Hidden complications: A case study in peripheral arterial disease

May 22, 2014February 25, 2020 Wound Care Advisor

By Pamela Anderson, MS, RN, APN-BC, CCRN, and Terri Townsend, MA, RN, CCRN-CMC, CVRN-BC

Jan Smith, age 59, is admitted to the coronary intensive care unit with an acute inferior myocardial infarction (MI). Recently diagnosed with hypertension and hyperlipidemia, she smokes a pack and a half of cigarettes daily. She reports she has always been healthy and can’t believe she has had a heart attack. (Note: Name is fictitious.)

On physical exam, the cardiologist finds decreased femoral pulses bilaterally and recommends immediate cardiac catheterization. Fortunately, primary percutaneous coronary intervention (PCI) is readily available at this hospital. PCI is the preferred reperfusion method when it can be provided by skilled cardiologists in a timely manner. (more…)

It takes a village: Leading a wound team

March 25, 2014February 25, 2020 Wound Care Advisor

By 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…)

Managing venous stasis ulcers

January 30, 2014February 25, 2020 Wound Care Advisor

Managing chronic venous leg ulcers — what’s the latest evidence?

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…)

How to apply a spiral wrap

January 30, 2014February 25, 2020 Wound Care Advisor

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.

Description

The spiral wrap is a technique used for applying compression bandaging.

Procedure

Here’s how to apply a spiral wrap to the lower leg. Please note that commercial compression wraps come with specific instructions for proper bandaging technique. Be sure to follow these instructions to provide safe and effective compression. (more…)

Have you made your New Year’s resolutions?

January 30, 2014February 25, 2020 Wound Care Advisor

Aresolution 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…)

A case of missed care

January 30, 2014February 25, 2020 Wound Care Advisor

By 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…)

The long and short of it: Understanding compression bandaging

November 21, 2013February 25, 2020 Wound Care Advisor

By Robyn Bjork, MPT, WCC, CWS, CLT-LANA

Margery Smith, age 82, arrives at your wound clinic for treatment of a shallow, painful ulcer on the lateral aspect of her right lower leg. On examination, you notice weeping and redness of both lower legs, 3+ pitting edema, several blisters, and considerable denudement of the periwound skin. She is wearing tennis shoes and her feet have relatively little edema, but her ankles are bulging over the edges of her shoes; both socks are wet. Stemmer’s sign is negative. The wound on the right leg is draining copious amounts of clear fluid; it’s dressed with an alginate, which is secured with conforming roll gauze. No signs or symptoms of infection are present. (more…)

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

November 21, 2013February 25, 2020 Wound Care Advisor

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 are the grades?,” funded by the Agency for Healthcare Research and Quality, analyzed 2 million all-payer administrative records from 448 California hospitals and quarterly hospital surveillance data from 213 hospitals from the Collaborative Alliance for Nursing Outcomes. (more…)

Skin problems with chronic venous insufficiency and phlebolymphedema

November 21, 2013February 25, 2020 Wound Care Advisor

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 common and often difficult to treat. The CVI cycle of skin and soft tissue injury from chronic disease processes can be unrelenting. If not properly identified and treated, these skin problems can impede the prompt treatment of lymphedema and reduce a patient’s quality of life.

This article reviews skin problems that occur in patients with CVI and phlebolymphedema and discusses the importance of using a multidisciplinary team approach to manage these patients. (more…)

Compression therapy for chronic venous insufficiency, lower-leg ulcers, and secondary lymphedema

July 19, 2013February 25, 2020 Wound Care Advisor

By Nancy Chatham, RN, MSN, ANP-BC, CCNS, CWOCN, CWS, and Lori Thomas, MS, OTR/L, CLT-LANA

An estimated 7 million people in the United States have venous disease, which can cause leg edema and ulcers. Approximately 2 to 3 million Americans suffer from secondary lymphedema. Marked by abnormal accumulation of protein-rich fluid in the interstitium, secondary lymphedema eventually can cause fibrosis and other tissue and skin changes. (more…)

What’s causing your patient’s lower-extremity redness?

July 19, 2013January 25, 2024 Wound Care Advisor

By Robyn Bjork, MPT, CWS, WCC, CLT-LANA

The ability to understand or “read” lower-extremity redness in your patient is essential to determining its cause and providing effective treatment. Redness can occur in multiple conditions—hemosiderin staining, lipodermatosclerosis, venous dermatitis, chronic inflammation, cellulitis, and dependent rubor. This article provides clues to help you differentiate these conditions and identify the specific cause of your patient’s lower-extremity redness. (more…)

Chronic venous insufficiency with lower extremity disease: Part 2

May 28, 2013February 25, 2020 Wound Care Advisor

By Donald A. Wollheim, MD, WCC, DWC, FAPWCA

To begin appropriate treatment for chronic venous insufficiency (CVI), clinicians must be able to make the correct diagnosis. Part 1 (published in the March-April edition) described CVI and its presentation. This article provides details of the CVI diagnosis (including the differential diagnosis from other diseases), disease classification to help assess the extent of CVI, diagnostic studies used to diagnose CVI, and various treatment options to “rescue” the patient from CVI. (more…)

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