Activity #1:
1. Opening sterile field bag away from us, following principles of sterility
2. Primary intention
3. Use sterile forceps to create a small bun with the gauze, soak with NS, swipe once
downward in the center of the wound, throw in garbage… repeat on the sides of the
wound with a new gauze each time… then dry and apply dressing
 Clean to dirty (wound to surrounding skin)
 Can irrigate OR use forceps and gauze
4. Dressing to upper R thigh changed. No drainage noted to old dressing. Surrounding skin
dry, intact and free of redness. Incision line well approximated with staples in
situ/intact. Cleansed incision site with 0.9% NS dried and covered with Mepore dressing.
Patient tolerated procedure well.
5. Adequate nutrition, contamination, trauma with delayed treatment, infection, long and
invasive surgery, post-op complications
Activity #2:
1. Tertiary wound due to infection
2. Wound is dry – not enough moisture to heal effectively… won’t pull off granulation
tissue
 Also, the packing can be removed more easily
 Can use intra-site gel (better than NS since NS will evaporate and leave behind dry
dressing/packing)
 If too wet, surrounding skin may become oversaturated
3. Everything in wound care bag, NS in irrigation syringe, ruler swabs, larger dressing, tape,
packing strings
4. Old dressing assess the shadowing and drainage, depth, length, type of drainage and
amount, surrounding skin, signs of infection (odour, discharge), assess the tissue within
the wound, tunneling, undermining, patient’s pain (analgesics can be administered prior
to wound care)
5. Aseptic for irrigating and measuring, then sterile technique for packing the wound
6. The size of the dressing should be appropriate for the size of the wound
7. Drainage
8. After because we want to avoid the culture being contaminated by any excess debris
9. Ensuring enough moisture (cream), daily assessments to catch signs of infection prior to
further progression
1. Stress (PSR) can delay wound healing, dietary needs (protein), is patient being cautious
of post-op restrictions? (think PT, OT)
2. Increase protein intake, don’t soak in water, don’t rub wound, avoid picking or
scratching, always wash hands before and after touching the wound, notify doctor if
signs and symptoms of infection (temp > 38C, chills), pain in and around area, bad odour
or pus, increasing redness around wound, swelling does not improve
 Manage diabetes to prevent exacerbations

Teach patient to check other parts of their body for wounds (daily inspection of
entire body -> neuropathy interferes in a diabetic’s ability to assess their body)
3. Dietician, PT, doctor, wound care nurse
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Wounds should be cleaned in the same way prior to removal of sutures/staples
o Remove every other one first
o Monitor for dehiscence – stop and cover the wound if noted during removal,
apply steri strips (going in opposite directions to pull skin together)