Phan, Nam Nguyen's mother fell in the yard and has abrasions on her knees and a deep puncture wound on her left hand, and a laceration on her scalp

Phan, Nam Nguyen's mother fell in the yard and has abrasions on her knees and a deep puncture wound on her left hand, and a laceration on her scalp.  Mr. and Mrs. Nguyen bring her to the clinic for assessment. She is moving all extremities, and expresses pain. No previous treatment has been given.

What should be your first course of action?

What kind of care will Mai need at the clinic?

You determine that the scalp laceration will need to be sutured.  What actions should you take to prepare Mai for the suturing?

One week later Mai arrives at the clinic with Nam Nguyen to have the sutures removed.  The scalp laceration is dried and healed.  When you inspect her other wounds you notice that her left knee is erythematous, warm and painful to touch, and that there is a moderate amount of purulent drainage. 

What assessment questions should you ask?

Nam states that Mai would not allow anyone to help take care of the wound. You cleanse the knee and remove several small pieces of gravel from the wound bed.  The wound is yellow and malodorous.

What kind of care will Nam need to provide to Mai to heal the knee wound?"

Initial Course of Action

 Primary Assessment:

 Check on Mai to see if she is stable on our arrival at the ER.

 G&G: Tertiary survey : Primary assessment should take place in any casualty, potential severe injuries, for instance, head injury due to the scalp laceration, shock, or internal haemorrhage must be checked.

 Palpate for pain and check whether any urgent request for Oropharyngeal area control is necessary.

 Triage the Wounds:

 Assess the severity of each wound: as for the injuries that range from the abrasions, puncture wound the laceration.

 Determine which of the two wound is more dangerous (For instance deep puncture injury coupled with scalp injury need more attention).

 The Clinic: An Exploration of the Possibilities for Care

 Wound Cleansing and Debridement:

 Rinse all the injuries with normal sterile saline solution so as to reduce infection possibilities due to dirt.

 Talking about the deep puncture wound it is very necessary to wash it, puncture wounds are usually prone to infections.

 Suturing Preparation:

 Prepare all the aseptic surgical equipment and preset to suture the wound in the scalp.

 Conventing Mai and her family that everything would be fine, describe the procedure to Mai family so that they do not get tensed.

 Place Mai in a proper position that will enable her to be holding antiseptic on the side of the injury.

 If some our surgery is required for whatever reason, give a local anaesthetic as and when required.

 Seven days later (suture removal, knee bacterial infection)

 Assessment Questions:

 Some general local measures that need to be taken at home for proper wound care are? As to daily care one should inquire a schedule and protocols of cleaning and other dress changes as well as other problems experienced.

 Has Mai indicated any other symptom or newly developed or worsening of the symptoms, pain or flu like symptoms?

 Were there any constraints (fear, lack of information etc. ) that may had denied proper management of the said wound.

 Wound Evaluation:

 Such manifestation as erythema, warmth and purulent discharges are signs of infection in the wound. This is particularly observed by the yellow colour and the bad odour which may indicate bacterial or an abscess formation.

 Interventions:

 Secondly the wound requires local debridement once again so as to remove debris on the tissue.

 By its severity, which is treatable with antibiotics only, topical or oral.

 Educate Nam on proper wound care, including:Teach Nam on how to take care of his wounds:

 The wound:should be washed with saline solutions daily and the correct dressing should be put on it.

 Supervision for signs of worsening of the infection for instance, pain, redness, or pus formation.

 Chronic wound can also lead to inadequate hydration and shield from the usual influences such as pathogenic attack.

 Focus begins and ends with observation, then advise that if the wound fails to heal as directed, one needs to consult a doctor.