APEARTD

Module overview For many people who have had a stroke, weakness or paralysis on one side – hemiparesis or hemiplegia – is the most obvious symptom. However, brain damage, including stroke, can cause a range of impairments that may be less obvious but equally devastating for people and their families. This module provides an overview of communication, movement and perception difficulties, and the strategies nurses can use to help people cope with any changes to their lives. Keywords agnosia, aphasia, apraxia, cardiovascular, cardiovascular diseases, communication, communication difficulties, nervous system diseases, neurology, stroke. Aims The aim of this module is to provide an overview of communication, movement and perception problems that may persist after a stroke. It considers the effect of these on people and their families, and some of the strategies nurses can use to help them cope with persisting disabilities. Intended learning outcomes After reading this module a

Fundamentação e pontos-chave Este módulo de como suturar uma ferida explora várias técnicas comuns.   O uso de diferentes técnicas de sutura depende de vários fatores, incluindo o tipo de ferida, sua localização, espessura da pele, tensão da ferida e considerações estéticas. Os enfermeiros devem ter uma compreensão abrangente da anatomia relevante e das estruturas subjacentes, e a perícia para determinar que a sutura, em vez de outros métodos de fechamento da ferida, é apropriada em cada caso. Enfermeiros devem trabalhar na sua prática respeitando os protocolos de departamentos acordados. Os enfermeiros devem auditar e refletir sobre sua prática para assegurar que suas habilidades de sutura sejam mantidas e melhoradas. Os enfermeiros devem estar cientes dos procedimentos locais em caso de lesão por picada de agulha. Palavras-chave procedimentos clínicos, habilidades clínicas, suturas, técnicas de sutura, viabilidade de tecidos, tratamento de feridas, encerramento de fer

Evidence base The purpose of suturing is to ( Al-Mubarak and Al-Haddab 2013 ): Close open wounds to minimise infection. Reduce functional loss. Improve the cosmetic results of wound healing. Other methods of closure include staples, steristrips and surgical tissue adhesive. However, sutures are more versatile and are able to close wounds that are unsuitable for other techniques. The primary aim of suturing is to join apposing margins of tissue. Eliminating dead space between the damaged tissues allows healing to progress and minimises the risk of infection by reducing the risk of haematoma formation ( Hollander and Singer 1999 ). A haematoma is a localised collection of blood formed outside of a blood vessel. Haematomas place pressure on healing wounds, thereby increasing the risk of tissue breakdown, and also act as a nutrient-rich medium for bacteria to multiply. The risk of delayed healing is minimised by ensuring that wound margins are everted during suture placement.

Rationale and key points This How to module explores how to suture a wound using several common techniques. The use of different suture techniques depends on various factors, including the type of wound, its location, skin thickness, wound tension and cosmetic considerations. Nurses should have a comprehensive understanding of the relevant anatomy and underlying structures, and the expertise to determine that suturing, rather than other methods of wound closure, is appropriate in each case. Nurses should work within their scope of practice and to agreed departmental protocols. Nurses should audit and reflect on their practice to ensure that their suturing skills are maintained and improved. Nurses should be aware of local procedures in the event of needle-stick injury. Keywords clinical procedures, clinical skills, suturing, suturing techniques, tissue viability, wound care, wound closure, wound management Learning objectives After reading this modul