As a wound care clinician, you may be called to work in a burn unit or be consulted on burn wounds. If that is not your normal work setting, it can be overwhelming.
Our purpose in this article is to address the fundamentals and provide a solid working knowledge of how to manage burn wounds.
Let’s start with terminology. The American Burn Association changed the classification of burns from the traditional first-, second-, third-, and fourth-degree burns to the following:
Given the fact that DFUs occur in approximately 15% of patients with diabetes and there are more than 34 million people in the U.S. with diabetes, using a relevant diabetic foot ulcer classification system for patients is essential.
There are several diabetic wound classification systems. But how do you choose which one to use?
This decision generally involves clinician preference along with the organization’s policy.
Two wound care specialists provide an overview of two systems for DFU classification: The Wagner Scale and the University of Texas (UT) Diabetic Wound Classification System.
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.
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.
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.”
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.
If you’re a nurse with a passion for skin and wound care, you may want to consider expanding your professional marketability by becoming wound care certified.
So how much do wound care nurses make? According to some online sources for wound care nurse salary data, the average annual wound care nurse salary ranges from $47,000 to $86,000 and an average annual wound care nurse salary at just over $69,000.
Keep in mind that salaries for wound care nurses can vary greatly from the annual rates, depending on a few other factors, including the state and city you in which you practice, your level of education, the size of the organization, and whether or not you have wound care certification. All of these play a role in your earning potential.
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:
So many PTs practice wound management that the American Physical Therapy Association (APTA) has a component group known as the Academy of Clinical Electrophysiology and Wound Management (ACEWM).
The ACEWM consists of nearly a thousand physical therapists and students interested in electrophysiology, biophysical agents, wound management, and neuromusculoskeletal ultrasonography. Within the ACEWM is another group known as the Wound Management Special Interest Group (WMSIG) whose focus is solely on wound management.
WCEI spoke with Patricia Larkin-Upton, PT, DPT, MS, CWS, CEEAA, vice chair of the ACEWM and WMSIG. Larkin-Upton collaborated with the WMSIG board of directors and the ACEWM president and vice president to provide insight into the history of these wound care organizations and some goals they have for the future.
The study was conducted by nurses and nurse faculty in Spain at two university hospitals and one public hospital in Spain. Twenty-one adult ostomy patients were asked for their insights before and after their ostomy surgery.
Fourteen of the patients had a gastrointestinal stoma due to cancer, six due to inflammatory bowel disease, and one due to familial polyposis. About 48% of the sample had an ileostomy and 52% had a colostomy. More than half (62%) had a permanent stoma, while 38% had a temporary stoma.
However, when considering the overall treatment plan, spending more doesn’t always equate to best practice or best results.
Cost-effective wound care means providing the most successful treatment to heal the wound at the least amount of cost. And with annual treatment costs of wound care in the billions in the U.S. alone, there’s plenty of reason to be cost conscious when choosing treatment strategies. Let’s take a look at some of the basic concepts behind this approach.