WOUND COMPLICATIONS

1. Wound infection 
     1. Predisposing factors 
          1. Obesity 
          2. Diabetes mellitus 
          3. Malnutrition 
          4. Elderly clients 
          5. Steroids and immunosuppressive agents 
          6. Lowered resistance to infection, as found in clients with cancer 

     2. Assessment findings: redness, tenderness, drainage, heat in incisional area; fever; usually
         occurs 3-5 days after surgery. 
     3. Prevention: see Care on Surgical Floor
     4. Nursing interventions 
          1. Obtain culture and sensitivity of wound drainage (S. aureus most frequently cultured). 
          2. Perform cleansing and irrigation of wound as ordered. 
          3. Administer antibiotic therapy as ordered. 

2. Wound dehiscence and evisceration

     1. Dehiscence: opening of wound edges 
     2. Evisceration: protrusion of loops of bowel through incision; usually accompanied by sudden
         escape of profuse, pink serous drainage 
     3. Predisposing factors to wound dehiscence and evisceration 
          1. Wound infection 
          2. Faulty wound closure 
          3. Severe abdominal stretching (e.g., coughing, retching) 

     4. Nursing interventions for wound dehiscence 
          1. Apply Steri-Strips to incision. 
          2. Notify physician. 
          3. Promote wound healing.

     5.  Nursing interventions for wound evisceration 
          1. Place client in supine position. 
          2. Cover protruding intestinal loops with moist normal saline soaks. 
          3. Notify physician. 
          4. Check vital signs. 
          5. Observe for signs of shock. 
          6. Start IV line. 
          7. Prepare client for OR for surgical closure of wound.