Lacerations: Nursing Care and Interventions

00:00 Let's take a look at the nursing care and interventions for someone with a laceration.

00:05 Now, when you initially see the patient, our number one role is to control the hemorrhage, right. You're going to make sure you do it with direct pressure and evaluate if you're able to stop the bleeding. We're going to assess their vital signs and watch for signs of significant blood loss. We're going to do a neurovascular assessment particularly distal or after that injury. And we're going to document the wound characteristics completely.

00:28 Now if the wound is going to need further treatment we're going to get a sterile field ready, and we're going to assist or even perform the wound cleansing and irrigation.

00:36 We're going to assist with applying the appropriate dressings based on the wound characteristics, and we're going to secure the dressings to maintain position without compromising circulation.

00:46 Now, that sounds really simple, but I promise you in your nursing career you're going to have some patients that is so difficult to secure that dressing and to keep it on them.

00:57 Now make sure you perform dressing changes using aseptic technique and monitor that wound appearance. Make sure you're monitoring and documenting how the healing is progressing, or if you see any signs of complications like infection, you're going to be in charge of assessing that pain and monitoring the treatment plan.

01:14 So you're going to assess the pain, use a scale, give analgesics as prescribed and as the patient needs them. You may consider doing things like cold therapy if it's appropriate or helping them position or even consider distraction techniques, particularly for pediatric patients.

01:30 When it comes to preventing infection, that's something we're excellent at.

01:35 So that's why when we're doing a dressing change, we maintain aseptic technique throughout all wound care. You'll teach your patient each time you're caring for them.

01:44 Teach them the signs of infection.

01:46 It's also a great way to give them encouragement.

01:48 When I'm changing a dressing and say, oh, this looks great, there's no signs of infection, I see this, I see that that's just good to give patient encouragement. Also helps you make mental notes for your documentation because that's what we're always doing is monitoring for infection.

02:04 We want to catch it early to stop it from becoming a bigger deal.

02:08 We'll also help give with prophylactic antibiotics if they have been ordered.

02:13 As a nurse, you'll also be thinking about the patient's functional needs.

02:16 You're going to assess and document their baseline function where they are.

02:20 Also the patient may need some type of immobilization device.

02:24 You'll help them put that on and teach them about it.

02:27 Teach them how to be safe with those devices.

02:29 You also think about early range of motion exercises when it's appropriate for the client.

02:35 It's great if a patient needs a physical therapist, but we work with them as a team member to continue those important range of motion exercises that are safe and effective for the client.

02:45 Nurses are also excellent at patient monitoring.

02:48 We'll reassess the wounds at appropriate intervals.

02:51 We're going to watch for signs of compartment syndrome if it's applicable.

02:55 And I'll come back to that.

02:56 We're going to assess for adequate pain control.

02:59 And we're going to evaluate how that wound is progressing in healing.

03:04 Now back to compartment syndrome.

03:06 If you haven't heard about this before let me explain it to you.

03:10 Compartment syndrome is what we watch for after certain injuries.

03:14 So think of your muscles as being organized in separate compartments like rooms in a house.

03:19 Now, these compartments are wrapped in really tough tissue that doesn't stretch much.

03:25 Now, this tough tissue is called fascia.

03:28 It's a sheet of strong connective tissue that surrounds muscles, groups of muscles, blood vessels and nerves.

03:35 Now the fascia helps keep these structures organized and in place.

03:39 It's almost like biological shrink wrap or a casing.

03:43 The fascia is primarily made of collagen, which gives it strength.

03:47 But that's the plus. Here's the negative.

03:50 It lacks the elasticity of other tissues like skin.

03:54 It doesn't stretch much. Now because it has this fascia has a limited ability to stretch that's normally beneficial for muscle function and body structure.

04:04 But in compartment syndrome this is where it becomes problematic.

04:09 When swelling occurs within a fascial compartment after an injury, the fascia doesn't expand easily to accommodate that increased volume, so this faces resistance to stretching is what causes the pressure to build up inside the the compartment. Now, when this pressure builds up inside that compartment, you're going to potentially compromise blood flow and nerve function to the tissues that are there.

04:35 Okay. So this is the problem.

04:36 This increased pressure. If it's significant, it can squeeze the blood vessels in the nerves inside that compartment. And this can potentially cause damage if it's not addressed quickly by you.

04:47 So it's similar like if you're wearing a watch band and it's suddenly way too tight.

04:51 It cuts off the circulation and causes pain and numbness.

04:55 This is what you're going to be on the lookout for now, the most common places we see compartment syndrome are the forearm and the hand, especially after a crush injury or a really deep laceration.

05:06 The lower leg, particularly around the shin area.

05:09 The foot, especially after injuries to the arch or the heel and you can even see them in the buttocks, the thighs and the abdomen.

05:17 After the procedure has been formed.

05:18 These are the things you're going to document Post-procedure you're going to reassess neurovascular status. Remember, particularly distal to the injury.

05:27 Again, the patient education that you provided during the procedure and after the procedure, the follow up instructions they were given, the prescriptions they were given and the expected outcomes you discussed with the client.

05:39 Now, for follow up visits, you're going to look at things like wound appearance and how it's continuing to heal.

05:44 There's a presence or absence of infection, suture or staple remover, the date, any complications they might have had, any changes to the treatment plan, and additional education that you provide at the follow up visit.

05:57 Photographs can be pretty helpful, but they come with some very specific rules.

06:01 You have to have patient consent, and it needs to be in compliance with your hospital or your clinic's rules and guidelines.

06:09 So how they could be used is you document, you do the initial wound appearance, then you do the post-closure appearance.

06:16 You can use it to document healing, progression or any complications.

06:19 But keep in mind it has to be with the patient consent and in compliance with any policies.