Chapter 4: Wound Care
4.7 Suture Removal
Critical Thinking Exercises: Questions, Answers, and Sources / References
Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.
- Jasbir is going home with a lower abdominal surgical incision following a c-section. What patient teaching is important in relation to the wound?
- Smoking cessation strategies if person is willing.
- Promote adequate nutrition with a well-balanced diet that includes protein, carbohydrates, fats, and at least 1.5–2 L/day fluid intake.
- Showers are OK. Baths aren’t. Soaking in water might encourage bacterial growth and result in wound infection.
- Protect the wound from friction and shear.
- Wounds can be exposed 48 hours post op if dry and approximated.
- Keep leaking wounds clean (shower) and dry (dressing).
- Report concerns of increased redness, swelling, or unusual drainage.
- Avoid lifting >20 lbs for at least 4 weeks. No abdominal exercising or strain.
- Report any concerns to HCP quickly.
Source:
Healthwise Staff. (2017, May 16). Incision care after surgery. HealthLinkBC. https://www.healthlinkbc.ca/health-topics/tc4128spec
- Acki is discharged from the clinic following removal of sutures in his knee due to a mountain biking accident. What patient teaching is important in relation to the wound?
- Risk of infection is still apparent because of the nature of his injury.
- Smoking cessation strategies if person is willing.
- Promote adequate nutrition with a well-balanced diet that includes protein, carbohydrates, fats, and at least 1.5–2 L/day fluid intake.
- Showers are OK. Baths aren’t. Soaking in water might encourage bacterial growth and result in wound infection.
- Protect the wound from friction or shear.
- Wounds can be exposed 48 hours post op if dry and approximated.
- Keep leaking wounds clean (shower) and dry (dressing).
- Report concerns of increased redness, swelling, or unusual drainage.
Sources:
Gallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant & D. P. Nix (Eds.), Acute and chronic wounds: Current management concepts (4th ed.). Elsevier; Mosby.
Healthwise Staff. (2017, May 16). Incision care after surgery. HealthLinkBC. https://www.healthlinkbc.ca/health-topics/tc4128spec
Perry, A., Potter, P., Ostendorf, W. (2017). Clinical Skills and Techniques (9th ed.) Elsevier; Mosby.
Stotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant & D. P. Nix (Eds.), Acute and chronic wounds: Current management concepts (4th ed.). Elsevier; Mosby.
- What situations warrant staple or suture removal to be a sterile procedure?
If the staples are within a wound that is being treated with strict asepsis; for example, an open wound requiring irrigation.
- What situations warrant staple or suture removal to be a clean procedure?
Wounds that have been exposed to the environment. Remember, staples are generally removed 7-10 days after insertion. Many wounds will not have a dressing after day 3. If the wound is exposed to the environment, they are contaminated with the bacteria that surrounds them.
- What is the purpose of applying Steri-Strips to the incision after removing sutures?
It provides additional support while the incision is healing.
- Which healthcare provider is responsible for assessing the wound prior to removing sutures?
The person who removes the sutures. If the nurse has doubts about wound healing and believes sutures should not be removed, they must consult the prescriber.
- What factors increase risk of delayed wound healing?
- Medications: Corticosteroids delay wound healing. Chemo = potential bone marrow suppression = ↓WBC = impaired immunity.
- Other chronic disease: Diabetes is characterized by delayed wound healing due to circulatory changes associated with fat, CHO, and protein metabolism. Anemia lowers available oxygen availability to tissues.
- Age: Associated with vascular changes = potential ↓ oxygen to the tissues = ↓ potential for healing.
- Smoking: Results in vasoconstriction and arterial damage = potential ↓ oxygen to the tissues = ↓ potential for healing.
- Obesity: Obese tissue is poorly vascularized = potential ↓ oxygen to the tissues = ↓ potential for healing.
Source:
Gallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant & D. P. Nix (Eds.), Acute and chronic wounds: Current management concepts (4th ed.). Elsevier; Mosby.
Perry, A., Potter, P., Ostendorf, W. (2017). Clinical Skills and Techniques (9th ed.) Elsevier; Mosby.
Stotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant & D. P. Nix (Eds.), Acute and chronic wounds: Current management concepts (4th ed.). Elsevier; Mosby.
- What patient teaching points should be included as ways to support wound healing?
- Keep chronic disease managed; for example, glycemic control for people with diabetes.
- Smoking cessation strategies if person is willing.
- Promote adequate nutrition with a well-balanced diet that includes protein, carbohydrates, fats, and at least 1.5–2 L/day fluid intake.
- Showers are OK. Baths aren’t. Soaking in water might encourage bacterial growth and result in wound infection.
- Protect the wound from friction or shear.
Source:
Healthwise Staff. (2017, May 16). Incision care after surgery. HealthLinkBC. https://www.healthlinkbc.ca/health-topics/tc4128spec