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A collaborative approach to wound care and lymphedema therapy: Part 2

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By Erin Fazzari, MPT, CLT, CWS, DWC

Have you seen legs like these in your practice?

Before-After

These legs show lymphedema and chronic wounds before treatment (left image) and after treatment (right image) with complex decongestive therapy (CDT)—the gold standard of lymphedema care. The patient benefited from multidisciplinary collaboration between wound care and lymphedema therapists. (more…)

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Clinician Resources: Nutrition, Treatment Algorithms, Pressure Ulcer Prevention

Check out these resources for your practice.

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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 and Diagnose All Patients at Risk of Malnutrition.” The videos show how to collaborate with the care team to become champions of nutrition and help improve patient outcomes. Watch the videos online or download them for later viewing. (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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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. The specific anatomy and physiology of vulnerable pediatric patients, however, requires detailed wound care. Unfortunately, little evidence-based research exists to support and direct the care of pediatric patients with pressure ulcers. This article describes efforts to reduce pressure ulcers in pediatric patients at Driscoll Children’s Hospital (DCH) in Corpus Christi, Texas. (more…)

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Comprehensive skin assessment

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 performing a comprehensive skin assessment.

In the healthcare setting, a comprehensive skin assessment is a process in which the entire skin of a patient is examined for abnormalities. It requires looking at and touching the skin from head to toe, with a particular emphasis on bony prominences and skin folds. Comprehensive skin assessment is repeated on a regular basis to determine whether changes in the skin’s condition have occurred. The goal of a skin assessment is to identify problem areas promptly for treatment and prevention. (more…)

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Case study: Early detection and treatment resolves a deep tissue injury

deep tissue injury

By Todd Zortman, RN, WCC, and James Malec, PhD

Pressure ulcers are a chronic healthcare burden for both patients and pro­viders. Over 2.5 million patients in the United States are affected annually by pressure ulcers, with nearly 60,000 of those cases directly resulting in death. From a provider’s perspective, the cost of individual care ranges anywhere from $500 to $70,000 per pressure ulcer, which translates to annual costs in the U.S. approaching $11 billion. (more…)

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Clinical Notes: Revascularization, Amputation Risk Score

Amputation Risk Score

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Leg revascularization fails to improve outcomes in nursing home patients

Lower-extremity revascularization often fails to improve outcomes in nursing home patients, according to an article in JAMA Internal Medicine.

Functional outcomes after lower extremity revascularization in nursing home residents: A national cohort study” found that few patients are alive and ambulatory a year after surgery, and those who are alive have little, if any, gain in function. The study, which included 10,784 patients, was based on data from nursing homes participating in Medicare or Medicaid. (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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Case study: Working under a time crunch in a short-stay facility

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By Janet Wolfson, PT, CWS, CLT-LANA

After landing my dream job as the wound care coordinator at an inpatient rehabilitation facility (IRF), I found myself trying to determine how much healing could be achieved for our more challenging patients, given the constraints of reimbursement and what can be done in the typical 10 to 14 days of a patient stay.

Here’s an example of how I worked with our team to help one of these challenging patients. (more…)

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From the Editor: Tips on staging pressure ulcers

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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 until 1975 did the staging classification system we’re familiar with begin. This system was designed to make things easier by creating a universal way to describe and communicate the various levels of tissue destruction. (more…)

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