31.1 Discuss the processes involved in wound healing

Taylor, Lillis, Lynn, & LeMone: Fundamentals of Nursing: The Art and Science of Person-Centered Nursing Care, 8th Edition

Lesson PlanChapter 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.......................................................................................................................................................................................................231.2 Identify factors that affect wound healing...................................................................................................................................................................................................................531.3 Identify patients at risk for pressure ulcer development..............................................................................................................................................................................................731.4 Describe the method of staging of pressure ulcers......................................................................................................................................................................................................931.5 Accurately assess and document the condition of wounds........................................................................................................................................................................................1231.6 Provide nursing interventions to prevent pressure ulcers..........................................................................................................................................................................................1431.7 Implement appropriate dressing changes for different kinds of wounds...................................................................................................................................................................1831.8 Provide information to patients and caregivers for self-care of wounds at home.....................................................................................................................................................2131.9 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 EditionChapter 31, Skin Integrity and Wound Care

31.1 Discuss the processes involved in wound healing.

Lecture OutlineFigures, Tables, and Features

Resources and In-Class Activities

Outside Assignments/ Evaluation Instructor’s Notes

Content Text page

PPT slide

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.

955–963

2–20 Figures31-1 A cross-section of normal skin, p. 957, PPT slide 5

Tables31-1 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

Boxes31-1 Principles of Wound Healing, p. 962

Reflective Practice: Cultivating QSEN CompetenciesChallenge to Ethical and Legal Skills, pp. 956–957

Focus on the Older AdultNursing Strategies to Address Age-Related Changes in Skin,

Pre-Lecture QuizzesTrue/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 TopicsCompare 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 StudiesYou 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

Written AssignmentsVisit 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 QuestionsUse the test generator software to identify questions related specifically to this objective.

*Adaptive Learning Powered by prepUIndividualized, adaptive learning through quizzing and remediation is available for this chapter.

*Study Guide

Page 2 of 22Copyright © 2015 Wolters Kluwer


p. 960 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 would you monitor his wound?

Outline signs and symptoms that might indicate his wound is infected. In what time frame might they appear?

Apply the ConceptsNCLEX-Style Review Questions: Students can use the NCLEX-Style Review Questions to review and practice for the NCLEX.

Concepts in Action Animations Hemostasis Wound Healing

Journal ArticleMedical Adhesives and Patient Safety Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive-Related Skin



Injuries. Journal of the Dermatology Nurses' Association.

Spanish-English Audio Glossary




31.2 Identify factors that affect wound healing.




Content Text page

PPT slide

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).

963–966

21–27 Figures31-2 Wound complications, p. 965, PPT slide 26

31-3 Fistula, p. 966

Focus on the Older AdultNursing Strategies to Address Age-Related Changes in Wound Healing, p. 964

Pre-Lecture QuizzesFill-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 TopicsCompare 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 StudiesYou are a nurse in a medical–surgical unit in a hospital caring for a 27-year-old professional football player


Group AssignmentsInterview 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?



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 would you monitor his wound?

Outline signs and symptoms that might indicate his wound is infected. In what time frame might they appear?



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 psychological effect of pressure ulcers on the patient?



*Study Guide




31.3 Identify patients at risk for pressure ulcer development.




Content Text page

PPT slide

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.

966–968

28–29 Figures31-4 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

Boxes31-2 Risk Factors for Pressure Ulcer Development, p. 968

Pre-Lecture QuizzesFill-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 TopicsOutline strategies to prevent pressure ulcer development in patients.

Case StudiesYou 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?

How would you stage his pressure ulcer?

Indicate the information that would be included in an assessment of his wound.

Identify appropriate outcomes for this patient’s plan of care.









*Study Guide




31.4 Describe the method of staging of pressure ulcers.




Content Text page

PPT slide

Be sure your students understand how pressure ulcers develop from blanching of the skin through the four stages of pressure ulcer development.

Review the process for cleaning and dressing a pressure ulcer.

968–971

30–35 Boxes31-3 Comparison of Stages of Pressure Ulcers, pp. 970–971

Research in NursingBridging the Gap to Evidence-Based Practice, p. 969

Pre-Lecture QuizzesTrue/False The first indication that a

pressure ulcer may be developing is a blanching of the skin over the area under pressure.

Case StudiesYou 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


What specific assessments should be performed to prevent formation of


Make a list of the type of blended skills you will need to diagnose and treat patients with alterations in skin integrity.




pressure ulcers? How would you stage his

pressure ulcer? Indicate the information

that would be included in an assessment of his wound.










Clinical AssignmentsWork in pairs to identify the pressure points on the body most susceptible to the development of a pressure ulcer. Devise positions to alleviate specific pressure ulcers and eliminate the effect of friction and shearing forces.

Test Generator Questions



Use the test generator software to identify questions related specifically to this objective.


*Study Guide




31.5 Accurately assess and document the condition of wounds.




Content Text page

PPT slide

Teach your students to use the nursing process for wound assessment. Discuss the techniques (inspection and palpation) used to assess wounds and make other important assessment observations (such as the existence of sutures, drains or tubes, manifestations of complications).

Review the NANDA nursing diagnoses in the textbook and brainstorm with the class to develop a list of possible diagnoses for patients with wounds.

973–981, 995–996

32, 36–37

Figures31-6 Incision with sutures, p. 976

31-7 Braden scale for predicting pressure sore risk, p. 977

31-8 Pressure Ulcer Scale for Healing (PUSH) PUSH Tool 3.0, p. 979, PPT slide 32

31-19 Wound and skin assessment/documentation tool, p. 995

31-20 Electronic wound and skin assessment/documentation tool, p. 996

Tables31-4 Common Types of Drains, p. 975

Boxes31-4 RYB Wound Classification, p. 976

Pre-Lectures QuizzesTrue/False Serosanguineous drainage,

which is clear and watery, is composed primarily of the clear, serous portion of the blood and from serous membranes.

There is no standard frequency for how often dressings should be changed.

Fill-in-the-Blank Dead tissue that appears as

dry, black, and leathery is known as ________, which delays wound healing.

Case StudiesYou 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


Make a list of the type of blended skills you will need to diagnose and treat patients with alterations in skin integrity.


*Adaptive Learning Powered by prepUIndividualized, adaptive learning through



Focused Assessment GuideSkin Integrity, p. 974

Guidelines for Nursing31-1 Measuring Wounds and Pressure Ulcers, p. 975

Examples of NANDA-I Nursing DiagnosesPatient With a Wound or Pressure Ulcer, p. 980

Examples of Nursing Interventions and Nursing Outcomes Classifications (NIC/NOC)Risk for Impaired Skin Integrity, p. 981

Promoting Health LiteracyIn Patients With Breast Cancer, p. 981

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








quizzing and remediation is available for this chapter.

*Lippincott DocuCare: Fundamentals: Wound Care: Irwina Russellinski

*Study Guide




31.6 Provide nursing interventions to prevent pressure ulcers.




Content Text page

PPT slide

Teach your students to use the nursing process to develop a plan of care to prevent or minimize pressure ulcers. Explain to your students how to use risk assessment forms such as the Norton scale and the Braden scale.

Discuss the type of information that should be collected in a nursing history designed to assess for skin integrity.

Discuss nursing interventions to prevent injury to the skin and to promote optimal health.

981–982, 994

Guidelines for Nursing Care31-2 Preventing Pressure Ulcers, p. 982

Discussion TopicsOutline strategies to prevent pressure ulcer development in patients.

Case StudiesYou 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




Written AssignmentsMake a list of the type of blended skills you will need to diagnose and treat patients with alterations in skin integrity.





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?


Interview someone with a skin alteration regarding the psychological effects that person is experiencing as well as the effect of the wound on the person’s activities of daily living. After preparing a list of possible effects, identify nursing interventions to minimize these complications. In a class discussion, express whether you feel comfortable taking care of a patient with a skin alteration and what you could do to improve your skills in this area.

Clinical AssignmentsWork in pairs to identify the pressure points on the body most susceptible to the



development of a pressure ulcer. Devise positions to alleviate specific pressure ulcers and eliminate the effect of friction and shearing forces.

Web AssignmentsSearch the Internet for nursing articles discussing new methods of treating pressure ulcers. Identify information patients may need to care for their wounds at home. Report your findings to the class.



*Study Guide






31.7 Implement appropriate dressing changes for different kinds of wounds.




Content Text page

PPT slide

Describe the two methods of caring for wounds (closed method and open method) and review when and why each method is used.

Discuss the types and purposes of dressings available for wound healing. Make sure the students understand that the number and types of dressings used depend on the location and size of the wound and the amount and type of drainage.

Review the procedure for cleaning a wound and changing a dressing. Demonstrate the procedure and have the students practice it with a partner.

Discuss the use of wound drains, tubes, and catheters and how to care for them.

Review the procedure for obtaining a wound culture.

Discuss the care of open wounds, infected wounds, and chronic wounds. Review the color classification system for care of an open wound (R, Y, B).

982–993

35–46 Figures31-9 Surgical pad applied as last layer of wound dressing, p. 983

3-10 Precut dressing placed around surgical drain, p. 983

31-11 Transparent film dressing placed on intravenous access site, p. 984

31-12 Hydrocolloid dressing in place on wound, p. 984

31-13 Techniques for applying various bandages, p. 989

31-14 Montgomery straps make it possible to care for a wound without removing adhesive strips with each dressing change, p. 990

31-15 Penrose drain,

Pre-Lecture QuizzesFill-in-the-Blank Ties attached to an

adhesive backing to hold dressings in place are known as _____________ straps.


Watch & Learn Videos Skin Integrity and Wound

Care: Irrigating a Wound Using Sterile Technique

Practice & Learn Interactive Case Studies Cleaning a Wound and

Applying Sterile Dressing


Group AssignmentsInterview someone with a skin alteration regarding the psychological effects that person is experiencing as well as the effect of the wound on the person’s activities of daily living. After preparing a list of possible effects, identify nursing interventions to minimize these complications. In a class discussion, express whether you feel comfortable taking care of a patient with a skin alteration and what you could do to improve your skills in this area.

Clinical AssignmentsYour teacher will provide a variety of bandages, binders, and/or other wound care products. Take turns demonstrating their use by applying them to a partner while ensuring asepsis.



p. 990, PPT slide 44

31-16 Jackson-Pratt drain, p. 991, PPT slide 45

31-17 Hemovac drain, p. 991

31-18 Applying Steri-Strips on an incision,p. 992

Tables31-5 Examples of Wound Dressings/Products, pp. 985–986

31-6 Types of Tape, p. 988

Guidelines for Nursing Care31-3 Cleaning Wounds, p. 987

31-4 Applying Bandages and Binders, p. 988

31-5 Removing Staples and Sutures, p. 993

Skills 31-1 Cleaning a

Wound and Applying a Dry,



*Study Guide



Sterile Dressing, pp. 1004–1009

31-2 Applying a Saline-Moistened Dressing, pp. 1009–1012

31-3 Performing Irrigation of a Wound, pp. 1013–1016

31-4 Caring for a Jackson-Pratt Drain, pp. 1017–1019

31-5 Caring for a Hemovac Drain, pp. 1019–1022

31-6 Collecting a Wound Culture, pp. 1022–1026

31-7 Applying Negative-Pressure Wound Therapy, pp. 1026–1029




31.8 Provide information to patients and caregivers for self-care of wounds at home.




Content Text page

PPT slide

Review the methods for obtaining dressing supplies and reimbursement for these supplies. Discuss infection prevention in the home, and interventions to promote wound healing.

Discuss the following sentence: “Education is a vital component in the treatment of pressure ulcers.” What is the nurse's role in educating the patient and family regarding management and treatment strategies?

972–973, 993–994

47–48 Focused Critical Thinking Guide31-1 Wound Care: Promoting Acceptance of Changes in Body Image, p. 972

Teaching Tips31-1 Wound Care and Healing, p. 994



Web AssignmentsSearch the Internet for nursing articles discussing new methods of treating pressure ulcers. Identify information patients may need to care for their wounds at home. Report your findings to the class.



*Study Guide




31.9 Apply hot and cold therapy effectively and safely.




Content Text page

PPT slide

Teach your students how to apply heat and cold to a specific part or all of a patient's body to bring about local or systemic change in body temperature. Discuss the various devices for applying heat or cold.

Explain the physiologic effects of the application of heat and cold and the nursing care necessary for patients receiving heat and cold therapy.

996–1003

49–53 Figures31-21 Cloth-wrapped ice bag, p. 1000

Guidelines for Nursing Care31-6 Assisting With a Sitz Bath, p. 999

Nursing Plan of Care31-1 For Mary Biesicker, pp. 1002–1003

FeaturesConcept map displaying the nursing process for Lucius Everly, p. 1001

Skills 31-8 Applying an

External Heating Pad, pp. 1030–1032



Web AssignmentsUse the Internet to research the use of hot and cold therapy for bringing about a change in body temperature. Note any new therapies regarding this practice, and report your findings to the class.



*Study Guide



Documents

31.1 Discuss the processes involved in wound healing