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Practical Issues in Wound, Skin and Ostomy Management
By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
The development of a care plan related to skin integrity can be challenging for any clinician. It takes a strong understanding of skin integrity risk factors and knowledge of how to modify, stabilize, and eliminate those risk factors. This article provides tips for the care-planning process. (more…)
Read MoreBy Judy Bearden, MSN/ED, RN
Changes in healthcare policy and reimbursement are pushing treatment from the hospital to the community. This shift is likely to result in a higher number of complex wounds being treated in the home, which can create stress for patients and families. Education plays a key role in reducing this stress. This article focuses on education for family members or friends who are caregivers for the patient. (more…)
Read MoreBy Catherine R. Ratliff, PhD, APRN-BC, CWOCN, CFCN
It’s estimated that about 70% of the 1 million ostomates in the United States and Canada will experience or have experienced stomal or peristomal complications. Peristomal complications are more common, although stomal complications (for example, retraction, stenosis, and mucocutaneous separation) can often contribute to peristomal problems by making it difficult to obtain a secure pouch seal. This article will help you differentiate types of peristomal complications, including how to prevent and manage them. (more…)
Read MoreBy Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
Prevention of pressure ulcers and skin breakdown begins with a comprehensive risk assessment. Most providers use a skin risk assessment tool, such as the Braden or Norton scale. While these tools have been validated to predict pressure ulcer development, their use alone isn’t considered a comprehensive assessment, and frequently the individual risk factors they identify aren’t carried through to the plan of care. (more…)
Read MoreBy Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
We’ve all experienced how a bad night’s sleep can affect our mood and ability to function the next day. Now imagine you’re a patient who has a pressure ulcer, most likely secondary to a declining disease state, and you’re being awakened and manipulated every 2 hours or in some cases hourly. How is your body supposed to recover without adequate sleep? (more…)
Read MoreBy Jennifer Oakley, BS, RN, WCC, DWC, OMS
I used to think I could do it alone. I took the wound care certification course, passed the certification exam, and took all of my new knowledge—and my new WCC credential—back to the long-term care facility where I worked. I was ready to change the world.
It didn’t take me long to figure out that I couldn’t change the complex world of wound care alone. I needed a team of specialists who could manage my patient’s troubles with nutrition, swallowing, activities of daily living, positioning, body image issues, and many other areas that required expertise I didn’t have. (more…)
Read MoreBy Jeri Lundgren, BSN, RN, PHN, CWS, CWCN
As wound care clinicians, we know that an interdisciplinary, holistic approach to prevention and management of a wound is crucial to positive outcomes, no matter where the patient is being seen. Yet too often when a patient transfers from one care setting to another, the only wound information that’s communicated is the current topical treatment. Most transfer forms only include generic spaces for “any skin concerns” and “treatments,” with no prompts for obtaining additional information. In fact, clinicians in many care settings frequently report they had no idea the patient had a wound until he or she was admitted.
Here’s how you can get the information you need to best care for the patient being transferred. (more…)
Read MoreBy Beth Hoffmire Heideman, MSN, BSN, RN, WCC, DWC, OMS
Fifty shades of wound care at home refers to treating the whole patient and the patient’s caregiving supporters—not just the wound. Only by understanding the nuances, or shades, of a patient and his or her environment can clinicians best achieve desired outcomes.
Wound healing in home care depends on teamwork. Members of the team must understand the unique situation of delivering care in the home and how to help patients adhere to the plan of care. (more…)
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By Kulbir Dhillon, MSN, FNP, APNP, WCC
Venous disease, which encompasses all conditions caused by or related to diseased or abnormal veins, affects about 15% of adults. When mild, it rarely poses a problem, but as it worsens, it can become crippling and chronic.
Chronic venous disease often is overlooked by primary and cardiovascular care providers, who underestimate its magnitude and impact. Chronic venous insufficiency (CVI) causes hypertension in the venous system of the legs, leading to various pathologies that involve pain, swelling, edema, skin changes, stasis dermatitis, and ulcers. An estimated 1% of the U.S. population suffers from venous stasis ulcers (VSUs). Causes of VSUs include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. Preventing VSUs is the most important aspect of CVI management. (more…)
Read MoreAresolution is a serious decision or determination to do, or not to do, something. Traditionally, most New Year’s resolutions focus on self-improvement: losing weight, giving up a bad habit, exercising more, being a better person. Because most of us spend about half of our waking lives at work, perhaps our work lives should be the subject
of some of our resolutions. Here are a few work-related resolutions I’ve come up with: (more…)
Read MoreBy Lydia A. Meyers RN, MSN, CWCN
Missed care, a relatively new concept in the medical community, refers to any part ofrequired patient care that is omitted of delayed. It’s not the same as a mistake or error, but like them, missed care can negatively affect patient outcomes.
I want to share the case of a patient admitted into home health care for wound care. The case includes several areas of missed care from many different different sources. (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.
Hydrated polymer (hydrogel) dressings, originally developed in the 1950s, contain 90% water in a gel base, which helps regulate fluid exchange from the wound surface. Hydrogel dressing are usually clear or translucent and vary in viscosity or thickness. They’re available in three forms: (more…)
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