Lacerations: Diagnostics (Nursing)

00:00 There are certain diagnostic tests and procedures that can be associated with a client who suffered a laceration. Initially, your assessment is going to involve these things.

00:10 You're going to visually inspect the laceration and make sure you have adequate lighting to take a really good look. You're going to measure the wound.

00:18 How long is it, how wide is it and how deep is it? You're going to do a neurovascular assessment distal to the injury.

00:25 So if I cut my hand here you're going to make sure that you do the neurovascular assessment distal to that injury in my fingers.

00:33 You're also going to do a functional assessment. Now this isn't a complete expert functional assessment. But I'm going to ask the patient if they have an injury on their hand can they move their fingers. How does that impact their pain.

00:44 Can they grip their fingers? I'm going to look for that type of assessment.

00:48 And finally pain assessment using an appropriate scale.

00:53 So when I first meet a patient who has a laceration, these are the things I'm going to do I'm going to visually inspect it, measure it, do a neurovascular assessment after the injury or distal to the injury.

01:04 I'm going to do a functional assessment as appropriate.

01:07 And I'm going to ask them their level of pain.

01:10 Now if we get into really taking a look at that wound, exploring that wound, as we would say, you would do this under sterile conditions.

01:17 We don't want to add any contaminants to that wound.

01:20 You're going to assess for foreign bodies.

01:23 Now an example. If a client had something at home, maybe they were in a hay bale incident and they ended up with pieces of hay in their wound, that would be an example of a foreign body.

01:33 So keep in mind, though, you may not be able to see it, even if you do direct wound inspection, you might not detect all the foreign bodies, especially if the base of the wound can't really be visualized because it's very deep or it's covered by something. So evaluation of the tendon, nerve and vascular integrity is something that will be done by the whole team.

01:56 But if you're the first person to see them you can begin that assessment process.

02:01 They're also going to take a look at the joint. If the wound is near or over a joint, you're going to want to assess that joint for mobility and function.

02:10 Now when we talk about assessing foreign bodies I just wanted to give you this kind of weird fun fact. Studies have shown that glass fragments are directly visualized in only about 4% of wounds.

02:21 Isn't that crazy? So if someone's been in an accident with a windshield or some other form of glass, we can't always see the glass.

02:28 But if they have an x ray, it can be detected in up to 21% of wounds.

02:33 If we can't fully visualize it.

02:35 Okay. So at least you go from 4% to 21%.

02:40 Now, when you do the evaluation we talked about, you're gonna look at tendons, nerves and the vascular integrity to make sure that's intact.

02:46 But be prepared that you may have an imaging study.

02:49 They might do an x ray because they're looking for suspected fractures and maybe looking for some radiopaque foreign bodies.

02:55 Now we know that plain radiographs have approximately 90% sensitivity for detecting glass fragments larger than 15mm, regardless of the color of that glass.

03:06 So while that may be more information than you thought you'd ever learn about X-rays and glass as foreign bodies. It's something that you're likely to see in the emergency department.

03:15 Now, also keep in mind if you see a wound that is a puncture wound or some of these other wounds I'm going to list, these are the types of wounds that are at a higher risk for things to be retained as foreign bodies inside these types of wounds.

03:28 So it could be puncture wounds, wounds that could be on the head or the foot and those that your client may have gotten when they stepped on glass or they were in a motor vehicle accident. Okay, we just went through a list.

03:41 Let's reorient ourself, know that these are the types of wounds that have a higher risk for foreign body still being inside the patient, puncture wounds, wounds on the head or foot and those that they got from stepping on glass or from a motor vehicle accident. So we talked about the x rays.

03:59 There might be an ultrasound for soft tissue foreign body detection.

04:03 They could go to a CT scan if it's a really complex wound or there's a really deep penetration. Or they can also go to an MRI if they're suspected that the tendons, ligaments or the nerve has been damaged.

04:15 So you may assess some things, but you're going to have some imaging studies that can help definitively diagnose that.

04:21 Now, what kind of lab work you might expect? Well, a CVC is pretty common, but particularly if infection is suspected or there's a significant injury, a CVC will be ordered from the lab.

04:31 There can be coagulation studies.

04:32 Well, that makes sense, because if you're concerned that the patient is going to have bleeding issues or an inability to clot, maybe they're on an anticoagulant.

04:40 You're probably going to do some coagulation studies.

04:43 Also, if the client's diabetic, you take a look at their blood glucose.

04:46 And if we really think something bad has happened or they're exposed, there's a high risk may even get cultures of that wound.

04:54 Now, if you have a laceration or an injury near an eye, you might use something that's called a Wood's lamp examination.

05:02 Now, this will help to detect if some of those foreign bodies happen to get inside the eye.

05:07 We're particularly worried if it's by the cornea.

05:09 So they illuminate them with this special ultraviolet light.

05:12 That's what a Wood's lamp is.

05:14 And it causes them to kind of glow if they're stained with a special dye.

05:18 So if we're worried about glass being in the eye, they'll probably be an examination with a Wood's lamp. So they can see that, visualize it more easily.

05:27 Other things this may be done, but remember it just depends on how severe things are. Could do a Doppler ultrasound to make sure they're still good blood supply or vascular assessment of that area. They might look at nerve conduction studies if we think there's been nerve injury. And they might also do some tendon function tests, depending on where the location is and what the patient is experiencing.

05:49 And lastly, we're going to talk about tetanus status assessment.

05:53 Whenever a patient has a laceration or a wound we need to verify their immunization history.

05:59 We need to be sure how recently they have received the vaccine.

06:04 So this will help us decide if they need tetanus prophylaxis with this visit, or if they're okay and safe.