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Practical Issues in Wound, Skin and Ostomy Management
By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
– Each month, Apple Bites brings you a tool you can apply in your daily practice.
Document if the diversion is an intestinal or urinary ostomy, whether it’s temporary or permanent, and the location— abdominal quadrant, skin fold, umbilicus. (See Descriptor reference.) (more…)
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Inappropriate footwear is the most common source of trauma in patients with diabetes. Frequent and proper assessment of appropriate footwear is essential for protecting the diabetic foot from ulceration.
Here is a step-by-step process for evaluating footwear. Be sure to evaluate footwear with the patient walking, standing, and sitting. (more…)
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As full-thickness wounds heal, they begin to fill in from the bottom upward with granulation tissue. At the same time, wound edges contract and pull together, with movement of epithelial tissue toward the center of the wound (contraction). These epithelial cells, arising from either the wound margins or residual dermal epithelial appendages within the wound bed, begin to migrate in leapfrog or train fashion across the wound bed. Horizontal movement stops when cells meet (contact inhibition). The ideal wound edge is attached to and flush with the wound bed, moist and open with the epithelial rim thin, and pale pink to translucent. (more…)
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Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds or ulcerations. It’s also an effective agent to cauterize bleeding in wounds. Silver nitrate is a highly caustic material, so it must be used with caution to prevent damage to healthy tissues. (more…)
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Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here are examples of medications that can affect wound healing.
Assessment and care planning for wound healing should include a thorough review of the individual’s current medications to identify those that may affect healing outcomes. Clinicians must then weigh the risks and benefits of continuing or discontinuing the medications. In some cases, the risk of discontinuing the medication outweighs the importance of wound healing, so the goal of the care plan should be adjusted to “maintain a wound” instead of “healing.” (more…)
Read MoreBy Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here’s an overview of cutaneous candidiasis.
Cutaneous candidiasis is an infection of the skin caused by the yeast Candida albicans or other Candida species. Here’s a snapshot of this condition. (more…)
Read MoreBy Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here’s an overview of performing a comprehensive skin assessment.
In the healthcare setting, a comprehensive skin assessment is a process in which the entire skin of a patient is examined for abnormalities. It requires looking at and touching the skin from head to toe, with a particular emphasis on bony prominences and skin folds. Comprehensive skin assessment is repeated on a regular basis to determine whether changes in the skin’s condition have occurred. The goal of a skin assessment is to identify problem areas promptly for treatment and prevention. (more…)
Read MoreBy Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here’s a brief overview on moldable, bendable, and stretchable adhesive rings and strips used to improve the seal around a stoma.
Adhesive rings and strips can be an alternative to stoma paste for filling or caulking uneven skin contours next to and around a stoma, fistula, or wound. They create a waterproof seal that protects the underlying skin from irritation and are used with (not in place of) the ostomy pouch and skin barrier. Moldable rings and strips may (more…)
Read MoreBy Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice.
Medical gauze, a bleached white cloth or fabric used in bandages, dressings, and surgical sponges, is the most widely used wound care dressing. Commonly known as “4×4s,” gauze is made from fibers of cotton, rayon, polyester, or a combination of these fibers. Surgical gauze must meet standards of purity, thread count, construction, and sterility according to the United States Pharmacopeia. (more…)
Read MoreBy Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice.
Measurement of wounds is an important component of wound assessment and provides baseline measurements, enables monitoring of healing rates, and helps distinguish among wounds that are static, deteriorating, or improving. All alterations in skin integrity, including those caused by ulcers, venous ulcers, arterial ulcers, neuropathic ulcers, incision lines, grafts, donor sites, abscesses, and rashes should be measured when they’re discovered and at intervals thereafter, based on institutional policy. (more…)
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By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice.
Transparent film dressings are thin sheets of transparent polyurethane (polymer) coated with an adhesive. These dressings are available in a variety of sizes and shapes. (more…)
Read MoreBy Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS
Each issue, Apple Bites brings you a tool you can apply in your daily practice.
The crusting procedure produces a dry surface and absorbs moisture from
broken skin through an artificial scab that’s created by using skin barrier powder (stoma powder) and liquid polymer skin barrier. The crusting procedure is most frequently used on denuded peristomal skin to create a dry surface for adherence of an ostomy pouching system while protecting the peristomal skin from effluent and adhesives. Crusting can increase pouching-system wear time, resulting in fewer pouch changes and less disruption to irritated peristomal skin. The crusting procedure can also be used for other denuded partial-thickness weeping wounds caused by moisture. (more…)
