Determining the best interventions, including dressing selection, for patients and their wounds requires looking at the situation holistically. Creating the treatment plan for a chronic wound is dependent upon many diverse patient, wound, economic, and social considerations. The dressing selection goes beyond simply choosing a product to cover the wound. Detailed assessments of the patient and wound should drive the components of goal-directed wound care. The health-care provider must determine the etiology of the wound, patient comorbidities that may impair the wound healing processes (e.g. diabetes and blood glucose levels), nutrition/hydration status, systemic and local tissue oxygenation, and patient/family concerns such as pain and odor issues. Each of these factors contributes to creating an individualized plan of care for choosing the most appropriate products and interventions.
A thorough wound assessment that looks at tissue types in the wound bed, infection/bioburden and chronic inflammation status, moisture/exudate issues, the edge effect, and the periwound status should be performed at regular intervals. (Please see Chapter 5: Wound Assessment for a review of the wound assessment parameters.)
Chronic wounds are dynamic, evolving as they progress toward closure or disintegrate to a worsened state. Therefore, the choice of dressings and treatments used for wound management must also change in tandem with the characteristics of the wound and the patient’s condition. It is uncommon for the initial wound care plan to remain the same throughout the healing processes. Clinicians should adapt treatments based upon ongoing assessments of the patient and the wound at regular intervals, so changes are made as the wound evolves.
Excerpted from Textbook of Chronic Wound Care: An Evidence-Based Approach to Diagnosis and Treatment with permission from the publisher.