TAYLOR, LILLIS, LYNN, & LEMONE: FUNDAMENTALS OF NURSING: THE ART AND SCIENCE OF PERSON-CENTERED NURSING CARE, 8TH EDITION

Lesson Plan Chapter 31, Skin Integrity and Wound Care Goals of the Lesson: Cognitive: Students will be able to discuss the processes involved in wound healing and list factors that affect it. They will be able to identify patients at risk for pressure ulcer development, explain the method of staging of pressure ulcers, and provide nursing interventions to prevent pressure ulcers. Students will be able to accurately assess and document the condition of wounds, implement appropriate dressing changes for different kinds of wounds, and provide information to patients and caregivers for self-care of wounds at home. They will be able to apply hot and cold therapy effectively and safely. Learning Objectives: The lesson plan for each objective starts on the next page. 31.1 Discuss the processes involved in wound healing 2 31.2 Identify factors that affect wound healing 5 31.3 Identify patients at risk for pressure ulcer development 7 31.4 Describe the method of staging of pressure ulcers. 9 31.5 Accurately assess and document the condition of wounds. 12 31.6 Provide nursing interventions to prevent pressure ulcers. 14 31.7 Implement appropriate dressing changes for different kinds of wounds. 18 31.8 Provide information to patients and caregivers for self-care of wounds at home 21 31.9 Apply hot and cold therapy effectively and safely 22 Legend: IR: Instructor’s Resource; SR: Student’s Resource; PPT: PowerPoint (IR); *Premium content: additional purchase required Taylor, Lillis, Lynn, & LeMone: Fundamentals of Nursing: The Art and Science of Person-Centered Nursing Care, 8th Edition Chapter 31, Skin Integrity and Wound Care 31.1 Discuss the processes involved in wound healing. Page 2 of 17 Copyright © 2015 Wolters Kluwer Lecture Outline Content Discuss the anatomy and physiology of the integumentary system and how the state of a person’s health and therapeutic treatments have a direct effect on the condition of the skin. Teach your students how wounds occur (mechanical forces or physical injury). Discuss types of wounds (intentional, unintentional, open and closed, acute and chronic, partial thickness, full thickness, complex) and their causes. Make sure your students understand the physiology of wound healing and can describe the four phases of wound healing (hemostasis, inflammatory, proliferation, maturation). Brainstorm with the class to develop a list of the characteristics of each phase. Discuss the interventions that help support the healing process of a wound. Text page 955– 963 PPT slide 2–20 Figures, Tables, and Features Figures 31-1 A cross-section of normal skin, p. 957, PPT slide 5 Tables 31-1 Functions of the Skin, p. 958 31-2 Factors Placing an Individual at Risk for Skin Alterations, p. 959 31-3 Types of Wounds, p. 961 Boxes 31-1 Principles of Wound Healing, p. 962 Reflective Practice: Cultivating QSEN Competencies Challenge to Ethical and Legal Skills, pp. 956–957 Focus on the Older Adult Nursing Strategies to Address Age-Related Changes in Skin, p. 960 Resources and In-Class Activities Pre-Lecture Quizzes True/False • Wounds that heal by tertiary intention are wounds left open for several days to allow edema or infection to resolve or fluid to drain. • Granulation tissue forms the foundation for scar tissue development during the proliferation phase of wound healing. Discussion Topics Compare and contrast the healing process (including factors that will affect that process) between the following two patients: An elderly patient who presented with a stage I pressure ulcer last week and a 25-year-old with an abdominal stab wound that was surgically repaired 2 days ago. Case Studies You are a nurse in a medical– surgical unit in a hospital caring for a 27-year-old professional football player who underwent surgery to repair a compound fracture of his femur. The surgery went smoothly and you are responsible for his postoperative care after he returns from PACU. • What is his skin’s role in preventing infection before surgery? • Describe how you would expect his wound to heal. • Indicate factors that could affect the healing of his surgical wound. • For which complications Outside Assignments/ Evaluation Written Assignments Visit a health care facility to assess and document the condition of a patient recovering from a serious wound. Write a brief report discussing the process of wound healing, the factors that affect this process, and the condition of the wound assessed. Test Generator Questions Use the test generator software to identify questions related specifically to this objective. *Adaptive Learning Powered by prepU Individualized, adaptive learning through quizzing and remediation is available for this chapter. *Study Guide Instructor’s Notes Taylor, Lillis, Lynn, & LeMone: Fundamentals of Nursing: The Art and Science of Person-Centered Nursing Care, 8th Edition Chapter 31, Skin Integrity and Wound Care 31.2 Identify factors that affect wound healing. Page 4 of 17 Copyright © 2015 Wolters Kluwer Lecture Outline Content Discuss the factors that affect wound healing (age, circulation to and oxygenation of tissues, nutritional status, condition of the wound, immunosuppression, medications, overall patient health). Review the complications that may occur with wound healing (infection, hemorrhage, dehiscence and evisceration, fistula formation) and the psychological effects of wounds on the patient (pain, anxiety, fear, impact on activities of daily living, change in body image). Text page 963– 966 PPT slide 21–27 Figures, Tables, and Features Figures 31-2 Wound complications, p. 965, PPT slide 26 31-3 Fistula, p. 966 Focus on the Older Adult Nursing Strategies to Address Age-Related Changes in Wound Healing, p. 964 Resources and In-Class Activities Pre-Lecture Quizzes Fill-in-the-Blank • The partial or total separation of wound layers is known as , the result of excessive stress on wounds that are not healed. Discussion Topics Compare and contrast the healing process (including factors that will affect that process) between the following two patients: An elderly patient who presented with a stage I pressure ulcer last week and a 25-year-old with an abdominal stab wound that was surgically repaired 2 days ago. List all the physical factors you can think of that can affect wound healing, and provide a strategy to facilitate healing for each factor. Case Studies You are a nurse in a medical– surgical unit in a hospital caring for a 27-year-old professional football player who underwent surgery to repair a compound fracture of his femur. The surgery went smoothly and you are responsible for his postoperative care after he returns from PACU. • What is his skin’s role in preventing infection before surgery? • Describe how you would expect his wound to heal. • Indicate factors that could affect the healing of his surgical wound. Outside Assignments/ Evaluation Written Assignments Visit a health care facility to assess and document the condition of a patient recovering from a serious wound. Write a brief report discussing the process of wound healing, the factors that affect this process, and the condition of the wound assessed. Group Assignments Interview experienced nurses in various health care settings about their experience with caring for patients with pressure ulcers. Then, answer the following related questions and share your findings in a class discussion: • What types of patients may be predisposed to the condition? • What factors contribute to the development of pressure ulcers? • What treatment do you find most effective? • How do you attempt to prevent pressure ulcers in your patients? • Have you incorporated any new methods for treating pressure ulcers in your care plan? • What is the Instructor’s Notes Taylor, Lillis, Lynn, & LeMone: Fundamentals of Nursing: The Art and Science of Person-Centered Nursing Care, 8th Edition Chapter 31, Skin Integrity and Wound Care 31.3 Identify patients at risk for pressure ulcer development. Page 6 of 17 Copyright © 2015 Wolters Kluwer Lecture Outline Content Make sure your students understand pressure ulcer formation and the underlying causes of pressure ulcers. Review the factors that place patients at risk for pressure ulcers (aging skin, chronic illnesses, immobility, malnutrition, fecal and urinary incontinence, altered level of consciousness, spinal cord and brain injuries, neuromuscular disorders). Discuss the mechanisms that contribute to pressure ulcer development including external pressure, friction, and shearing forces. Text page 966– 968 PPT slide 28–29 Figures, Tables, and Features Figures 31-4 Common sites for development of pressure ulcers, p. 967 31-5 Shearing forces can occur when a patient is moved carelessly or slides down in bed, p. 967 Boxes 31-2 Risk Factors for Pressure Ulcer Development, p. 968 Resources and In-Class Activities Pre-Lecture Quizzes Fill-in-the-Blank • A ulcer, a localized area of injury to the skin, may develop when soft tissue is compressed between a bony prominence and an external surface. • Patients who are pulled, rather than lifted, when being moved up in bed or from the bed to the chair are at risk for injury from forces. Discussion Topics Outline strategies to prevent pressure ulcer development in patients. Case Studies You are a visiting nurse caring for a 32-year-old writer who became paraplegic as a result of a motorcycle accident 1 year ago. He is recovering from a subsequent depression; your visits are to monitor not only his emotional outlook but also to encourage his hygienic self- care and offer strategies for his success. He wears a leg bag and is incontinent of stool. You are monitoring a red spot on his left buttock, which has progressed to a pressure ulcer in which subcutaneous fat is visible. • Outline the mechanisms that contributed to the development of the pressure ulcer. • What specific assessments should be performed to prevent formation of pressure ulcers? Outside Assignments/ Evaluation Written Assignments Visit a health care facility to assess and document the condition of a patient recovering from a serious wound. Write a brief report discussing the process of wound healing, the factors that affect this process, and the condition of the wound assessed. Group Assignments Interview experienced nurses in various health care settings about their experience with caring for patients with pressure ulcers. Then, answer the following related questions and share your findings in a class discussion: • What types of patients may be predisposed to the condition? • What factors contribute to the development of pressure ulcers? • What treatment do you find most effective? • How do you attempt to prevent pressure ulcers in your patients? • Have you incorporated any new methods for treating pressure ulcers in your care plan? • What is the Instructor’s Notes Taylor, Lillis, Lynn, & LeMone: Fundamentals of Nursing: The A