{"id":126,"date":"2019-09-12T22:12:06","date_gmt":"2019-09-13T02:12:06","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/?post_type=chapter&#038;p=126"},"modified":"2020-03-23T14:16:56","modified_gmt":"2020-03-23T18:16:56","slug":"4-7-suture-removal","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/chapter\/4-7-suture-removal\/","title":{"raw":"4.7 Suture Removal","rendered":"4.7 Suture Removal"},"content":{"raw":"<h2 style=\"text-align: center\"><strong>Critical Thinking Exercises: Questions, Answers, and Sources \/ References<\/strong><\/h2>\r\nCritical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.\r\n<ol>\r\n \t<li><strong>Jasbir is going home with a lower abdominal surgical incision following a c-section. What patient teaching is important in relation to the wound?<\/strong><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li><em>Smoking cessation strategies if person is willing. <\/em><\/li>\r\n \t<li><em>Promote adequate nutrition with a well-balanced diet that\u00a0<em>includes protein, carbohydrates, fats, and at least\u00a0<\/em>1.5\u20132 L\/day fluid intake.<\/em><\/li>\r\n \t<li><em>Showers are OK. Baths aren\u2019t. Soaking in water might encourage bacterial growth and result in wound infection.<\/em><\/li>\r\n \t<li><em>Protect the wound from friction and shear.<\/em><\/li>\r\n \t<li><em>Wounds can be exposed 48 hours post op if dry and approximated.<\/em><\/li>\r\n \t<li><em>Keep leaking wounds clean (shower) and dry (dressing).<\/em><\/li>\r\n \t<li><em>Report concerns of increased redness, swelling, or unusual drainage.<\/em><\/li>\r\n \t<li><em>Avoid lifting &gt;20 lbs for at least 4 weeks. No abdominal exercising or strain.<\/em><\/li>\r\n \t<li><em>Report any concerns to <\/em><em>HCP<\/em><em> quickly.<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nHealthwise Staff. (2017, May 16). <em>Incision care after surgery<\/em>. HealthLinkBC.\u00a0<a href=\"https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec\">https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec<\/a>\r\n\r\n&nbsp;\r\n<ol start=\"2\">\r\n \t<li><strong>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?<\/strong><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li><em>Risk of infection is still apparent because of the nature of his injury. <\/em><\/li>\r\n \t<li><em>Smoking cessation strategies if person is willing. <\/em><\/li>\r\n \t<li><em>Promote adequate nutrition with a well-balanced diet that\u00a0<em>includes protein, carbohydrates, fats, and at least\u00a0<\/em>1.5\u20132 L\/day fluid intake.<\/em><\/li>\r\n \t<li><em>Showers are OK. Baths aren\u2019t. Soaking in water might encourage bacterial growth and result in wound infection.<\/em><\/li>\r\n \t<li><em>Protect the wound from friction or shear.<\/em><\/li>\r\n \t<li><em>Wounds can be exposed 48 hours post op if dry and approximated.<\/em><\/li>\r\n \t<li><em>Keep leaking wounds clean (shower) and dry (dressing).<\/em><\/li>\r\n \t<li><em>Report concerns of increased redness, swelling, or unusual drainage.<\/em><\/li>\r\n<\/ul>\r\nSources:\r\n\r\nGallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.\r\n\r\nHealthwise Staff. (2017, May 16). <em>Incision care after surgery<\/em>. HealthLinkBC. <a href=\"https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec\">https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec<\/a>\r\n\r\nPerry, A., Potter, P., Ostendorf, W. (2017). \u00a0<em>Clinical Skills and Techniques<\/em> (9th ed.) Elsevier; Mosby.\r\n\r\nStotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.\r\n<ol start=\"3\">\r\n \t<li><strong>What situations warrant staple or suture removal to be a sterile procedure?<\/strong><\/li>\r\n<\/ol>\r\n<em>If the staples are within a wound that is being treated with strict asepsis; for example, an open wound requiring irrigation. <\/em>\r\n<ol start=\"4\">\r\n \t<li><strong>What situations warrant staple or suture removal to be a clean procedure?<\/strong><\/li>\r\n<\/ol>\r\n<em>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.<\/em>\r\n<ol start=\"5\">\r\n \t<li><strong>What is the purpose of applying Steri-Strips to the incision after removing sutures?<\/strong><\/li>\r\n<\/ol>\r\n<em>It provides additional support while the incision is healing.<\/em>\r\n<ol start=\"6\">\r\n \t<li><strong>Which healthcare provider is responsible for assessing the wound prior to removing sutures?<\/strong><\/li>\r\n<\/ol>\r\n<em>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.<\/em>\r\n<ol start=\"7\">\r\n \t<li><strong>What factors increase risk of delayed wound healing?<\/strong><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li><em>Medications: Corticosteroids delay wound healing.\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">Chemo = potential bone marrow suppression = \u2193WBC = impaired immunity.<\/em><\/li>\r\n \t<li><em>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. <\/em><\/li>\r\n \t<li><em>Age: Associated with vascular changes = potential \u2193 oxygen to the tissues = \u2193 potential for healing.<\/em><\/li>\r\n \t<li><em>Smoking: Results in vasoconstriction and arterial damage = potential \u2193 oxygen to the tissues = \u2193 potential for healing.<\/em><\/li>\r\n \t<li><em>Obesity: Obese tissue is poorly vascularized = potential \u2193 oxygen to the tissues = \u2193 potential for healing.<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nGallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.\r\n\r\nPerry, A., Potter, P., Ostendorf, W. (2017). \u00a0<em>Clinical Skills and Techniques<\/em> (9th ed.) Elsevier; Mosby.\r\n\r\nStotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.\r\n<ol start=\"8\">\r\n \t<li><strong>What patient teaching points should be included as ways to support wound healing?<\/strong><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li><em>Keep chronic disease managed; for example, glycemic control for people with diabetes. <\/em><\/li>\r\n \t<li><em>Smoking cessation strategies if person is willing. <\/em><\/li>\r\n \t<li><em>Promote adequate nutrition with a well-balanced diet that\u00a0<em>includes protein, carbohydrates, fats, and at least\u00a0<\/em>1.5\u20132 L\/day fluid intake.<\/em><\/li>\r\n \t<li><em>Showers are OK. Baths aren\u2019t. Soaking in water might encourage bacterial growth and result in wound infection.<\/em><\/li>\r\n \t<li><em>Protect the wound from friction or shear.<\/em><\/li>\r\n<\/ul>\r\nSource:\r\n\r\nHealthwise Staff. (2017, May 16). <em>Incision care after surgery<\/em>. HealthLinkBC. <a href=\"https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec\">https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec<\/a>\r\n\r\n&nbsp;","rendered":"<h2 style=\"text-align: center\"><strong>Critical Thinking Exercises: Questions, Answers, and Sources \/ References<\/strong><\/h2>\n<p>Critical thinking questions are in bold type, and the answers are italicized. Additional resources or references are provided below.<\/p>\n<ol>\n<li><strong>Jasbir is going home with a lower abdominal surgical incision following a c-section. What patient teaching is important in relation to the wound?<\/strong><\/li>\n<\/ol>\n<ul>\n<li><em>Smoking cessation strategies if person is willing. <\/em><\/li>\n<li><em>Promote adequate nutrition with a well-balanced diet that\u00a0<em>includes protein, carbohydrates, fats, and at least\u00a0<\/em>1.5\u20132 L\/day fluid intake.<\/em><\/li>\n<li><em>Showers are OK. Baths aren\u2019t. Soaking in water might encourage bacterial growth and result in wound infection.<\/em><\/li>\n<li><em>Protect the wound from friction and shear.<\/em><\/li>\n<li><em>Wounds can be exposed 48 hours post op if dry and approximated.<\/em><\/li>\n<li><em>Keep leaking wounds clean (shower) and dry (dressing).<\/em><\/li>\n<li><em>Report concerns of increased redness, swelling, or unusual drainage.<\/em><\/li>\n<li><em>Avoid lifting &gt;20 lbs for at least 4 weeks. No abdominal exercising or strain.<\/em><\/li>\n<li><em>Report any concerns to <\/em><em>HCP<\/em><em> quickly.<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>Healthwise Staff. (2017, May 16). <em>Incision care after surgery<\/em>. HealthLinkBC.\u00a0<a href=\"https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec\">https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec<\/a><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"2\">\n<li><strong>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?<\/strong><\/li>\n<\/ol>\n<ul>\n<li><em>Risk of infection is still apparent because of the nature of his injury. <\/em><\/li>\n<li><em>Smoking cessation strategies if person is willing. <\/em><\/li>\n<li><em>Promote adequate nutrition with a well-balanced diet that\u00a0<em>includes protein, carbohydrates, fats, and at least\u00a0<\/em>1.5\u20132 L\/day fluid intake.<\/em><\/li>\n<li><em>Showers are OK. Baths aren\u2019t. Soaking in water might encourage bacterial growth and result in wound infection.<\/em><\/li>\n<li><em>Protect the wound from friction or shear.<\/em><\/li>\n<li><em>Wounds can be exposed 48 hours post op if dry and approximated.<\/em><\/li>\n<li><em>Keep leaking wounds clean (shower) and dry (dressing).<\/em><\/li>\n<li><em>Report concerns of increased redness, swelling, or unusual drainage.<\/em><\/li>\n<\/ul>\n<p>Sources:<\/p>\n<p>Gallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.<\/p>\n<p>Healthwise Staff. (2017, May 16). <em>Incision care after surgery<\/em>. HealthLinkBC. <a href=\"https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec\">https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec<\/a><\/p>\n<p>Perry, A., Potter, P., Ostendorf, W. (2017). \u00a0<em>Clinical Skills and Techniques<\/em> (9th ed.) Elsevier; Mosby.<\/p>\n<p>Stotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.<\/p>\n<ol start=\"3\">\n<li><strong>What situations warrant staple or suture removal to be a sterile procedure?<\/strong><\/li>\n<\/ol>\n<p><em>If the staples are within a wound that is being treated with strict asepsis; for example, an open wound requiring irrigation. <\/em><\/p>\n<ol start=\"4\">\n<li><strong>What situations warrant staple or suture removal to be a clean procedure?<\/strong><\/li>\n<\/ol>\n<p><em>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.<\/em><\/p>\n<ol start=\"5\">\n<li><strong>What is the purpose of applying Steri-Strips to the incision after removing sutures?<\/strong><\/li>\n<\/ol>\n<p><em>It provides additional support while the incision is healing.<\/em><\/p>\n<ol start=\"6\">\n<li><strong>Which healthcare provider is responsible for assessing the wound prior to removing sutures?<\/strong><\/li>\n<\/ol>\n<p><em>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.<\/em><\/p>\n<ol start=\"7\">\n<li><strong>What factors increase risk of delayed wound healing?<\/strong><\/li>\n<\/ol>\n<ul>\n<li><em>Medications: Corticosteroids delay wound healing.\u00a0<\/em><em style=\"text-align: initial;text-indent: 1em;font-size: 1em\">Chemo = potential bone marrow suppression = \u2193WBC = impaired immunity.<\/em><\/li>\n<li><em>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. <\/em><\/li>\n<li><em>Age: Associated with vascular changes = potential \u2193 oxygen to the tissues = \u2193 potential for healing.<\/em><\/li>\n<li><em>Smoking: Results in vasoconstriction and arterial damage = potential \u2193 oxygen to the tissues = \u2193 potential for healing.<\/em><\/li>\n<li><em>Obesity: Obese tissue is poorly vascularized = potential \u2193 oxygen to the tissues = \u2193 potential for healing.<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>Gallagher-Camden, S. (2012). Skin care needs of the obese patient. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.<\/p>\n<p>Perry, A., Potter, P., Ostendorf, W. (2017). \u00a0<em>Clinical Skills and Techniques<\/em> (9th ed.) Elsevier; Mosby.<\/p>\n<p>Stotts, N. A. (2012). Nutritional assessment and support. In R. A. Bryant &amp; D. P. Nix (Eds.),\u00a0<em>Acute and chronic wounds: Current management concepts<\/em>\u00a0(4th ed.). Elsevier; Mosby.<\/p>\n<ol start=\"8\">\n<li><strong>What patient teaching points should be included as ways to support wound healing?<\/strong><\/li>\n<\/ol>\n<ul>\n<li><em>Keep chronic disease managed; for example, glycemic control for people with diabetes. <\/em><\/li>\n<li><em>Smoking cessation strategies if person is willing. <\/em><\/li>\n<li><em>Promote adequate nutrition with a well-balanced diet that\u00a0<em>includes protein, carbohydrates, fats, and at least\u00a0<\/em>1.5\u20132 L\/day fluid intake.<\/em><\/li>\n<li><em>Showers are OK. Baths aren\u2019t. Soaking in water might encourage bacterial growth and result in wound infection.<\/em><\/li>\n<li><em>Protect the wound from friction or shear.<\/em><\/li>\n<\/ul>\n<p>Source:<\/p>\n<p>Healthwise Staff. (2017, May 16). <em>Incision care after surgery<\/em>. HealthLinkBC. <a href=\"https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec\">https:\/\/www.healthlinkbc.ca\/health-topics\/tc4128spec<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"author":397,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-126","chapter","type-chapter","status-publish","hentry"],"part":112,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/126","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":8,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/126\/revisions"}],"predecessor-version":[{"id":712,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/126\/revisions\/712"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/parts\/112"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapters\/126\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/media?parent=126"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/pressbooks\/v2\/chapter-type?post=126"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/contributor?post=126"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/facultyancillaryresourceforclinicalproceduresforsaferpatient\/wp-json\/wp\/v2\/license?post=126"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}