Archive for the ‘Clinical – Treatment’ Category

What Happened to Practicing Wound Care Basics?

Friday, September 23rd, 2022

Having been involved in wound care for about 25 years, I have seen many changes in our understanding of wound healing, research evidence, and technology, often straying from wound care basics.  

As I hear my students describe common practices today and the many myths of wound care, I’m led to wonder, “What happened to starting with wound care basics for healing?”

A colleague of mine once stated there are basically two fundamentals to healing wounds: a healthy patient and a healthy wound environment. Once those are accomplished, topical treatments will not make that big of a difference.

However, clinicians often cling to some “holy grail” treatment in the form of a dressing or adjunctive modality that will somehow overcome the need to practice solid, evidence-based wound care.

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COVID-19 Complicates Skin and Wound Care

Thursday, July 7th, 2022

The pandemic has brought skin and wound care challenges on many levels. One challenge is that COVID-19 can compromise the skin, leading to wounds that are harder to heal, according to Dianna Dashner, DNP, WCC, CLNC, LLE, senior nurse practitioner at ProMedica Skilled Nursing and Rehabilitation.

SARS-CoV-2 infection can cause virus-mediated endothelial dysfunction, which decreases tissue tolerance, authors wrote in a paper published in the summer 2022 issue of AACN Advanced Critical Care.

Dashner said the body’s inflammatory markers remain high long after an infected person’s symptoms go away.

“Inflammation markers actually take one year from the time you’ve been infected to go back to normal. So for patients who have an autoimmune disease or an inflammatory process in their bodies from a condition they already have, their markers are going to be sky high,” said Dashner, who is presenting “COVID’s Impact on the Skin: A Look at What We Know” at the September Wild on Wounds conference in Hollywood, Florida. The conference explores skin and wound care challenges and provides hands-on learning opportunities.

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Wound Debridement Basics: The 5 Major Methods Explained

Friday, June 24th, 2022

What is Debridement?

Wound debridement is the removal of necrotic, dead tissue from the wound bed. It also plays a vital role in the tissue management concept of wound bed preparation. Wound bed preparation is the comprehensive approach we use to get our chronic wounds to heal. There are two main categories of debridement: selective and non- selective. Selective methods are when only necrotic, non-viable tissue is removed from the wound bed. Non-selective methods remove both necrotic tissue and viable living tissue.

The 5 Major Debridement Methods

These five major debridement methods for wound clinicians are easy to remember (BEAMS), and key to the wound healing process. Debridement methods can be categorized under two main types.

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Spotting Signs of Wound Infection is the First Step in Proper Treatment

Tuesday, May 31st, 2022

Understanding the most current literature describing stages and signs of wound infection helps clinicians to accurately assess wounds.

“If we allow wounds to become infected then it certainly impedes the healing process,” said Patricia A. Slachta, PhD, RN, APRN, ACNS-BC, CWOCN, co-director of the Wound Care Nurse Education Program at Relias.

With an accurate assessment, wound care clinicians can prevent infection or identify signs of wound infection early and allow the body to heal the wound as quickly as possible, without using antibiotics, according to Slachta, who shared her expertise on how to determine if a wound is infected and needs antibiotic treatment.

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Treating Pediatric Burns Takes Skills and Sensitivity

Saturday, December 11th, 2021

Knowledgeable wound care clinicians are needed not only for adults but for the pediatric population too. Burns are common injuries incurred by children. We spoke with two experts to learn more about this important area of wound care for pediatric burns.

Stats on Pediatric Burns

“Burns are a leading cause of death and disability for children worldwide,” said Tina Palmieri MD, FACS, FCCM, Assistant Chief of Burns at Shriners Hospital for Children Northern California and Burn Division Chief at the University of California, Davis.

In the U.S., the stats are staggering. “Nearly each week in 2018 in the U.S. alone, approximately six children aged 0-19 died, 139 were hospitalized, and 1,762 were taken to the emergency room due to fire and burn injuries,” said Palmieri.

According to the American Burn Association Fact Sheet, 24% of all burn injuries occur in children under the age of 15, said Jenna Leach MSN, RN, WCC, plastic surgery specialty nurse at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Palmieri pointed out risk factors for pediatric fire and burn deaths are: (more…)

How Do You Treat a Malignant Wound? Let’s Look at the Options

Monday, November 8th, 2021

Wounds can present in patients as a result of various etiologies. One cause of wounds not typically on most clinicians’ radars are wounds that result from primary tumors.

We spoke with Joni Brinker, MSN/MHA, RN, WCC, an Ohio-based consultant and clinical nurse educator with Optum Hospice Pharmacy Services of Eden Prairie, Minnesota, and speaker for WCEI’s Wild on Wounds (WOW) national conference, to gain insight on malignant wounds that can develop from primary tumors.

What Is a Malignant Wound?

“A malignant wound is a manifestation of malignant (cancerous) cells that have infiltrated through the skin,” said Brinker.

Other structures such as blood and lymphatic vessels also can be invaded by malignant cells and produce wounds, she said.

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Let’s Walk Through the Stages of Wound Healing

Wednesday, August 4th, 2021

When teaching, I often get the question “What’s my role in the different stages of wound healing?”

To address this common question, I thought a review of basic wound physiology and the clinicians’ role during each of the stages of wound healing (aka phases of wound healing) would be helpful.

We know that the four phases of wound healing are driven by a mixture of chemical stimuli (growth factors and cytokines). Any diminished or excessive levels of these different chemicals can have a negative impact on the wound healing process. The phases are continuous and overlap each other to some extent. However, they must occur in a particular sequence to result in a healed wound.

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Necrotic Tissue: How to Identify and Treat It

Friday, July 30th, 2021

Living with necrotic tissue is challenging for patients and requires evidence-based treatments from skilled wound care clinicians to achieve improved patient outcomes. Let’s explore what it is, how to spot it, and where to go from there.

What Is Necrotic Tissue?

First, what is necrotic tissue and necrosis? The term necrosis stems from the Greek work nekros, which means death.

“Necrosis is a loose term, and it can appear in two ways – under a microscope and grossly viewed with the naked eye,” said Brian Gastman, MD, Surgical Director of Melanoma and High-Risk Skin Cancer Program at the Cleveland Clinic in Cleveland and Professor in the Department of Surgery at Case Western Reserve University School of Medicine in Cleveland.

When tissue is necrotic, there is a loss of tissue integrity, he said. “The tissue becomes discolored, there is fluid and exudative material present, and it becomes fodder for bacterial colonization.”

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20+ Factors That Affect and Delay Wound Healing

Tuesday, July 13th, 2021

Let’s say the wound you are working on is not healing. Why is the normal healing process not occurring?

You should approach healing not only by what you see, but also by what you can’t see happening at the cellular and molecular level.

To understand the factors that delay wound healing, you must first understand what normal healing is.

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Explore 3 Types of Wound Closure: Primary, Secondary, and Tertiary

Thursday, May 20th, 2021

You are called in to care for a patient with a full thickness wound. Now what?

Your goal should be to heal the wound as soon as possible and to keep it healed. There are three types of wound closure techniques to consider, and they include:

  • Primary Intention
  • Secondary Intention
  • Tertiary Intention

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