Archive for the ‘Diabetic Wound Care’ Category

How to treat diabetic foot ulcers with a total contact cast

Thursday, October 10th, 2019
A man sits with his total contact cast elevated on a chair.

There are times when clinicians and patients have done all they can to prevent diabetic foot ulcers, and they still develop.

“The patients who develop a diabetic foot ulcer are the ones who fell through the cracks,” said Don Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery.

Wollheim has 25 years of experience in general/vascular surgery and 13 years as a wound care specialist and educator. He also is a medical-legal consultant, college science instructor and clinical instructor for the Wound Care Education Institute.

“Once a diabetic foot ulcer develops, it’s essential it is treated aggressively with proven, standardized methods, as 85% of the amputations performed on diabetic patients began as a diabetic foot ulcer,” Wollheim said.

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Instructor takes wound care education across South Pacific

Monday, July 29th, 2019

wound care education

When Nancy Morgan, MBA, BSN, RN, WOC, WCC, DWC, OMS, began her career in wound care, she never imagined her work would someday take her to American Samoa.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

In June 2019, it did just that. Morgan, who co-founded the Wound Care Education Institute (WCEI), spent three days consulting with Samoan clinicians on specific wound patients and presented a one-day formal wound care class.

At the same time, she enjoyed a life-changing experience by connecting with her newly discovered people, culture and nation.

Adopted at the tender age of five days old, Morgan grew up an only child. Even though her adoptive parents were wonderful and Morgan said she felt blessed, as time went on she yearned to learn who her biological parents were.

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Learn about the cause and prevention of diabetic foot ulcers

Tuesday, July 2nd, 2019

diabetic foot ulcers

With more than 30 million people in the U.S. afflicted with diabetes, clinicians are very likely to encounter diabetic patients.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

Diabetic foot ulcers occur in approximately 15% of diabetic patients. And if you’re a wound care clinician, you’ll likely find yourself caring for patients with diabetic foot ulcers more often than not.

To learn more about the causes and how to prevent diabetic foot ulcers, we spoke with Don Wollheim, MD, FAPWCA, WCC, DWC, a board-certified surgeon of the American Board of Surgery.

He has 25 years of experience in general/vascular surgery and 13 years of experience as a wound care specialist and educator. Wollheim is also a medical-legal consultant, college science instructor and clinical instructor at the Wound Care Education Institute (WCEI).

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Learn why many organizations need a wound expert today

Monday, June 17th, 2019

wound expert

Organizations need for trained wound experts is on the rise.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

The reasons for this increase are multifactorial, said wound expert Nancy Morgan, MBA, BSN, RN, WOC, WCC, DWC, OMS, cofounder and clinical consultant with the Wound Care Education Institute.

We sat down with Morgan to learn why more patients than ever need expert wound care.

Q: What role do chronic diseases play in creating a need for wound care?

People are living longer with chronic diseases such as diabetes and obesity, which predisposes these patients to the development of chronic wounds.

Chronic wounds require treatment with the skills of knowledge of wound experts over the course of several weeks, months and sometimes years.

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How to pick the best wound care certification to fit your role

Tuesday, April 16th, 2019

wound care certification

If you’re working in wound care and seeking to earn wound care certification, kudos because your skills are in great demand.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

“The wound care industry in general lacks enough knowledgeable clinicians to handle the challenges of chronic wounds, as rarely is comprehensive wound care training included during college training of all disciplines, this includes MDs, NPs, PAs, RNs, PTs, OTs and LVNs,” said Bill Richlen, PT, WCC, DWC, one of our clinical wound care instructors.

The lack of standardized, pervasive wound care training for clinicians, sets the foundation for why clinicians working with wound patients on a routine basis, may want to get certified in wound care, said Richlen, who also owns Infinitus LLC, in Santa Claus, Ind., a wound care instruction and consulting company.

If you’re having difficulty trying to decide which wound care certification to start with, the info below may be just what you’re looking for to help you decide which certification route to go.

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5 common myths debunked about nutrition for wound healing

Tuesday, March 26th, 2019

nutrition for wound healing

Wound care clinicians work diligently to find the most relevant products while using the latest evidence-based treatments to provide the best patient care.

Carole Jakucs

By Carole Jakucs, MSN, RN, PHN

For optimum wound healing to occur there is another important factor – a nutritious diet.

Proper nutrition for wound healing includes a diet with the right number of calories, vitamins, minerals and nutrients necessary to maintain skin integrity and promote wound healing.

To learn more about nutrition for wound healing, we spoke with Julie Stefanski, MEd, RDN, CSSD, LDN, CDE, FAND, spokesperson for the Academy of Nutrition & Dietetics and content writer for food, nutrition and dietetics at Relias Healthcare, about five of the most common myths regarding nutrition and wounds.

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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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Diabetic Foot Screening Guide

Friday, July 29th, 2016

Five clinical tests for diagnosing loss of protective sensation in the diabetic foot, plus tips on inflammation assessment.

 

Diabetic Foot Screening Guide

 

How serious are diabetic foot ulcers? The statistics are sobering:

  • It is estimated that between 10 and 25% of patients with diabetes will develop a foot ulcer in their lifetime.
  • Diabetic foot ulcers precede 84% of all lower leg amputations.
  • The five-year mortality of patients with newly diagnosed diabetic foot ulcers (DFUs) is nearly 50%, and carries a worse prognosis than breast cancer, prostate cancer, or Hodgkin’s lymphoma.

In addition, DFUs are at increased risk for infections and other complications, and continue to be a major cause of hospitalizations and additional healthcare expenditures.  So while patients suffer greatly from DFUs, these chronic wounds are also a huge financial burden on healthcare systems. This is because these same patients spend more days in the hospital, and experience more visits to the emergency room and outpatient physician offices than other patients with diabetes.

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Diabetic Footwear: If The Shoe Fits, Wear It

Friday, April 29th, 2016

When it comes to diabetic wound care, footwear matters – and proper diabetic patient shoe assessment is key.

Diabetic Footwear

 

Wound clinicians know how devastating foot amputations are for diabetic patients. But what you might not know is that a whopping 50% of diabetic foot amputations are a direct result of patients wearing improper footwear. Surprised? Unfortunately, this staggering statistic is accurate. But the good news is that there’s something we can do about it. If we get diabetic patients to wear the proper shoes, we can cut diabetic foot amputations in half.

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Diabetic Wound Care: Monofilament Testing

Friday, March 11th, 2016

Detecting neuropathy in the diabetic foot is crucial for patient care, which is why the 10-step monofilament test is a must when it comes to injury and ulceration prevention.

Monofilament Testing

 

Healing patients and helping them get on the road to recovery are always at the top of any wound clinician’s list. We are always on alert and in constant assessment mode, looking for ways to prevent further complications or possible injury. So when a patient also happens to be diabetic, our assessment mode goes into overdrive.

One of the most common complications of diabetes is neuropathy, or nerve damage of the extremities. With sensory neuropathy, the patient loses protective sensation and the ability to feel pain and temperature changes. Without protective sensation, the diabetic patient is at an increased risk for foot injury or ulceration, and may not realize anything is amiss until there are serious complications.

Neuropathy Screening

This is why testing your diabetic patients for neuropathy is so important. In fact, the American Diabetes Association recommends that we screen diabetic patients for neuropathy annually, at minimum. Once we note any diminished sensation, we should check quarterly.

One way to assess protective sensation in the diabetic foot is to perform a Semmes Weinstein 10g Monofilament Test across designated sites on the foot.  The test uses a 5.07 monofilament that exerts 10 grams of force when bowed into a C-shape against the skin for one second.

 

Monofilament Diagrams

 

How to Perform the Semmes Weinstein 10g Monofilament Test

The test procedure is as follows:

  1. Use the 10gm monofilament to test sensation.
  2. Have patient close his or her eyes.
  3. Apply the filament perpendicular to the skin’s surface.
  4. Be aware that the approach, skin contact and departure of the monofilament should be approximately 1.5 seconds in duration.
  5. Apply sufficient force to allow the filament to bend. (Figure 1).
  6. Do not apply to an ulcer site or on a callous, scar, or necrotic tissue.
  7. Do not allow the filament to slide across the skin or make repetitive contact at the test site. Randomly change the order and timing of successive tests.
  8. Ask the patient to respond, “Yes,” when he or she feels the filament.
  9. Document response when felt, and test for sensation (Figure 2).
  10. Be aware that neuropathy usually starts in the first and third toes, and progresses to the first and third metatarsal heads. It is likely that these areas will be the first to have negative results with the 10gm monofilament. Repeated testing can demonstrate vividly to the patient the progression of the disease.

Record the results on the screening form, noting a “+” for sensation felt, and a “-” for no sensation felt. The patient is said to have an insensate foot if they fail on retesting at just one or more sites on either foot. Injury is much more likely to occur in these insensate areas and we must take protective measures. Provide patient education verbally and in writing, such as these materials from the American Diabetes Association, and be sure to do a good shoe fit assessment as part of your care plan.

Do you administer the Monofilament test?

Are you familiar with the Semmes Weinstein 10g Monofilament Test, and do you administer it on a regular basis to your diabetic patients? Has monofilament testing produced significant results in terms of prevention and assessment? We are interested to know about your experiences in diabetic foot testing, so please leave your comments below.

 

Free Download - Neuropathic Foot Exam Guide

Click to download this easy-to-use resource for performing foot examinations.