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Pressure Injury

Pressure Injury

localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. It can present as intact skin or an open ulcer and may be painful. It occurs as a result of intense or prolonged pressure or pressure in combination with shear.

  1. FAQs for pressure ulcer staging

    pressure ulcer stagingBy Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Staging pressure ulcers can be challenging. Below are some common questions—and answers—about staging. Q. If a pressure ulcer heals (completely epithelialized over), but later reopens at the same site, how should it… Read more…

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  2. Guidelines for safe negative-pressure wound therapy

    safe negative-pressure wound therapyBy Ron Rock MSN, RN, ACNS-BC Since its introduction almost 20 years ago, negative-pressure wound therapy (NPWT) has become a leading technology in the care and management of acute, chronic, dehisced, traumatic wounds; pressure ulcers; diabetic ulcers; orthopedic trauma; skin… Read more…

    Comments: 7 Comments

  3. Pressure mapping: A new path to pressure-ulcer prevention

    pressure-ulcer preventionBy: Darlene Hanson, MS, RN, Pat Thompson, MS, RN, Diane Langemo, PhD, RN, FAAN,  Susan Hunter, MS, RN, and Julie Anderson, PhD, RN, CCRC Faced with the nursing diagnosis of Impaired skin integrity, we've all written care plans that state… Read more…

    Comments: 4 Comments

  4. Using maggots in wound care: Part 1

    maggots in wound careBy: Ronald A. Sherman, MD; Sharon Mendez, RN, CWS; and Catherine McMillan, BA Maggot therapy is the controlled, therapeutic application of maggots to a wound. Simple to use, it provides rapid, precise, safe, and powerful debridement. Many wound care professionals… Read more…

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  5. A pressure ulcer by any other name

    Just when we think we’ve figured out pressure ulcer staging, it changes again. In April 2016, the National Pressure Ulcer Advisory Panel (NPUAP) held a consensus conference on staging definitions and terminology. The purpose: to analyze and discuss the rationale for the panel’s changes. One of the… Read more…

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  6. Why not call it a pressure ulcer?

    By: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS The most basic principle of healing a wound is to determine the cause—and then remove it. This is easier said than done, as many wounds have similar characteristics and we don’t… Read more…

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  7. Device–related pressure ulcers: Avoidable or not?

    device related pressure ulcerBy: Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS A medical device–related pressure ulcer (MDRPU) is defined as a localized injury to the skin or underlying tissue resulting from sustained pressure caused by a medical device, such as a brace; splint;… Read more…

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  8. Preventing pressure ulcers starts on admission

    By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN The first 24 hours after a patient’s admission are critical in preventing pressure ulcer development or preventing an existing ulcer from worsening. A skin inspection, risk assessment, and temporary care plan should… Read more…

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  9. Improving outcomes with noncontact low-frequency ultrasound

    By Ronnel Alumia, BSN, RN, WCC, CWCN, OMS Achieving excellent wound care outcomes can be challenging, given the growing number of high-risk patients admitted to healthcare facilities today. Many of these patients have comorbidities, such as obesity, diabetes, renal disease,… Read more…

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  10. Developing a cost-effective pressure-ulcer prevention program in an acute-care setting

    By Tamera L. Brown, MS, RN, ACNS-BC, CWON, and Jessica Kitterman, BSN, RN, CWOCN Pressure ulcers take a hefty toll in both human and economic terms. They can lengthen patient stays, cause pain and suffering, and increase care costs. The… Read more…

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  11. 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… Read more…

    Comments: 2 Comments

  12. Medical gauze 101

    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. Medical gauze, a bleached white cloth or fabric used in bandages, dressings, and surgical sponges,… Read more…

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  13. Skin problems with chronic venous insufficiency and phlebolymphedema

    Dermatologic difficulties: Skin problems in patients with chronic venous insufficiency and phlebolymphedema By Nancy Chatham, RN, MSN, ANP-BC, CWOCN, CWS; Lori Thomas, MS, OTR/L, CLT-LANA; and Michael Molyneaux, MD Skin problems associated with chronic venous insufficiency (CVI) and phlebolymphedema are… Read more…

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  14. Assessing risk of pressure and moisture-related problems in long-term care patients

    By Patricia A. Slachta, PhD, RN, ACNS-BC, CWOCN Assessing moisture and pressure risk in elderly patients continues to be a focus for clinicians in all settings, particularly long-term care. Ongoing research challenges our ideas about and practices for cleansing and… Read more…

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  15. Immobility as the root cause of pressure ulcers

    By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN Many factors can contribute to the formation of a pressure ulcer, but it’s rare that one develops in an active, mobile patient. As the National Pressure Ulcer Advisory Panel 2014 guidelines state,… Read more…

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  16. The Buzz Report: A wound care clinician’s best friend

    Clinician Knowledge NursingBy Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS In 2014, more than 8,000 new articles related to wound healing were added to the PubMed online database and hundreds of new patents for topical wound formulations were filed. Staying up-to-date… Read more…

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  17. Clinician Resources: Nutrition, Treatment Algorithms, Pressure Ulcer Prevention

    Check out these resources for your practice. Be a nutrition champion One in three patients enters a hospital malnourished. Fight malnutrition by viewing six short videos from the Alliance to Advance Patient Nutrition, including “Rapidly Implement Nutrition Interventions” and “Recognize… Read more…

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  18. Understanding therapeutic support surfaces

    By Rosalyn S. Jordan, BSN, RN, MSc, CWOCN, WCC, and Sandra Phipps, BSN, RN, MBA, WCC Pressure-ulcer prevention and management guidelines recommend support-surface therapy to help prevent and treat pressure ulcers. Support surfaces include pads, mattresses, and cushions that redistribute… Read more…

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  19. Clinical Notes: Aspirin, Skin Infections, NPWT surgical incisions

    Aspirin inhibits wound healing A study in the Journal of Experimental Medicine describes how aspirin inhibits wound healing and paves the way for the development of new drugs to promote healing. The authors of “12-hydroxyheptadecatrienoic (12-HHT) acid promotes epidermal wound… Read more…

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  20. Clinician Resources: human trafficking, npuap, caregiver, ostomy, HIV

    Check out the following resources, all designed to help you in your clinical practice. Human trafficking resources Victims of human trafficking often suffer tremendous physical and psychological damage. Clinicians play an important role in identifying potential victims so they can obtain help. Here are some… Read more…

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  21. Frequently asked questions about support surfaces

    The National Pressure Ulcer Advisory Panel (NPUAP) describes support surfaces as “specialized devices for pressure redistribution designed for management of tissue loads, microclimate, and/or other therapeutic functions.” These devices include specialized mattresses, mattress overlays, chair cushions, and pads used on… Read more…

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  22. Clinical Notes: Pressure-Ulcer Data, Diabetic Foot Ulcers, IFG & HbA1c

    Hospital pressure-ulcer comparison data not accurate Performance scores for rates of hospital-acquired pressure ulcers might not be appropriate for comparing hospitals, according to a study in the Annals of Internal Medicine. “Hospital report cards for hospital-acquired pressure ulcers: How good… Read more…

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  23. Providing skin care for bariatric patients

    Providing skin care for bariatric patientsBy Gail R. Hebert, MS, RN CWCN, DWC, WCC, OMS How would you react if you heard a 600-lb patient was being admitted to your unit? Some healthcare professionals would feel anxious—perhaps because they’ve heard bariatric patients are challenging to… Read more…

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  24. Wise use of antibiotics in patients with wound infections

    Antibiotic resistance is a pressing public health threat not only in the United States, but worldwide. According to the World Health Organization (WHO), it is one of the major threats to human health. Despite these concerns, antibiotics continue to be widely used—and overused. In long-term care,… Read more…

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  25. Clinical Notes: ostomy, pressure ulcer, burn treatment

    Self-management ostomy program improves HRQOL A five-session ostomy self-care program with a curriculum based on the Chronic Care Model can improve health-related quality of life (HRQOL), according to a study in Psycho-Oncology. “A chronic care ostomy self-management program for cancer survivors” describes results from a longitudinal pilot… Read more…

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  26. Clinician Resources: falls, npuap, patient safety, civility

    End your year by checking out these resources for your practice.   Sentinel event alert for falls As part of its sentinel event alert “Preventing falls and fall-related injuries in health care facilities,” The Joint Commission has assembled information and multiple… Read more…

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  27. No more skin tears

    Imagine watching your skin tear, bleed, and turn purple. Imagine, too, the pain and disfigurement you’d feel. What if you had to live through this experience repeatedly? That’s what many elderly people go through, suffering with skin tears through no fault of their own. Some go on… Read more…

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  28. Nutritional considerations in patients with pressure ulcers

    Optimizing nutritional status is a key strategy both in preventing and managing pressure ulcers. In patients across all care settings, compromised nutrition— as from poor intake, undesired weight loss, and malnutrition—increases the risk of pressure ulcers. It contributes to altered immune function, impaired collagen synthesis, and decreased tensile… Read more…

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  29. A Saudi rehabilitation facility fights pressure ulcers

    Sultan Bin Abdulaziz Humanitarian CityBy Joanne Aspiras Jovero, BSEd, BSN, RN; Hussam Al-Nusair, MSc Critical Care, ANP, RN; and Marilou Manarang, BSN, RN A common problem in long-term care facilities, pressure ulcers are linked to prolonged hospitalization, pain, social isolation, sepsis, and death. This… Read more…

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  30. Case study: Bariatric patient with serious wounds and multiple complications

    By Hedy Badolato, RD, CSR, CNSC; Denise Dacey, RD, CDE; Kim Stevens, BSN, RN, CCRN; Jen Fox, BSN, RN, CCRN; Connie Johnson, MSN, RN, WCC, LLE, OMS, DAPWCA; Hatim Youssef, DO, FCCP; and Scott Sinner, MD, FACP Despite the healthcare… Read more…

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  31. Comprehensive turning programs can avoid a pain in the back

    Turning programs are essential to prevent and promote healing of pressure ulcers and to prevent the many negative effects of immobility, ranging from constipation to respiratory infections. However, turning a patient often puts a caregiver’s body in an awkward position,… Read more…

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  32. Better Skin Grafts – take only one layer

    skin grafts take one layerResearch shows that a skin-graft harvesting system aids chronic wound recovery and reduces care costs by accelerating the healing process. More than six million cases of chronic wounds cost $20 billion each year in the United States. Diabetic ulcers, pressure sores,… Read more…

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  33. Clinical Notes: biofilm, bariatric surgery, statins and more

    Management of biofilm recommendations The Journal of Wound Care has published “Recommendations for the management of biofilm: a consensus document,” developed through the Italian Nursing Wound Healing Society. The panel that created the document identified 10 interventions strongly recommended for clinical practice; however, panel members noted that, “there… Read more…

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  34. Wounds that won’t heal can be devastating

    diabetic foot ulcerCarol Emanuele beat cancer. But for the last two years, the Philadelphia woman has been fighting her toughest battle yet. She has an open wound on the bottom of her foot that leaves her unable to walk and prone to… Read more…

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  35. 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… Read more…

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  36. Wound Photography – How it Benefits Clinical Documentation

    wound photographyAccurate assessment and documentation of wounds is essential for developing a comprehensive plan of care. Photography now plays a key role in wound care. The use of digital photography has enhanced the reliability and accuracy of wound documentation. Though a wound assessment… Read more…

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  37. Gene Therapy for Non-Healing Diabetic Foot Ulcers Starts Phase III Trial

    Diabetic Foot UlcersSafety and Efficacy Study of VM202 in the Treatment of Chronic Non-Healing Foot Ulcers. This study will assess the safety and efficacy of using gene therapy via intramuscular injections of the calf for patients with chronic non-healing foot ulcers. The first… Read more…

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  38. 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… Read more…

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  39. Understanding NPUAP’s updates to pressure ulcer terminology and staging

    On April 13, 2016, the National Pressure Ulcer Advisory Panel (NPUAP) announced changes in pressure ulcer terminology and staging definitions. Providers can adapt NPUAP’s changes for their clinical practice and documentation, but it’s important to note that, as of press time, the Centers for Medicare & Medicaid… Read more…

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  40. Pressure Injury Prevention: Managing Shear and Friction

    pressure injury interventionLet us start off this post with a typical scenario. You walk into any facility or institution and you see a patient slouched in their wheelchair, with no wheelchair cushion. You notice part of their brief hanging out of the… Read more…

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  41. Buzz Report: Latest trends, Part 1

    We all lead busy lives, with demanding work schedules and home responsibilities that can thwart our best intentions. Although we know it’s our responsibility to stay abreast of changes in our field, we may feel overwhelmed when we try to… Read more…

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  42. Empowering patients to play an active role in pressure ulcer prevention

    Developing a pressure ulcer can cause the patient pain, lead to social isolation, result in reduced mobility, and can even be fatal. According to the Agency for Healthcare Research and Quality, estimated costs for each pressure ulcer range from $37,800… Read more…

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  43. Restorative nursing programs help prevent pressure ulcers

    Immobility affects all our body systems, including our skin. According to the National Pressure Ulcer Advisory Panel, many contributing factors are associated with the formation of a pressure ulcer, with impaired mobility leading the list. So what can clinicians do… Read more…

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  44. Clinician Resources: Opioid-Prescribing, Diabetes, Pressure Injuries

    Here are a variety of resources you might want to explore. Considering opioid-prescribing practices Healthcare providers’ prescribing patterns for opioids vary considerably by state, according to a report in Vital Signs from the Centers for Disease Control and Prevention (CDC).… Read more…

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  45. Hyperbaric oxygen therapy for treatment of diabetic foot ulcers

    By Carrie Carls, BSN, RN, CWOCN, CHRN; Michael Molyneaux, MD; and William Ryan, CHT Every year, 1.9% of patients with diabetes develop foot ulcers. Of those, 15% to 20% undergo an amputation within 5 years of ulcer onset. During their… Read more…

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  46. Clinical Notes: Healing SCI Patients, antiseptics on mahout, diabetes

    Electrical stimulationElectrical stimulation and pressure ulcer healing in SCI patients A systematic review of eight clinical trials of 517 patients with spinal cord injury (SCI) and at least one pressure ulcer indicates that electrical stimulation increases the healing rate of pressure ulcers. Wounds with electrodes overlaying the wound… Read more…

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  47. Clinician Resources: Pressure-Injuries, Ostomy, Lymphedema, Delirium

    Here is a round-up of resources that you may find helpful in your practice. New illustrations for pressure-injury staging The National Pressure Ulcer Advisory Panel (NPUAP) has released new illustrations of pressure injury stages. You can download the illustrations, which include normal Caucasian and non-Caucasian skin… Read more…

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  48. Get positive results with negative-pressure wound therapy

    By Ronald Rock, MSN, RN, ACNS-BC Complex wound failures are costly and time-consuming. They increase length of stay and contribute to morbidity and mortality in surgical patients. Negative-pressure wound therapy (NPWT)—a common adjunct to wound-care therapy—is used to accelerate wound… Read more…

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  49. More from The Buzz Report: A wound care clinician’s best friend

    By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Keeping clinicians up to date on clinical knowledge is one of the main goals of the Wild On Wounds (WOW) conference,held each September in Las Vegas. Each year, I present the… Read more…

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  50. Preventing pressure ulcers in pediatric patients

    By Roxana Reyna, BSN, RNC-NIC, WCC, CWOCN As wound care clinicians, we are trained—and expected—to help heal wounds in patients of any age and to achieve positive outcomes. Basic wound-healing principles apply to all patients, whatever their age or size.… Read more…

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  51. From the Editor: Tips on staging pressure ulcers

    By Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Pressure ulcers have been a health concern for a long time—since at least 5,000 years ago, when evidence of a pressure ulcer was found on an ancient Egyptian mummy. But not… Read more…

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