascular disease, rheumatoid arthritis and dermatological conditions). The patient may also have pain that is unrelated to the wound, which may impact on the background pain experience (eg herpes zoster (shingles), osteoarthritis and cancer).

Incident (breakthrough) pain can occur during day-to-day activities such as mobilisation, when coughing or following dressing slippage.

Procedural pain results from a routine, basic procedure such as dressing removal, cleansing or dressing application. Non-pharmacological techniques and analgesia may both be required to manage the pain.

Operative pain is associated with any intervention that would normally be performed by a specialist clinician and require an anaesthetic (local or general) to manage the ...