Posts Tagged ‘Dr. Nancy Collins’

Help! My Wound Patient Is a Vegetarian

Thursday, July 12th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

Patients with wounds require increased amounts of dietary protein, typically meaning meats, poultry, dairy products, and eggs. Vegetarians will need alternate sources of protein and amino acids to meet their needs and heal their wounds.

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

If you have ever heard me talk about nutrition interventions for wound healing, you surely heard me emphasize the patients’ need for protein. In order to build new tissue to heal a wound, patients must consume enough protein each and every day to meet their increased needs. Typically, this means eating increased amounts of meat, poultry, fish/seafood, eggs, and dairy products. This seems simple enough, but what if you have a vegetarian patient?

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The Head to Toe Search for Wounds

Tuesday, June 12th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

A comprehensive skin assessment should look for more than just wounds because many medical problems have telltale signs that are easy to see if you know what to look for.

comprehensive skin assessment

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

POA. These three little letters have become very important in wound care because we must document any wounds present on admission (POA). By doing so, we are saying that these wounds began somewhere else—maybe at home, maybe in another care setting, but definitely not while under the present facility’s care. This distinction of origin has great implications both financially and legally.

 

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Nutrition Tips for Wound Patients With Cancer

Friday, May 11th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Patients with wounds usually have multiple medical problems, and often the other diagnoses make meeting the nutritional plan difficult, such as when the wound patient also has cancer.

Nutrition Tips for Wound Patients With Cancer

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

I often discuss the increased nutritional requirements to fuel wound healing. Patients need extra calories and protein each day, plus an adequate amount of fluids, the right mix of vitamins and minerals, and any adjuvant treatments, such as targeted amino acids. A question that I often am asked is how you accomplish this when the patient has an additional diagnosis that impedes or supersedes the recommended nutritional plan. It is rare that a patient presents with only a single medical problem, and sometimes the other problems pose challenges to the nutritional plan.

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Helping Wounds Heal With Amino Acids

Friday, April 6th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

The use of targeted amino acids is becoming more common as a strategy to help heal a variety of conditions, including wounds, because of the role key amino acids have in rebuilding tissue.

Helping Wounds Heal With Amino Acids

 

Chronic wounds, meaning those that have not healed in 12 weeks, affect approximately 6.5 million patients in the United States annually at a cost of $25 billion.1 The term chronic wound refers to various types of skin integrity problems, such as pressure injuries, diabetic foot ulcers, venous ulcers, arterial ulcers, burns, and traumatic wounds to name a few.

The Role of Nutrition

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Nutrition often is not the first thing you think of when talking about wounds, but it is important to understand the link between poor nutrition and wound healing. Essentially, when a body has a wound, it has competition for the nutrients it needs. Wound healing is very energy dependent; energy is another word for calories. If your patient is not eating well and not meeting his or her caloric and protein goals every day, weight loss typically occurs.

When nutritional substrate is in short supply, the body decides whether to use the available substrate to build new tissue for the wound or to use it to keep its vital organs functioning. If weight loss continues unchecked, wound healing is impaired and eventually it will cease altogether in favor of the body’s vital organs.2

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Stinging. Burning. Painful. Wounds Hurt!

Saturday, March 10th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

The pain of a wound is sometimes difficult to quantify, but if a patient complains of pain, this requires effective and timely pain management.In the midst of the war on narcotics, that might mean looking for alternative pain management techniques and learning new approaches.

Wound Pain

 

Several months ago, I was attacked by the most venomous scorpion in North America, the Arizona bark scorpion. This stealth attack happened while I slept in my own bed at home in our southern Nevada desert home. I woke up with a jolt knowing that something was terribly wrong with me, but not quite sure what was happening. I felt a fiery tingling pain in both my hands and my abdomen, yet at the same time I also had a total loss of feeling in those areas. I remember yelling to my family that I was paralyzed, but they were confused because I was running around and frantically waving my arms obviously not paralyzed at all. We only figured out what had happened when I tried to crawl back into bed and saw the scorpion on my pillow.

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

My scorpion stings were an indescribable sensation and unlike any type of pain I had ever experienced. Even today, I am struggling to find the words to tell you what it felt like. All I knew was that it hurt and was unlike any pain I had previously experienced or could even compare it to. For the record, I did some research afterward—people describe it as feeling quite similar to being electrocuted.  Luckily, I can say that I was never electrocuted, but that is how people describe it.

Just as luckily, I have never had a pressure injury or a diabetic foot ulcer, so I am not really sure what those feel like either. My patients tell me they hurt. Some patients seem like they are in extreme pain, while others seem to have only mild pain. How do we quantify pain, and more importantly, how do we manage it effectively?

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Diabetes: Eight Reasons to Get It Under Control Now!

Friday, January 12th, 2018

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Patients with diabetes are more likely to suffer many serious health issues besides foot wounds and amputations. This makes it imperative that they resolve to get their blood glucose levels under control.

Diabetes: 8 Reasons to Get It Under Control Now!

 

All of the lawsuits I review have a common theme. The plaintiff suffers from a chronic wound and some degree of malnutrition and/or dehydration. I have started to notice that in addition to these problems, the plaintiff also quite often has diabetes. This trifecta of problems leads to pain, suffering, disability, and discontent.

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

People with diabetes are 10 to 20 times more likely to have a lower extremity amputation than those without diabetes.1 This is a scary statistic compounded by the fact that people with diabetes may not even notice a foot wound developing because they cannot feel it because of neuropathy. A foot ulcer is the initial event in more than 85% of major amputations that are performed on people with diabetes.2 Knowing this should provide enough motivation for patients to get their diabetes under control, but some people need even more reasons. Here are eight more consequences you can discuss with your patients. Hopefully, one will hit home.

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The Case of the Dirty Wound Care Clinic

Friday, December 15th, 2017

Nancy Collins, PhD, RDN, LD, NWCC, FAND

We have made progress in reducing healthcare-associated infections, but still have a long way to go, especially when patients complain of dirty, dingy hospitals and clinics.

Dirty Wound Care Clinics and Infections

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

 

I feel a little like girl detective Nancy Drew as I ask you to consider the Case of the Dirty Wound Care Clinic. Let me explain. In a recent lawsuit, the plaintiff alleged that her mother’s wound did not heal and became infected because of the lack of cleanliness in the hospital-based clinic where she was receiving treatment. It would not surprise me if your initial reaction to this claim is that it is nonsense, so let’s take a closer look.

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Can You Use Job Burnout as a Legal Defense?

Friday, November 10th, 2017

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Wound care is a stressful profession, and sometimes your empathy bucket becomes empty, but job burnout is not a proper professional or legal defense.

Can You Use Job Burnout as a Legal Defense?

 

A group of my professional friends were having lunch together and catching up when one friend disclosed that she was taking a month off of work. We all looked at her agape and at the same time exclaimed “a month?” We had a dozen questions for her. Was she ill? How did she arrange this? What did her supervisor say? Would she still have her job at the end of the month? And most importantly, why was she taking a month off?

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Medicare Spending on Wound Care: The First Comprehensive Study

Friday, October 13th, 2017

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Chronic wounds impact 15% of Medicare beneficiaries at an estimated annual cost of $28 billion to $32 billion, making nutrition a seemingly cost-effective purchase.

Medicare Spending on Wound Care: The First Comprehensive Study

 

Dr Nancy Collins

Nancy Collins, PhD, RDN, LD, NWCC, FAND

Did you ever wonder how much it really costs to treat and heal various wounds? Patients, family members, and healthcare team members often complain to me that $5/day for nutrition therapy is “too expensive.” Cost is relative, because according to the first comprehensive study of Medicare spending on wound care, it appears that an investment in medical nutrition therapy is a wise investment indeed.

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Malpractice or Obesity: Can a 276-Pound Patient Heal a Pressure Injury?

Friday, September 8th, 2017

Nancy Collins, PhD, RDN, LD, FAPWCA, FAND

Obesity presents challenges to wound healing, but with knowledge and appropriate care interventions, we can provide optimal conditions to support the best possible outcome for every patient, no matter what size.

Malpractice or Obesity?

 

The US obesity epidemic reached a new all-time high in 2016, according to newly released Centers for Disease Control and Prevention data.1 Every single state has an obesity rate greater than 20%, and in five states it’s even greater than 35%. Topping the chart is West Virginia, at 37.7%.

Many of these people end up in the healthcare system because of obesity-related diseases and sometimes develop a wound, such as a pressure injury. As we know, wounds that do not heal after 12 weeks are termed chronic, and lawsuits because of chronic wounds and their consequences are rampant

The Obese Plaintiff

The discovery process surely will reveal whether a patient was overweight or obese because nutritional status and body weight are factors in the healing process. The tricky part is deciding how much, if any, of the chronicity of the wound was because of obesity.

In a recent case, the patient was 5′3″ and weighed 276 pounds. Can a person of this size heal? The defendants claimed they did everything according to the standard of care, but despite excellent care, the patient did not heal. They recounted some difficulty repositioning the patient because of her size and problems with moisture management in her skin folds. The plaintiff thought those were excuses and that there was size bias in the care given to the patient. So what are the facts when dealing with a larger patient with a wound?

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