Considering the evaluation of a high-tension area, such as the hand, treatment is guided by initial control of bleeding, prevention of infection, physical assessment, obtaining a health history, allergies, current medications and tetanus immunization history. Primarily, a focused assessment for the presence or absence of tendon, vascular or nerve damage, taking wound measurements, exploring the mechanism of injury and the length of time since the initial injury is paramount.
As might be expected, in Mr. Jones’ case, there is an increased risk of infection with closing the wound with sutures. Furthermore, his simple hand laceration, a 2-inch cut on the anterior aspect of the hand, is superficial, greater than 6 hours old and is best treated conservatively without closure or stitches to heal, so his wound will heal by …show more content…
Jones’ is at an increased risk for impaired wound healing because of his age and his underlying condition of diabetes. With a chronic illness, such as diabetes, wounds heal slower and have the possibility to progress from acute inflammation to chronic inflammation. Mr. Jones’ diabetes causes increased serum glucose levels, vascular changes that lead to microcirculation and glycosylated hemoglobin, causing tissue ischemia (peripheral vascular disease (PVD), neuropathy) related to decreased oxygen release to tissue. During an acute inflammation, insulin needs are increased and Mr. Jones’ wound becomes more compromised. Increased serum glucose and tissue hypoxemia inhibits the inflammatory process since leukocytes require glucose for energy to promote intercellular decontamination (chemotaxis, phagocytosis). This causes prolonged infection, which delays healing and wounds progress to chronic inflammation. Chronic inflammation, increased lymphocyte and macrophage activity, is an extension of acute inflammation that lasts 2 or more weeks and eventually leads to the formation of a granuloma (Huether & Rote,
As might be expected, in Mr. Jones’ case, there is an increased risk of infection with closing the wound with sutures. Furthermore, his simple hand laceration, a 2-inch cut on the anterior aspect of the hand, is superficial, greater than 6 hours old and is best treated conservatively without closure or stitches to heal, so his wound will heal by …show more content…
Jones’ is at an increased risk for impaired wound healing because of his age and his underlying condition of diabetes. With a chronic illness, such as diabetes, wounds heal slower and have the possibility to progress from acute inflammation to chronic inflammation. Mr. Jones’ diabetes causes increased serum glucose levels, vascular changes that lead to microcirculation and glycosylated hemoglobin, causing tissue ischemia (peripheral vascular disease (PVD), neuropathy) related to decreased oxygen release to tissue. During an acute inflammation, insulin needs are increased and Mr. Jones’ wound becomes more compromised. Increased serum glucose and tissue hypoxemia inhibits the inflammatory process since leukocytes require glucose for energy to promote intercellular decontamination (chemotaxis, phagocytosis). This causes prolonged infection, which delays healing and wounds progress to chronic inflammation. Chronic inflammation, increased lymphocyte and macrophage activity, is an extension of acute inflammation that lasts 2 or more weeks and eventually leads to the formation of a granuloma (Huether & Rote,