Author Archive

Educate Patients about Effects of Smoking on the Wound Healing Process

Wednesday, November 7th, 2018
A patient breaks a cigarette after learning about the effects of smoking on the wound healing process.

Editor’s note: The name and specific patient details were changed for privacy.

Smoking is known to hinder wound healing, yet most wound care practitioners fail to document any smoking cessation discussion or education.

The daughter of Mrs. Bradley* was barely able to contain herself while giving her deposition. She was sobbing from a place deep in her heart as she retold the story of how her mother lost her leg partly due to the effects of smoking on the wound healing process.

Her mother started limping, and they realized she had an “opening” in the skin on the bottom of her foot.

Despite treatment, the wound grew in size and became infected. It soon became apparent that she was facing an amputation.

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Sacral Wounds and Diarrhea Don’t Mix, Part 2

Monday, October 15th, 2018

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

Frequent bouts of diarrhea make it difficult to care for wounds on the sacrum or coccyx, and healing often is impeded because of fecal contamination.

 

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Sacral Wounds and Diarrhea Don’t Mix, Part 1

Wednesday, September 12th, 2018

Frequent bouts of diarrhea make it difficult to care for wounds on the sacrum or coccyx, and healing often is impeded because of fecal contamination.

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What Would You Do if Your Patient Chokes?

Friday, August 31st, 2018

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

Every minute counts when a patient chokes, so you must react confidently and have a plan in place to handle this emergency situation.

Dr Nancy Collins

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

John Quiñones stars in the ABC television show What Would You . The program features actors cast in scenes of conflict or illegal activity in public settings, while hidden cameras record the situation. The focus of the show is to see whether ordinary people intervene or just pass by and how they react. For example, a recent episode featured a young girl’s nanny berating her in public and calling her stupid. Several passersby asked the nanny to cool it, while others just squirmed and silently hurried by. The point of the show is that we never really know how we will react to a situation until we are actually in it, and then each of us has to make a choice.

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The Head to Toe Search for Wounds

Tuesday, June 12th, 2018

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

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. For example, what should you do when treating wound patients with cancer? 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

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

Wound pain 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 wound pain, and more importantly, how do we manage it effectively?

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Discover the Benefits of Wound Care Nutrition Certification

Friday, February 9th, 2018

Whether you are looking to increase your wound care nutrition knowledge or advance your career, a new wound care certification course for Registered Dietitians (RD) and Registered Dietitian Nutritionists (RDN) will help you meet your goals, while improving outcomes for your wound care patients.

Discover the Benefits of Wound Care Nutrition Certification

I often get funny reactions when I tell people I specialize in wounds. Lay people always assume I mean bullet wounds. I notice them nodding with confusion when I go on to explain that I do not see many bullet wounds, but treat plenty of pressure injuries and diabetic foot ulcers.

Dr Nancy Collins

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

When I have the same conversation with nurses, patient care assistants, and other healthcare providers who do not specialize in wounds, they seem to nod with a similar amount of confusion. They immediately think of topical care and turning and repositioning—all important to wound healing—but they overlook the fact that in order to build new tissue it is necessary to have adequate nutritional substrate onboard.

Clearing up this confusion is one of the reasons I am so excited to share the new nutrition certification available from the National Alliance of Wound Care and Ostomy® (NAWCO®). Hopefully every skin and wound care team will soon have a certified nutrition member to help heal wounds from the inside out!

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Diabetes: Eight Reasons to Get It Under Control Now!

Friday, January 12th, 2018

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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