Case study: Bariatric patient with serious wounds and multiple complications

November 20, 2014February 25, 2020 Wound Care Advisor

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 team’s best efforts, not all hospitalizations go smoothly. This article describes the case of an obese patient who underwent bariatric surgery. After a 62-day hospital stay, during which a multidisciplinary team collaborated to deliver the best care possible, he died. Although the outcome certainly wasn’t what we wanted, we’d like to share his story to raise awareness of the challenges of caring for bariatric patients. (more…)

Ramblings of an Itinerant Wound Care Guy

October 21, 2014February 25, 2020 Wound Care Advisor

Renaissance and the New Golden Rule

by Dr. Michael Miller

To paraphrase Carol Ann from the Movie Poltergeist…”He’s Baaaaaaaaack” ! At the end of this past May, I had a sudden and disappointing parting of the ways from my prior blog host when I discovered the newest version of the Golden Rule…those that have the gold, make the rules. Is it possible to be too opinionated? Does the textual asbestos statement at the bottom of almost every web page regarding the dissociation between the hosts and the writer’s opinions really have any meaning? I am nonetheless extremely grateful to my prior hosts for allowing me the bytes to educate, illuminate and aggravate. The silent majority, mostly practitioners and patients who appreciate the inside story versus those with the gold (who don’t mind independent thinking, as long as it comes in their flavor of Kool-Aid) have both spoken.

But as PT Barnum said “’There’s no such thing as bad publicity’ and so, recognizing that more and more people are looking for a shoulder to cry on, a voice of reason, and the company that misery loves, “Ramblings of an Itinerant Wound Care Guy” re-emerges with this blog. I want to assure you that I have always relished comments and criticism both of which are proudly posted along with the blog, as long as you agree with me.

But enough fanfare and bravado and back to the bastion of wound dabblers anonymous. My three-month involuntary hiatus did little to quench the fires of indignation regarding medicine in general and wound care in particular. I had the great honor recently of meeting one of the creators of the wound care protocols for a large wound management organization. My initial disdain at our handshake turned to admiration as he explained with great pride, how the guidelines were created for diagnosis and care at their facilities. His background in wound care was impressive and his passion for care was the purest. However, in keeping with the mantra that “No Good Deed Goes Unpunished”, he related how his master plan had become intellectual oatmeal as the docs and nurses reverted to prior, Neanderthal practices. One of the major flies in his ointment was the fact that at least one facility under management had a huge number of men over 70 in treatment including hyperbarics with 100% having the diagnosis of venous insufficiency. Not a single mention of an arterial or diabetic etiology. When he brought it to the medical directors attention, the response was simply that was what had been diagnosed. He has since gone on to what he hopes are greener pastures. As far as the pitiful remnants of the wound caregivers he left behind, we agreed that they all deserve to be patient in their own centers.

To my prior readers who once again have elected to join in on the cacophony of intolerance or a newbie who on the advice of a friend decided to see what that crazy guy is writing about this month, I offer you my thanks and a promise to ignore the golden rule whenever and wherever I can. And by the way…the opinions of the statements made in this blog do not reflect those of the web site, the publisher or the editors…Got it.

Until we ramble next time.

Click here to return to Dr. Miller’s Ramblings of an Itinerant Wound Care Guy Blog page.

Disclaimer: The views expressed in this article are those of the author and do not necessarily represent the views of, and should not be attributed to, Wound Care Advisor. All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

Education vital for successful wound management in the home

July 21, 2014February 25, 2020 Wound Care Advisor

By 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…)

Using maggots in wound care: Part 1

July 21, 2014February 25, 2020 Wound Care Advisor

By: 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 don’t provide maggot therapy (also called wound myiasis) because they lack training. But having maggot therapy technology available for patients adds to your capabilities as a wound care provider. (more…)

Creating effective education programs on a shoestring budget

July 21, 2014February 25, 2020 Wound Care Advisor

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

It’s time again for annual staff education, and you, the certified wound clinician, need to teach the staff at your organization. You dream of staff entering a state-of-the-art classroom with computers at each station, mannequins, wound anatomy models, and enough products for each student to do hands-on demonstrations. But when you open your eyes, you’re sitting in a room with ordinary tables and chairs, your laptop, a screen, a brain full of knowledge, and a very tight budget. (more…)

Confronting conflict with higher-ups

July 21, 2014February 25, 2020 Wound Care Advisor

By Pam Bowers, RN, and Liz Ferron, MSW, LICSW

Conflict in the workplace is a fact of life, and dealing with it is never easy. Sometimes it seems easier to ignore it and hope it will take care of itself. But in healthcare organizations, that’s not a good strategy. Unresolved conflict almost always leads to poor communications, avoidance behavior, and poor working relationships—which can easily affect patient safety and quality of care. (more…)

You want to touch me where?

July 21, 2014February 25, 2020 Wound Care Advisor

By Debra Clair, PhD, APRN, WOCN, WCC, DWC

Providing wound care requires a great deal of knowledge and skill. To become a wound care nurse entails taking classes, gaining and maintaining certifications, and acquiring on-the-job experience. But despite your education, knowledge, skills, and certifications, you may encounter problems when wound care requires you to touch the patient in a sensitive or embarrassing area. Touching the patient in these areas is called intimate touch. (more…)

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…)

The DIME approach to peristomal skin care

May 22, 2014February 25, 2020 Wound Care Advisor

By 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…)

What is a comprehensive risk assessment?

May 22, 2014February 25, 2020 Wound Care Advisor

By 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…)

Wound Care Advisor Journal 2014 Vol3 No2

Becoming a wound care diplomat

The Rolling Stones may have said it best when they sang, “You can’t always get what you want,” a sentiment that also applies to wound care. A common frustration among certified wound care clinicians is working with other clinicians who have limited current wound care education and knowledge. This situation worsens when these clinicians are making treatment recommendations or writing treatment orders not based on current wound-healing principles or standards of care.

Frequently, these same clinicians seem uninterested in listening to what you say and aren’t receptive to treatment suggestions. This is where your skills of diplomacy will make all the difference. Rarely is it a simple matter of sharing your expertise to change a person’s mind. Lack of training and knowledge of current best practices may be part of the reason for resistance. “We’ve always done it that way” or “The rep told me” are common statements you might hear.

“This is how we’ve always done it” isn’t good enough

Posted: March 25, 2014

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS Have you ever faced responsibility for a patient-care situation you learned about in school but had yet to encounter in the real world? With so many different health conditions and constant advancements in medical care, it’s not surprising that this happens frequently to many clinicians. The first and easiest way for most…

A Saudi rehabilitation facility fights pressure ulcers

Posted: March 25, 2014

By 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 article explains how a Middle East rehabilitation facility battles pressure ulcers with the latest evidence-based practices, continual staff education, and…

Achieving a work-life balance

Posted: March 25, 2014

By Julie Boertje, MS, RN, LMFT, QMRP, and Liz Ferron, MSW, LICSW Almost everyone agrees that achieving a work-life balance is a good thing. Without it, we risk long-term negative effects on our physical and mental health, our relationships, and our work performance. But many clinicians have a hard time achieving this balance due to job demands, erratic work schedules,…

Becoming a wound care diplomat

Posted: March 25, 2014

By Bill Richlen, PT, WCC, CWS, DWC, and Denise Stetter, PT, WCC, DCCT The Rolling Stones may have said it best when they sang, “You can’t always get what you want,” a sentiment that also applies to wound care. A common frustration among certified wound care clinicians is working with other clinicians who have limited current wound care education and…

Clinical Notes: Low BMD, CKD, hypoglycemia, HBOT

Posted: March 25, 2014

Low BMD common after ostomy Low bone mineral density (BMD) is common in patients with inflammatory bowel disease who have a stoma placed, according to “Frequency, risk factors, and adverse sequelae of bone loss in patients with ostomy for inflammatory bowel diseases,” published in Inflammatory Bowel Diseases.

Clinician Resources: Intl Ostomy Assoc., Substance Use Disorder

Posted: March 25, 2014

Take a few minutes to check out this potpourri of resources. International Ostomy Association The International Ostomy Association is an association of regional ostomy associations that is committed to improving the lives of ostomates. Resources on the association’s website include: a variety of discussion groups information for patients list of helpful links. The site also provides contact information for the…

Guidelines for safe negative-pressure wound therapy

Posted: March 25, 2014

By 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 flaps; and grafts. NPWT applies controlled suction to a wound using a suction pump that delivers intermittent, continuous, or variable…

How to assess wound exudate

Posted: March 25, 2014

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. Exudate (drainage), a liquid produced by the body in response to tissue damage, is present in wounds as they heal. It consists of fluid that has leaked out of blood vessels and closely resembles blood…

It takes a village: Leading a wound team

Posted: March 25, 2014

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…

Medicare reimbursement for hyperbaric oxygen therapy

Posted: March 25, 2014

By Carrie Carls, BSN, RN, CWOCN, CHRN, and Sherry Clayton, RHIA In an atmosphere of changing reimbursement, it’s important to understand indications and utilization guidelines for healthcare services. Otherwise, facilities won’t receive appropriate reimbursement for provided services. This article focuses on Medicare reimbursement for hyperbaric oxygen therapy (HBOT). (See What is hyperbaric oxygen therapy?) Indications and documentation requirements

Turning programs hinder a good night’s sleep

Posted: March 25, 2014

By 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…

2014 Journal: March April Vol. 3 No. 2

Turning programs hinder a good night’s sleep

March 25, 2014February 25, 2020 Wound Care Advisor

By 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…)

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