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 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…)

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Ramblings of an Itinerant Wound Care Guy

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.

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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). Here are some facts from the report:

• Each day, 46 people die from an overdose of prescription painkillers in the United States.*
• Healthcare providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills.
• Ten of the highest prescribing states for painkillers are in the South. (more…)

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Best of the best, the sequel

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

Welcome to our second annual “Best of the Best” issue of Wound Care Advisor, the official journal of the National Alliance of Wound Care and Ostomy (NAWCO). This may be the first time you have held Wound Care Advisor in your hands because normally we come to you via the Internet. Using a digital format for this peer-reviewed journal allows us to bring you practical information that you can access anytime, anywhere and gives you the ability to access videos and other links to valuable resources for you and your patients. (more…)

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Device–related pressure ulcers: Avoidable or not?

device related pressure ulcer

By: 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; cast; respiratory mask or tubing; tracheostomy tube, collar, or strap; feeding tube; or a negative-pressure wound therapy device. The golden rule of pressure ulcer treatment is to identify the cause of pressure and remove it. Unfortunately, many of the medical devices are needed to sustain the patient’s life, so they can’t be removed. (more…)

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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 healing by accelerating keratinocyte migration via the BLT2 receptor” report that aspirin reduced 12-HHT production, which resulted in delayed wound closure in mice. However, a synthetic leukotriene B4 receptor 2 (BLT2) agonist increased the speed of wound closure in cultured cells and in diabetic mice. (more…)

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Creating an effective care plan

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

The development of a care plan related to skin integrity can be challenging for any clinician. It takes a strong understanding of skin integrity risk factors and knowledge of how to modify, stabilize, and eliminate those risk factors. This article provides tips for the care-planning process. (more…)

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Education vital for successful wound management in the home

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…)

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Using maggots in wound care: Part 1

maggots in wound care

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…)

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What you need to know about transparent film dressings

transparent film dressings

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.

Transparent film dressings are thin sheets of transparent polyurethane (polymer) coated with an adhesive. These dressings are available in a variety of sizes and shapes. (more…)

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Creating effective education programs on a shoestring budget

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…)

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