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Category: Resources

Providing evidence-based care for patients with lower-extremity cellulitis

By Darlene Hanson, PhD, RN; Diane Langemo, PhD, RN, FAAN; Patricia Thompson, MS, RN; Julie Anderson, PhD, RN; and Keith Swanson, MD

Cellulitis is an acute, painful, and potentially serious spreading bacterial skin infection that affects mainly the subcutaneous and dermal layers. Usually of an acute onset, it’s marked by redness, warmth, swelling, and tenderness. Borders of the affected skin are characteristically irregular. Although cellulitis may occur in many body areas, this article discusses the most common location—the lower limb. (more…)

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Ankle-brachial index: A dirty word?

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Silence, roving eyes, fidgeting, excuses, a quick subject change—these are typical responses from healthcare clinicians when asked, “What’s the patient’s ankle-brachial index?” You’d think someone had just uttered a dirty word.

The ankle-brachial index (ABI) is a key component of the lower-extremity vascular exam, recommended and in some cases mandated by numerous clinical practice guidelines, including the most recent international guidelines on preventing and treating pressure ulcers. (more…)

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Clinician Resources: Nutrition, Workplace Violence, Pressure Injuries

Learn about resources useful to your practice.

Nutrition and pressure ulcers

Advances in Skin & Wound Care has published “The role of nutrition for pressure ulcer management: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper.” The white paper includes evidence-based nutrition strategies for preventing and managing pressure ulcers. (more…)

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Get the ‘SKINNI’ on reducing pressure ulcers

By Cindy Barefield, BSN, RN-BC, CWOCN

Like many hospitals, Houston Methodist San Jacinto Hospital uses national benchmarks such as the National Database of Nursing Quality Indicators (NDNQI®) to measure quality outcomes. Based on benchmark reports that showed an increased trend of pressure ulcers in critically ill patients in our hospital, the clinical nurses in our Critical Care Shared Governance Unit-Based Council (CCSGUBC) identified an improvement opportunity. (more…)

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Helping patients with lower-extremity disease benefit from exercise

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

Research has shown that exercise can help ease symptoms in patients with arterial insufficiency, venous insufficiency, neuropathic disease, or a combination of these conditions. Here’s what you need to know to ensure your patients reap the most benefits from exercise. (more…)

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Moldable ostomy barrier rings and strips

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. Here’s a brief overview on moldable, bendable, and stretchable adhesive rings and strips used to improve the seal around a stoma.

Benefits

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…)

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Clinical Notes: diabetes, LMW heparin, dressings, lymphedema

Factors affecting medication adherence in patients with diabetes identified

Factors associated with better adherence to antidiabetic medications taken by patients with diabetes include older age, male sex, higher education, higher income, use of mail-order vs. retail pharmacies, primary care vs. nonendocrinology specialist prescribers, higher daily total pill burden, and lower out-of-pocket costs. (more…)

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A collaborative approach to wound care and lymphedema therapy: Part 1

By Erin Fazzari, MPT, CLT, CWS, DWC

Have you seen legs like those shown in the images below in your practice? These images show lymphedema and venous stasis ulcers, illustrating the importance of collaboration between clinicians in two disciplines: lymphedema and wound care. (more…)

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Finding common ground: Surviving wound care communication

By Jennifer Oakley, BS, RN, WCC, DWC, OMS

The author describes how to overcome challenges to effective communication in the healthcare setting.

Accurate communication among healthcare professionals can spell the difference between patient safety and patient harm. Communication can be a challenge, especially when done electronically. With an e-mail or a text, you can’t hear the other person’s voice or see the body language, so it’s easy to misinterpret the words. (more…)

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Palliative wound care: Part 2

This approach brings patient-centered care to life.

 By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA

Editor’s note: This article is the second in a two-part series on palliative wound care. For the first part, click here.

By preventing and relieving suffering, palliative care improves the quality of life for patients facing problems associated with life-threatening illness. This care approach emphasizes early identification, impeccable assessment, and treatment of pain and other issues—physical, psychosocial, and spiritual. (more…)

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If pressure ulcers were apples: A fun inservice program

 By Karen Culp, RN, WCC

I’m one of the nurses responsible for the pressure ulcer prevention education program at the 150-bed skilled nursing facility where I work. We try to keep education sessions simple, fun, and interactive. One day, our administrator asked us to develop a crossword puzzle and “minute to win it” education game that would be appropriate for all staff—registered nurses, licensed practical nurses, certified nursing assistants, and staff from administration, the business office, scheduling, maintenance, dietary, and housekeeping. (more…)

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Evolution of the deep tissue injury or a declining pressure ulcer?

 By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN

A declining pressure ulcer decreases the quality of life for patients and places providers at risk for regulatory citations and litigation. But it’s important for clinicians to determine whether the first appearance of skin injury is truly a stage I or II pressure ulcer or if it’s a deep tissue injury (DTI), a unique staging category for a pressure ulcer. Otherwise, a clinician might think a pressure ulcer is getting worse instead of the change being the normal progression of a pressure ulcer that is presenting as a DTI. (more…)

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