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, which can lead to musculoskeletal damage, especially back injuries.

According to the U.S. Bureau of Labor Statistics, healthcare workers suffer the highest rate of musculoskeletal disorders for all occupational groups and more than seven times the average rate for all occupations. Direct caregivers are the group most likely to experience musculoskeletal injuries. During turning tasks, excessive forces are imposed on the caregiver’s musculoskeletal structure due to the external load of the patient and the caregiver’s form and position during the task. Fragala and Fragala found that turning patients in bed is one of the highest-risk activities that lead to low back pain. (more…)

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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 strength. In many cases, malnutrition also contributes to wound chronicity and increases the risk for delayed and impaired wound healing. In patients with chronic wounds, such as pressure ulcers, a chronic inflammatory state can induce catabolic metabolism, malnutrition, and dehydration. (more…)

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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 to prevent harm caused by immobility? One often-overlooked strategy is a restorative nursing program. (See About restorative nursing.)

Moving up the time line

Most patients who score poorly for mobility and/or activity impairments on the Braden Scale for Predicting Pressure Ulcer Risk are referred to physical therapy, but too often a restorative nursing program (more…)

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Cutaneous candidiasis

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 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…)

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Is your therapy department on board with your wound care team?

therapy department wound care

By Cheryl Robillard, PT, WCC, CLT, DWC

Patients in your clinical practice who develop wounds should prompt a call for “all hands on deck” to manage the situation, but some personnel may be missing the boat. Physical therapists (PTs), occupational therapists (OTs), and speech-language pathologists (SLPs) should be on board your wound care ship so patients can receive care they need. But unfortunately, sometimes they aren’t. (more…)

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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, “Pressure ulcers cannot form without loading, or pressure on the tissue. Extended periods of lying or sitting on a particular body part and failure to redistribute the pressure can lead to ischemia and therefore tissue damage.” Thus, immobility is frequently the root cause of pressure ulcer development. (more…)

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Motivational interviewing: A collaborative path to change

By Sharon Morrison, MAT, RN

Michael had diabetes and a history of elevated blood glucose levels. A long-time drinker, he seemed to have no interest in giving up the habit. I met him while working as a diabetes nurse educator for the Boston Health Care for the Homeless Program, traveling from shelter to shelter to help persons with diabetes set goals to improve their health.

If our meeting had taken place a decade earlier, I might have given Michael information about diabetes and talked with him about his alcohol use. I would have encouraged him to stop drinking by explaining the problems alcohol can cause for people with diabetes. (more…)

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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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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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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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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 opening session of this conference, called “The Buzz Report,”which focuses on the latest-breaking wound care news—what’s new, what’s now, and what’s coming up. I discuss innovative new products, practice guidelines, resources, and tools from the last 12 months in skin, wound, and ostomy management. (more…)

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Clinical Notes

Diabetes carries high economic burden

According to a study published in Diabetes Care, the economic burden associated with diagnosed diabetes (all ages) and undiagnosed diabetes, gestational diabetes, and prediabetes (adults) exceeded $322 billion in 2012, amounting to an economic burden exceeding $1,000 for each American. (more…)

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