Ask the Treatment Expert about ... surgical incisions
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
I recently admitted my first resident with a surgical incision with staples intact in a hip wound. Do you have tips on how to care for this wound?
First and foremost, ensure that you read and understand the surgeon's order. It must be incorporated into the resident's plan of care. The goals of care provided are wound closure and a return of the area to prior use and function.
Be sure you clearly understand why the surgery was performed. An initial assessment is essential. Is the incision healing as expected? To answer this, the surgical date must be included in the first assessment. If the resident was in good health prior to the surgical intervention, you should expect that the skin of the incision line will form a “healing ridge” within five to nine days.
The healing ridge will appear along the line of the incision. It is palpable tissue, about one-half centimeter thick.
Observe and assess the incision for signs and symptoms of infection. Within the first three to five days after surgery, expect to visualize signs of the healing inflammatory process. After five days, observe for acute signs and symptoms of infection such as:
• Pain in the area around the incision
• Warmth or heat in the tissue surrounding the incision
• Edema of the incision area
• Erythema of the staple line
• Elevated white blood cell count
• Purulent drainage
• Elevated temperature
If any of the signs and symptoms occur, notify the physician immediately. These conditions require close observation and also documentation in the resident's medical record.
Also, ensure that all contact with the physician, physician's assistant or nurse practitioner is documented. If new physician orders are given, be sure these are captured in the care plan by revising the plan of care.