Wound Diagnostic, Assessments, and Treatments
Effective Wound Healing Starts with an Accurate Assessment
Assessment is a vital first step in wound care because it allows healthcare professionals to devise and implement the appropriate treatment strategy – leading to faster healing rates. Diagnostic assessment is the process that enables the doctor to diagnose the wound and administer the proper treatments. Strong observation skills, medical knowledge, and clinical experience are desired qualities when performing an effective wound assessment. Additionally, it is essential for the clinician to use the correct terminology in written documentation to ensure clear communication between all healthcare team members.
- General Patient Health: This includes age, living environment, mental health, pre- existing conditions, nutrition, the number of wounds present, and each wound’s history.
- Wound Location: This wound characteristic should be documented using landmarks and directions such as medial, posterior, superior, etc.
- Wound Dimensions: These measurements should be documented in millimeters or centimeters.
- Wound Pattern: The dispersion of lesions within a specific area should be noted. “Linear” lesions form a straight line pattern while “satellite” lesions are small peripheral areas centered around a larger lesion. “Candidiasis” presents as multiple satellite lesions.
- Wound Tissue: A description of tissues found in the wound should also be documented. Documentation examples include normal granulation tissue, hypergranulation tissue, and necrotic tissue.
- Wound Drainage: The amount of drainage (exudate) should be noted, along with the color and consistency.
- Wound Odor: Although a foul-smelling wound may indicate infection, it is essential to determine whether the odor is coming from a wound dressing such as a hydrocolloid.
- Pain: The patient should be asked to score their wound pain level based on the pain scale used by the healthcare facility.
- Assessment of the surrounding skin: The skin bordering the wound should be evaluated for redness (erythema), stripping of the upper layers of the epidermis (excoriation), any changes in skin texture (induration), and tissues becoming waterlogged due to excess skin moisture (maceration).
Once the clinician has accurately assessed a wound, it may be classified into one of four main categories:
- Burn Wounds: These wounds are chemical or thermal in nature.
- Chronic Wounds: This category includes wounds such as pressure ulcers and leg ulcers that fail to heal within three months.
- Malignant Wounds: These wounds are caused by some type of cancer, for instance, primary lesions resulting from melanoma.
- Mechanical Wounds: This category includes surgical and traumatic wounds.
After assessment signs and symptoms have been documented, the clinician may initiate primary treatment objectives that include wound cleaning, debridement/de-sloughing, exudate management, bleeding management, and the minimization of infection effects.
The patient may then be treated with interventions that include:
- Wound Management Products: These materials may be alginates, enzymes, foams, films, hydrogels, hydrocolloids, and other products.
- Active Wound Management Materials: These products introduce growth factors that stimulate the healing environment and may include epidermal growth factor (EGF) or platelet-derived growth factor (PDGF).
- Newer Wound Care Technologies: These innovations include low-level laser therapy, negative-pressure wound therapy, and hyperbaric oxygen therapy.
Once the primary treatment objective has been achieved, ongoing assessments should be performed to identify the next objective and document evidence of wound healing or the presence of further wound deterioration. Photographic records aid in this process by providing visual evidence of healing. Any wound that becomes fixed in one of the major phases of healing (inflammation, regeneration, or maturation) for more than six weeks should be considered chronic.
