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Damage to the skin includes moisture-associated skin damage, pressure injuries, incontinence-associated dermatitis, skin tears due to inappropriate caregiver handling, and slow or non-healing surgical wounds. Nurses will also be responsible for monitoring the wound for any signs of infection and providing necessary preventive care. In addition, nurses must educate the patient and their family/caregiver on how to care for the wound at home and provide emotional support and reassurance. With their knowledge, expertise, and compassion, nurses are essential to helping patients heal from denuded wounds.
What is a Denuded Wound?Table of Contents
A denuded wound is an injury that occurs when the protective top layer of the skin is gone, leaving the underlying tissue exposed. This wound is the most severe type and requires immediate medical attention. Denuded wounds are particularly common in elderly patients with fragile skin and an impaired ability to heal. These wounds are especially vulnerable to infection and require special treatment for proper healing and to prevent further damage.
Difference Between Excoriation and Denuded SkinAn excoriation is a wound caused by rubbing or scratching the skin. It is usually superficial and appears as a linear scrape or abrasion on the skin. Denuded wounds occur when the entire upper layer(epidermis) and even parts of the dermis is stripped away or removed due to severe trauma. This type of wound is usually deep and can cause significant damage to the underlying tissue. An excoriated wound typically heals within a few days, while denuded skin wounds may take much longer to heal, depending on the severity of the injury. Additionally, denuded skin wounds are more prone to infection and other complications, making it essential to clean and care for the wound promptly and properly. All nurses and medical professionals should know what can cause a denuded wound, as this education will help prevent its occurrence.
Causes of Denuded WoundsCommon causes of denuded wounds include trauma, burns, surgical procedures, and wound debridement. Trauma can include lacerations, abrasions, and puncture wounds. In addition, medical practices can cause denuded wounds if they involve scraping away the skin, such as in wound debridement. Other causes of denuded wounds include chronic diseases, such as diabetes and vascular disease, which can lead to ulcerations. Additionally, the skin can become denuded by prolonged contact with waste body fluids such as urine, wound exudate, and stool. Nurses must be aware that medical equipment can create a denuded wound. Some equipment responsible for denuded wounds are
Many more devices can create denuded wounds, and they all require careful monitoring by the nurse. Most patients requiring these devices cannot voice complaints about the pain they are experiencing from the device. The nurse must be alert to any damage to the patient and be ready to provide treatment.
Treating Denuded WoundsNurses must be aware that a denuded wound can become infected quickly. This infection can spread to the bloodstream, creating sepsis (a deadly response to widespread infection). To avoid this, the nurse must be skilled at wound management which involves the following:
Most Common Complications Associated with Denuded WoundsThe area where the wound is located may be exposed to repeated trauma such as the perianal area of the elderly. This prevents healThe open condition of a denuded wound makes it particularly difficult to manage and may lead to various complications. The most common complications associated with denuded wounds include infection, poor healing with dehiscence and wound bleeding, necrosis, and scarring.
Increased Risk of Infection
Infections occur when bacteria and other harmful organisms enter the wound and cause an inflammatory (bacteria or trauma damages tissue, causing blood vessels to leak fluid in the tissues, resulting in swelling and pain). The wound can enlarge; tunneling (bacteria eating a hole deeper in the wound) can occur and may result in sepsis. The nurse must check the wound and dressing at least once every 24 hours. Is it hot to touch? Is there a foul odor? Is there increased pain and swelling? Is the wound red and the drainage yellow and copious? Infection is indicated if the answer is yes to any of these questions.
Poor Healing and Dehiscence
Poor healing can also result from infection. Obesity can cause poor wound healing and dehiscence (reopening a closed wound). Wound bleeding and reopening occur when there is pressure on the wound. The patient's medical condition such as malnutrition and diabetes can cause poor healing and wound dehiscence, which may require emergency surgery to reclose the wound.
Necrosis
Necrosis is a form of tissue death. It can occur if blood circulation to the wound is poor. The healthcare provider must remove the skin, and it will be irreversible. Necrosis looks different; in some wounds, it is a thick yellow liquid; sometimes, it is white and soft, and sometimes it appears as a fibrinous wound. The fibrinous wound occurs when infection damages the blood vessels. Gangrenous necrosis occurs when there is no blood flow to the wounded area. Nurses must ensure this does not happen, as necrosis can quickly cause death. The healthcare provider must remove necrosis for healing to occur.
Scarring
Denuded wounds often result in long-term scarring that can cause disfigurement and permanent changes to the appearance of the skin. Scarring that results from a denuded wound can be particularly severe and may not respond to standard treatments. Treatment for denuded wounds is often expensive and may not always successfully eliminate the scarring, though specific techniques may help minimize its appearance.
Preventive Measures to Reduce the Risk of Developing a Denuded WoundAll nurses must know how to prevent or reduce the risk of developing a denuded wound.
The ANA (American Nurse Association) national standards of nursing practice include preventing and controlling healthcare-associated infections and recognizing and responding to clinical deterioration in acute healthcare. All nurses must adopt this practice. Patients will benefit, and you will have the satisfaction of providing care that matches the national standard of nursing care.
STAFF NOTE: Original Community Post
This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:
ReferencesAbout Lydia Seales-Fuller, BSN
Lydia has over ten years of experience as a medical-surgical nurse.
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