Hey there! Welcome back. This is the third instalment of a four-part series – All About Wound Care. In each instalment, we present an aspect of wounds to help you understand wounds and provide functional information to assist your relative’s medical team with better treating the wound.
The more information you can provide to your elderly relative’s doctor or health care team about their wound, the easier it is to treat that wound correctly. A thorough history is important for all diagnoses. Remember the doctor is not around your elderly relative on a daily basis, and can only rely on the information you provide, to help decipher what they see.
You see, the more precise you are with the information, the more reliable the treatment the doctor gives. That is because some things may influence a wound’s healing, and these things are not known by just watching the wound. It is known by taking a history from a close relative.
In the previous blog (http://niceusgeriatric.com/2021/10/03/all-about-wounds-part-two-of-a-four-part-series/ ), we looked at the definition, classification and types of wounds. Not all wounds are equal and some need faster intervention than others do. Today, we look at the basics of wound assessment.
The ability to assess a wound is very important when you have to provide information about the wound. Communication is essential to health care, especially continuity of care, to allow the standard of care to continue. A drop in the standard of care for someone who is ill may be detrimental to that person. Having the knowledge and skill to do a basic assessment of a wound and provide that information to your relative’s medical team is an empowering experience. Moreover, it keeps you actively involved in their care.
So, what is this basic wound assessment? It is a system used to identify a wound so it can be described appropriately to anyone treating the wound or taking care of it. It focuses on the characteristics of the wound and is as follows:
Wound Age Wound Depth Wound Colour
This type of classification is used to determine whether the wound is acute or chronic. It is not a “set” classification because no time frame specifies when an acute wound becomes chronic. It should simply be used as a guide.
Acute wounds are new or relatively new, occurs suddenly, and healing occurs in a timely and predictable manner. An example may be a surgical wound.
Chronic wounds may develop over time, heal slower or stopped healing altogether. An example may be a diabetic ulcer.
This type of classification takes into account how deep the wound is, using the terms partial thickness or full thickness. This is a description also used to classify burns. Check out the blog ( http://niceusgeriatric.com/2021/09/19/all-about-wound-care-a-four-part-series/ ) to understand the meaning of the words – Epidermis, Dermis and Subcutaneous Layer used in the definitions below.
Partial Thickness Wound – involves only the epidermis or extend into the dermis but not through it.
Full Thickness Wound – extends through the dermis into tissues beneath and may expose the subcutaneous layer, muscle or bone.
This type of classification called the “Red-Yellow-Black Classification System” is a commonly used approach to determine how well a wound is healing. There is more detail to this system than mentioned here, but we shall simply focus on a basic guide and not get too technical. This classification is by far the most relevant and most practical to the wound’s description for the relative to relay to the doctor. It is easy to identify for someone who isn’t trained in health care. It is also simpler to communicate this information to your doctor/medical team especially if you are giving information remotely (on the phone/ in a direct message etc)
Red Wounds – typically red wounds indicate healing
Yellow Wounds – may be a sign that healing is hindered and the yellow parts (called slough) may provide a medium for bacterial growth. This wound needs intervention if it was not addressed before.
Black Wounds – black, the least healthy colour is a sign of dead tissue. Healing is slowed and bacterial growth may occur. Please consult your doctor as soon as possible for these types of wounds.
The wound itself may not be totally black or totally yellow, but you may see bits of these colours in the wound.
There are also factors that may influence wound healing and is important information to provide to your health care team. Let’s take a look at these factors.
In the previous blog, we looked at the types of wounds, which heavily influences how fast a wound heals. Even with the best treatment, depending on the type of wound, healing can only occur so fast. Check out the blog if you haven’t before.
Age of person
The age of the person with the wound is a major influencing factor in healing. As explained in the first instalment in this series, the skin goes through degenerative changes as we age, as such the older you are, the more challenges there may be in the healing process.
The location of a wound may pose issues with healing. For example, a wound on the buttocks of someone who is wheelchair-bound may heal slower because the weight of the person is always exerted in that area. A wound on a limb may require elevation to assist with the healing process.
Certain diseases may hinder healing such as Diabetes. Let your doctor know all medical conditions that your loved one suffers from and any recent vital signs you may be monitoring (example blood pressure, blood sugar etc)
If the elderly don’t have a strong support system, whether it be a family member or a certified caregiver, the wound may take a turn for the worst. Having someone to assist with nutritional needs, timely administration of medication, dressing the wound and taking them to their doctor’s appointments are all important to assist with wound healing. They are more dependent and so what used to be easy may be quite a chore if they don’t have help. Having a strong support system is essential to all-around wellness.
As stated before, the information in this series is simply given to provide knowledge and should never be taken as medical advice. Always consult with a doctor for the treatment of wounds. Next week we will look at the Dynamics of Wound Healing. Feel free to share this with someone who may benefit from this knowledge!