Question

As the nurse you are caring for a patient with stage 2 wound on their coccyx. How as the nurse would you care for this patient? ( Include a description of the wound, nursing care-nutrition, dressing care for the wound, turning of the patient, etc. Maximum 2 pages.

Answer 1

   A wound can be defined as an injury to living tissue, breaking its continuity.Both external and internal factors can contribute to the formationof a wound and a holistic approach is essential for accurateassessment and planning care.

• External : mechanical (friction, surgery), chemical, electrical,temperature extremes, radiation, micro-organisms, environment.
• Internal : circulatory system failure (venous, arterial, lymphatic),endocrine (diabetes), neuropathy, haematological, nutritional    status (smokingand alcohol history), malignancy, infection and age.

stage 2 wounds are characterised by loss of dermis presenting as a shallow, open ulcer with a pink wound bed without slough.It may also prsent as shiny ulcer without slough or bruising.

Stage 2 wound at the coccyx

This wound is a localized area of tisue necrosis and typically developed when soft tissue is compressed in between the bony prominence and the external surface for a very long time.There is a partial thickness skin loss but it is not deeper than the dermis.It has a both intact and ruptured blisters and abrasions.

NURSING CARE

• The primary goal of a nurse who cares stage 2 wound at the coccyx is to clean cover and protect the area.Reduce the pressure in the area promotes wound healing.
• The nurse should always take special attention to keep the area clean and dry.
• It is always important to encourage the patient to take adequate amount of protein and calories.example,meat,fish,cheese,eggs pulses.
• the diet also should include vitamin c and zinc as it enhance the formation of new tissue and wound healing. example,citrus fruits,vegetables like broccoli,peppers,fruit juices,berries and tomatoes,red meat,eggs ,beans and green leafy vegitables,milk and dairy products.
• propper iron in the diet encourages the oxygen supply and it promotes sudden wound healing.
• The nurse should always keep a blood sugar monitoring,because propper blood glucose levels are important in wound healing.
• provide propper hydration to the patient ,if the patient become dehydrated ,his skin becomes less elastic fregile and more susceptible to breakdown.
• Encourage the patient to mobilize or help him to do that if he is not bed ridden.
• As the patient is assessed as having a stage–2 wound, foam mattress or cushion with pressure-reducing
  properties should be provided.
• Observation of skin changes should be documented.
• If there is any potential or actual deterioration of aff ected areas or further pressure ulcer development, an AP (alternating pressure) continuous low pressure (CLP) system (e.g. low air loss, air fl uidized,
  air fl otation, viscous fl uid) should be used.

DRESSING CARE OF THE WOUND.

• The nurse should always use a clean technique to clean the wound.
• Normal saline can be used to clean the wound.
• Transperent films,composite,hydrocolloid,hydrogel dressings can be used if there is minimal exudates.
• For moderate to large amount of exudates:foams,calcium alginates and secondary dressing can be used.
• If there is a sighn of infection,antimicrobial dressings like silver based can be used and apply secondary dressings as per the amount of exudates

TURNING OF THE PATIENT

• the patient should be turned every 2 hours to every other side.

It is always important to take patient's cooperation to do that.make sure the atient understands what the nurse do and why she does if the patient is conscious.

It is always important to do documentation of the nursing care what the nurse provides to the patient.