WOUND CARE. By Laural Aiesi, RN, BSN Alina Kisiel RN, BSN Summit ElderCare

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1 WOUND CARE By Laural Aiesi, RN, BSN Alina Kisiel RN, BSN Summit ElderCare

2 PRESSURE ULCER

3 DIABETIC FOOT ULCER

4 VENOUS ULCER

5 ARTERIAL WOUND

6 NEW OR WORSENING INCONTINENCE CHANGE IN MENTAL STATUS DECLINE IN MOBILITY CHANGE IN ENVIRONMENT CHANGE IN CAREGIVER WEIGHT LOSS ILLNESS >48HRS

7 DIABETES OBESITY SMOKING CAD HYPERTENSION

8 IDT REVIEWING ANY PPT s WITH NEWLY RECOGNIZED RISK FACTORS HEALTH AIDE OBSERVATION END OF DAY WRAP-UP WITH PROVIDERS

9 WEEKLY SKIN MEETINGS: F/U ON CURRENT WOUNDS REVIEW PPT S IDENTIFIED TO HAVE ANY OF THE RISK FACTORS

10 VISITS TO HOMEBOUND PPTS AT RISK PPT S RECEIVE HEAD TO TOE SKIN ASSESSMENT FOOT CHECKS BY HEALTH AIDES PREVENTION RESULTED IN IDENTIFYING NUMEROUS STAGE 1 S, POOR FITTING SHOES, NEED FOR FAMILY EDUCATION, REFERRAL S TO PT/PROVIDER

11

12 ONCE A WOUND IS IDENTIFIED THE FOLLOWING THEN TAKES PLACE

13 PRIMARY RN VISITS HOME W/IN 1 ST 2 WKS PRIMARY RN DOES ALL TXs CONTINUITY OF CARE RD INVOLVED IN 1 ST WK - DETERMINE NEED FOR SUPPLEMENTS PT INVOLVED IN 1 ST WK DETERMINE NEED FOR SPECIALTY EQUIPMENT, SHOES, ETC HOME CARE INVOLVED IN 1 ST WK MAKES CHANGES TO HHA CARE PLAN

14 PROVIDER/RN WORK COLLABORATIVELY TRUST IS KEY. PROVIDING COMPLETE, THOROUGH ASSESSMENTS IMPORTANT TYPE OF WOUND DETERMINES TYPE OF DRESSING

15 PROVIDES MOIST WOUND HEALING INDICATED FOR PARTIAL THICKNESS WOUNDS NON-DRAINING WOUNDS DRESSING CHANGED DAILY OR QOD

16 PROVIDES moist wound healing and autolysis Feels soothing upon application Adds moisture to wound bed Indicated for partial / full thickness wounds Primary wound layer, requires secondary dressing. Dressing change frequency BID or daily

17 Provides moist wound healing & autolysis (duoderm, comfeel) Available in variety of sizes and shapes Absorption of minimal to moderate exudate Primary dressing for partial / full thickness wounds Dressing change frequency every 2-3 days Must have intact periwound skin for adhesion

18 Absorbs moderate to heavy exudates Can use in infected wounds Available in sheet and rope style Indicated as primary dressing for full thickness wounds Dressing change frequency, daily

19 Absorb moderate to heavy exudates Moist wound healing Most are nonadherent Indicated for partial / full thickness wounds Dressing frequency, q2-3 days

20 UNNA BOOTS TX FOR VENOUS STASIS ULCERS

21 VENOUS STASIS ULCERS Unna boots, 2-4 layer wrap from toes to knee) Used for venous stasis ulcers Frequency of dressing change is 1-2 x weekly Provides 32mmHg pressure to the leg Once wounds are healed, need compression stockings (jobst type) for prevention Mixed venous/arterial disease, TED stockings (12mmhg pressure)

22 STAGE 2 PRESSURE ULCER If shallow or opened blister Transparent dressing, or hydrophilic wound cream and foam dressing If superficial and related to incontinence and friction, use thick barrier cream

23 STAGE 3 If shallow Stage 3, hydrocolloid, Foam If slough or necrotic tissue, use debridement (sharp, enzymatic) If deep crater, gauze impregnated with wound Gel, secondary dressing

24 STAGE 4 PRESSURE ULCER In clean wounds, use wound vac In wounds with slough or necrotic tissue, use debridement (sharp, enzymatic), wound gel/cream, cover with secondary dressing. Skin grafts, surgical repair

25 ARTERIAL WOUND Vascular Consultation Monitor for infection Wound gel/cream Debridement (sharp, enzymatic) DO NOT APPLY UNNA BOOTS OR OTHER COMPRESSION

26 DIABETIC FOOT ULCER FOAM DRESSING CHOSEN ACCORDING TO SIZE, DEPTH, AND AMOUNT OF DRAINAGE PODIATRY CONSULTATION PEDORTHIC CONSULTATION

27 LOCATION LENGTH WIDTH DEPTH UNDERMINING SURROUNDING TISSUE EXUDATE ODOR WOUND BED (%SLOUTH,ESCHAR,GRANULATION TISSUE) TUNNELING TYPE OF DRESSING FREQUENCY OF DRESSING CHANGE EDUCATION

28 PHOTOGRAPH SHOULD IDENTIFY BODY PART, SHOW ORIENTATION, DATE, MEASUREMENTS PHOTOGRAPH WEEKLY OR WITH CHANGE S TO WOUND

29 NOTIFY PROVIDER IF ANY WORSENING OF WOUND AFTER 2-3 WEEKS OF TREATMENT WITH LITTLE TO NO CHANGES IT IS TIME TO REASSESS THE WOUND TREATMENT PLAN WITH THE PROVIDER ROOT CAUSE ANALYSIS ON WOUND - WHY IS IT NOT GETTING BETTER? SOMETHING IN HOME? HOME CARE? FAMILY/NEW CAREGIVER? EQUIPMENT?

30 IF NO IMPROVEMENT IN WOUND HEALING SEND TO WOUND CLINIC

31 STAGE 1 AVG IS 10 DAYS STAGE 2 AVG IS 23 DAYS STAGE 3,4 AND UNSTAGEABLE s AVG IS 33 DAYS

32 MONITOR SKIN DAILY AND REPORT INCONTINENT CARE AND SKIN BARRIER CREAMS SPECIALTY MATTRESS (AVOID THICK LAYERS) DME REPOSITIONING HYDRATION/NUTR ITION

33 HOW TO KEEP HEELS OFF- LOADED USE OF PILLOWS, WEDGES HOW TO DO SIMPLE DRESSINGS MEDICATING FOR PAIN SIGNS/SYMPTOMS OF INFECTION MANAGING DIABETES

34 OUR PREVENTION, TREATMENTs, REASSESSMENTS, COLLABORATION BETWEEN STAFF AND EDUCATION TO FAMILIES KEPT OUR WOUND RATES LOW APPROXIMATELY 5.5% OF OUR POPULATION WERE TREATED FOR VARIOUS WOUNDS THIS MONTH

35 Success of wound care depends on the entire team. The collaboration and trust between each member is key, especially so between the nurse and provider.

36 QUESTIONS?

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