Month: March 2017

By: Nancy Morgan, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC

I was thrilled to be asked to write a blog for Wound Care Advisor. They asked me to come up with a name for the blog. I thought it would be easy… NOT ! I found myself doing all this research on how to make up a good name that would be catchy and memorable. I reached out to all my wound care friends for ideas and started a long list of names. Every morning I would look at this list and add more. Then I said I had to STOP THE INSANITY! I had to refocus and asked myself… who are you writing the blog for? It’s for people like me! I am a nurse that is in love with wound care, I have been in this field for almost two decades—ouch! that just dated me. I started at bedside then moved to an educator role co-founding the Wound Care Education Institute where we have taught over 16,000 clinicians, spreading the knowledge of Wound Care so they can make a difference in their patients’ lives. I am that person that “gets the rush” every time I see a wound. (more…)

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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Wound healing and nutrition go hand in hand. Without adequate fluids, calories, and protein, wound healing can be delayed.

Protein is extremely important in wound healing. Patients with wounds require almost double the protein intake (1.2 to 1.5 g/kg/day) of those without wounds. All stages of wound healing require adequate protein. The basis of the human body structure, protein is responsible for making enzymes involved in wound healing, cell multiplication, and collagen and connective-tissue building. (more…)

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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Support surfaces are geared for managing our patients’ tissue load and redistributing it to prevent skin breakdown. There are three types of pressure redistribution mattresses available, classified as group 1, group 2, and group 3.  Group 1 mattresses lack a power source and maintain a constant state of inflation.  They include foam mattresses, gel mattresses, and air mattresses.  Group 2 support surfaces, such as powered, low-air-loss, and alternating pressure mattresses use inflation and deflation to spread the tissue load over a large surface area. Group 3 mattresses include the air-fluidized mattress, a special type of powered mattress that provides the highest-pressure redistribution via a fluid-like medium created by forcing air through beads, as characterized by immersion and envelopment. (more…)

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By Nancy Morgan, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Staging pressure ulcers can get tricky, especially when we’re dealing with a suspected deep-tissue injury (SDTI). The National Pressure Ulcer Advisory Panel defines an SDTI as a “purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue… Deep tissue injury may be difficult to detect in individuals with dark skin tones. Evolution may include a thin blister over a dark wound bed. The wound may further evolve and become covered by thin eschar. Evolution may be rapid, exposing additional layers of tissue even with optimal treatment.” (more…)

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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
We’ve talked about types of exudate (drainage). Now let’s consider the amount of exudate in wounds, which is a key part of our assessment.

No exudate present: The wound is too dry.
Scant amount of exudate present: The wound is moist, even though no measurable amount of exudate appears on the dressing.
Small or minimal amount of exudate on the dressing: Exudate covers less than 25% of the bandage. (more…)

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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
Lower extremity ulcers are often referred as the “big three”—arterial ulcers, venous ulcers, and diabetic foot ulcers. Are you able to properly identify them based on their characteristics? Sometimes, it’s a challenge to differentiate them.

Arterial ulcers tend occur the tips of toes, over phalangeal heads, around the lateral malleolus, on the middle portion of the tibia, and on areas subject to trauma. These ulcers are deep, pale, and often necrotic, with minimal granulation tissue. Surrounding skin commonly is pale, cool, thin, and hairless; toenails tend to be thick. Arterial ulcers tend to be dry with minimal drainage, and often are associated with significant pain. The patient usually has diminished or absent pulses. (more…)

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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
An essential part of weekly wound assessment is measuring the wound. It’s vitally important to use a consistent technique every time you measure. The most common type of measurement is linear measurement, also known as the “clock” method. In this technique, you measure the longest length, greatest width, and greatest depth of the wound, using the body as the face of an imaginary clock. Document the longest length using the face of the clock over the wound bed, and then measure the greatest width. On the feet, the heels are always at 12 o’clock and the toes are always 6 o’clock. Document all measurements in centimeters, as L x W x D. Remember—sometimes length is smaller than width. (more…)

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BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC
You’ve identified your patient’s lower extremity ulcer as a venous ulcer. It has irregular edges, a ruddy wound base, and a moderate amount of drainage. The patient’s bilateral lower extremities are edematous. As a wound care clinician, you know sustained graduated compression is key to healing stasis ulcers and preventing their recurrence. (more…)

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