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Melakukan Asuhan Keperawatan (Askep) merupakan aspek legal bagi seorang perawat walaupun format model asuhan keperawatan di berbagai rumah sakit berbeda-beda. Seorang perawat Profesional di dorong untuk dapat memberikan Pelayanan Kesehatan seoptimal mungkin, memberikan informasi secara benar dengan memperhatikan aspek legal etik yang berlaku. Metode perawatan yang baik dan benar merupakan salah satu aspek yang dapat menentukan kualitas “asuhan keperawatan” (askep) yang diberikan yang secara langsung maupun tidak langsung dapat meningkatkan brand kita sebagai perawat profesional. Pemberian Asuhan keperawatan pada tingkat anak, remaja, dewasa, hingga lanjut usia hingga bagaimana kita menerapkan manajemen asuhan keperawatan secara tepat dan ilmiah diharapkan mampu meningkatkan kompetensi perawat khususnya di indonesia

Cuts, Scrapes and Puncture Wounds

What is the best way to care for a cut or scrape?

The first step in the care of cuts and scrapes is to stop the bleeding. Most wounds respond to gentle direct pressure with a clean cloth or bandage. Hold the pressure continuously for approximately 10-20 minutes. If this fails to stop the bleeding or if bleeding is rapid you should seek medical assistance.

The next step is to thoroughly clean the wound with soap and water. Remove any foreign material, such as dirt or bits of grass, that might be in the wound and which can lead to infection. You may use tweezers (clean them with alcohol first) to remove foreign material from the wound edges, but do not dig into the wound as this may push bacteria deeper into the wound. You may also gently scrub the wound with a washcloth to remove dirt and debris. Hydrogen peroxide and providone-iodine (Betadine) products may be used to clean the wound initially, but may inhibit wound healing if used long-term.

Cover the area with a bandage (such as gauze or a Band-Aid) to help prevent infection and dirt from getting in the wound. A first aid antibiotic ointment such as Bacitracin or Neosporin can be applied to help prevent infection and keep the wound moist.

Continued care to the wound is also important. Three times a day, wash the area gently with soap and water, apply an antibiotic ointment and cover with a bandage. Also, change the bandage immediately if it gets dirty or wet.
Who should seek medical care for a cut?

If you cannot control the bleeding from a cut, seek medical attention. Any cut that goes beyond the top layer of skin or is deep enough to see into might need stitches (sutures), and should be seen by a healthcare professional as soon as possible. Generally, the sooner sutures are put in, the lower the risk of infection. Ideally, wounds should be repaired within six hours of the injury.

People with suppressed immune systems (including diabetics, cancer patients on chemotherapy, people who take steroid medications, such as prednisone, or people with HIV) are more likely to develop a wound infection and should be seen by a healthcare professional.

Any wound that shows signs of infection should be seen by a healthcare professional (the "What are the signs of a wound infection" section).
What are the signs of a wound infection?

If the wound begins to drain yellow or greenish fluid (pus), or if the skin around the wound becomes red, warm, swollen, or increasingly painful; a wound infection may be present and medical care should be sought. Any red streaking of the skin around the wound may indicate an infection in the system that drains fluid from the tissues, called the lymph system. This infection (lymphangitis) can be serious, especially if it is accompanied by a fever. Prompt medical care should be sought if streaking redness from a wound is noticed.
How are puncture wounds different?

A puncture wound is caused by an object piercing the skin, creating a small hole. Some punctures can be very deep, depending on the source and cause.

Puncture wounds do not usually bleed much, however, treatment is necessary to prevent infection. A puncture wound can cause infection because it forces bacteria and debris deep into the tissue and the wound closes quickly forming an ideal place for bacteria to grow.

For example, if a nail penetrates deep into the foot, it can hit a bone and introduce bacteria into the bone. This risk is especially great if an object has gone through a pair of sneakers. The foam in sneakers can harbor a bacteria (Pseudomonas) that can lead to serious infection in the tissues.

First aid for puncture wounds includes cleaning the area thoroughly with soap and water. These wounds are very difficult to clean out. If the area is swollen, ice can be applied and the area punctured should be elevated. Apply antibiotic ointments (bacitracin or Polysporin) to prevent infection. Cover the wound with a bandage to keep out harmful bacteria and dirt.

Monitor at least daily (ideally three times a day) for signs of infection (the same signs as above in the cuts section). Change the bandage at least daily, or any time it becomes wet or dirty.

Additionally, people with suppressed immune systems or any particularly deep puncture wounds should be seen by a healthcare professional. If it is difficult to remove the puncturing object, it may have penetrated the bone and requires medical care.

Most puncture wounds do not become infected, but if redness, swelling or bleeding persists, see your healthcare professional.

Feet are a particular concern. Wear shoes to minimize the risk of a puncture wound from a nail or glass, especially if you have diabetes or loss of sensation in the feet for any reason.

Additional common causes of puncture wounds can include animal or human bites, or splinters from wood or other plant material, which carry a high risk of infection and should be treated by a physician.

Will I need a tetanus shot?

Most people in the United States have been immunized against tetanus (lockjaw). If you have been immunized, you will need a booster shot if you have not had one within 10 years (if it is a very dirty wound or occurs in a tetanus prone area-you need a booster within five years). If you have never had a tetanus shot, or if your series is incomplete (fewer than three shots), you might need tetanus immunoglobulin, a medication that can prevent lockjaw.
Cuts, Scrapes & Puncture Wounds At A Glance

* Washing a cut or scrape with soap and water and keeping it clean and dry is all that is required to care for most wounds.

* Cleaning the wound with hydrogen peroxide and iodine is acceptable initially but can delay healing and should be avoided long-term.

* Apply antibiotic ointment and keep the wound covered.

* Seek medical care within six hours if you think you might need stitches. Any delay can increase the rate of wound infection.

* Any puncture wound through sneakers has a high risk of infection and should be seen by your healthcare professional.

* Any redness, swelling, increased pain, fever or pus draining from the wound may indicate an infection that requires professional care.