Beyond the Basics ImprovingYour Wound Care Knowledge. Berna Goldentyer RN, BSN, CWOCN Kathy Hugen RN, BSN, CWOCN
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1 Beyond the Basics ImprovingYour Wound Care Knowledge Berna Goldentyer RN, BSN, CWOCN Kathy Hugen RN, BSN, CWOCN
2 Projects and Posters These resources were developed by creative VA nurses who had no special wound care training. They were interested in sharing what they learned about wounds and treatments with their co-workers. Their desire was to increase staff s knowledge and skills in order to enhance patient care.
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7 ICU Pressure Ulcer Bundle Beds-air flow, alternating pressure (only two layers of linen/products under patient). Repositioning- HOB<30 degrees, OOB in chair. Border dressing-to sacrum, heels and oxygen cannula, heel protectors, chair cushions. Skin champions- round, educate, chart review. Assigned- turning partners, lunch and breaks. Nutrition. Thorough skin and risk assessments. Education- assigned modules, pre/post test.
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9 What is this? How to treat?
10 Incontinent Dermatitis Protective barrier cream - Zinc/Dimethicone. For satellite lesions -antifungal cream, then apply protective barrier cream over top. Incontinent wipes or ph balanced cleansers - no soap. Open to air -minimize use of briefs, use absorbent bed underpad. Toileting program. Fecal collection system if liquid stool.
11 The True Story About Briefs Promotes perspiration and perineal dermatitis. Susceptible to friction, erosion, pressure ulcers. Liquid stool is most irritating change brief after every episode. Briefs must absorband wickmoisture away from skin.
12 What stage is this? How to treat?
13 Stage 2 Pressure Ulcer Cleanse and protect area. Turning schedule, offloading device. Border dressing-good up to 7 days. Hydrocolloid -scant or no drainage. Protective Barrier Cream - coccyx/sacrum.
14 What is this? How to treat?
15 Pressure Ulcer Stage 4 Air mattress-keep off area as much as able. Negative pressure - if depth or drainage. Wound geland saline dampened gauze, if dry. Antimicrobial dressing -silver, medical grade honey. Flap/graft- surgical closure. Nutrition management.
16 Why Wet to Dry Dressings Should NOT Be Used Increased risk of infection -bacteria dispersed into air when dressing removed. Consistent moisture -needed to heal (40% faster healing if kept moist). Impedes healing -for six hours after dressing change (must maintain a certain temperature in wound bed to heal). New dressing technology -heals wound faster without harming healthy tissue, stays in place longer, minimal pain on removal at less cost.
17 What is this? How to treat?
18 Heel UnstageablePressure Ulcer Betadine swab and gauze roll bandage -if no drainage and firm eschar. Float-heel off mattress (heel protector or pillows). If drainage, odor, or boggy, consult podiatry or surgery (debridement). No occlusive dressing -such as a border dressing or hydrocolloid. Keep dry as much as is possible -don t let it become moist.
19 What is this? How to treat?
20 Escharand Slough Surgical consult -for sharp debridement. Vascular consult. Enzymatic debridement -Collagenase (Santyl-daily, apply nickel thickness, cover with damp saline gauze), medical grade honey, Cadexomer Iodine(if drainage).
21 What is this? How to treat?
22 Suspected Deep Tissue Injury Keep off pressure area. Specialty air mattress, chair cushion. Moisture barrier ointment -balsam peru, petrolatum - something NOT drying. No rubbing or scrubbing-cleanse skin gently. No border or adhesive dressing -will peel fragile skin off. Treat when, and if, area opens up.
23 What is this? How to treat?
24 UnstageablePressure Ulcer with Deep Tissue Injury Surgeryconsult for debridement. Specialty air mattress. Reposition. Nutrition. Possibility of end of life skin failure.
25 What is this? How to treat?
26 Skin Tear No transparent or adhesive dressing that will adhere. Reapproximate skin, cleanse with saline, apply skin prep, steri-strip. Foam -if drainage. Silicone -good 7 days, oil emulsion, Xeroform (if minimal to no drainage). Prevention: long sleeves or pants, roll gauze, no tape, no harsh soap, moisturizing cream.
27 What is this? How to treat?
28 Venous Stasis Ulcer Foam, silver absorptive dressing, ABD pad -NO HYDROCOLLOID. ABI s, Toe Pressures - if poor, get vascular consult. Compression Low -kerlex and coban, Unna s boot -if no heavy drainage and patient ambulatory, ted hose not indicated for compression. Medium to high -two to four layer compression wraps. COMPRESSION STOCKINGS -knee high, if wounds are closed compliance issues.
29 What is this? How to treat?
30 Diabetic Foot Ulcer Podiatry consult -callus removal, x-rays. Offloading shoe. Diabetic education -including foot inspection and care, regular follow-up in podiatry. Antimicrobial dressing -silver, honey, Cadexomer Iodine or gauze packing strip (add wound gel if dry).
31 What is this? How to treat?
32 Vascular Ulcer (Arterial) Keep dry -betadine swab, gauze roll bandage to protect. Vascular consult.
33 What is this? How to treat?
34 Basal Cell Carcinoma Dermatologyconsult for biopsy. If a treatment does not improve the wound within two weeks, try a different approach. If a wound you ve been treating for a long time does not close (or closes and reopens), refer the patient to a specialist.
35 QUESTIONS?????
36 THE END
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