My Resident Has a Chronic Wound Now What??? Jolene Heil RN ET MClScWH April 8, 2014 Overview Wound Causes Factors that impair wound healing Wound Assessment Holistic Approach What is the cause of the wound? What factors are influencing healing of the wound? What are the patient s goals? Is this wound healable? 1
Wound Causes Pressure, friction, shear Venous insufficiency Arterial insufficiency Skin turgor Malignancy Surgery Factors that Impair Healing Mobility Moisture Nutrition & hydration Infection Circulation Hemodynamic Status Assess and Optimize Nutrition and Hydration Albumin & Prealbumin levels BUN : Creatinine Total Protein FBS, HgbA1C Serum Iron TIBC Ferritin Consult Registered Dietician Consult Speech- Language Pathology 2
Clinical Signs of Infection NERDS (Local) Non-healing Exudate increased Red (friable wound bed) Debris Smell (post irrigation) STONEES (Systemic) Size is bigger Temperature increased Os (probes to bone) New breakdown Erythema Edema Smell (post irrigation) Sibbald RG, 2006 Investigating Infection CBC ESR & CRP Probes to bone x-rays, MRI, bone biopsy What About C&S??? 3
Assess and Optimize Circulation Perform Ankle / Brachial Pressure Index Testing Toe pressures / PPG for Diabetics Compression wraps or stockings Hemodynamic Status Acute Illness Palliation Diabetes Hypothyroid Anemia Wound Assessment Exudate Odour Wound base Periwound skin Measurement Undermining / tunneling / Sinus tracts / abscesses 4
Choosing a Dressing Is the wound healable? What do I want the dressing to accomplish? Moist Wound Healing Wound Treatment Treat the CAUSE Treat the PATIENT Treat the WOUND 5
Questions? References Campbell KE&H,P. Proteases in Chronic Wounds: A Primer for Health Professionals. Rehab & Community Care Medicine 2003 Summer:24-26. Kane, D. Chronic Wound Healing and Chronic Wound Management. In: Krasner D, Rodeheaver G, Sibbald RG, editors. Chronic Wound Care: A Clinical Source for Health Professionals. 4th ed. Malvern, PA: HMP Communications; 2007. p. 11-24. Landis S; Ryan S; Woo K; Sibbald RG. Infection in Chronic Wounds. In: Krasner D, Rodeheaver G, Sibbald RG, editors. Chronic Wound Care: A Clinical Source for Health Professionals. 4th ed. Malvern, PA: HMP Communications; 2007. p. 299-321. RNAO. Risk assessment and prevention of pressure ulcers. 2011(Supplement) doi:http://www.rnao.org/storage/83/7749_pressureulcers_supplement_2011.pdf Sibbald RG; Orstead H Schultz, GS; Coutts P; Keast D Preparing the wound bed 2003: Focus on infection and inflammation. Ostomy Wound Manage 2003;49(11):24-51. Sibbald RG, Coutts P, Woo KY. Reduction of bacterial burden and pain in chronic wounds using a new polyhexamethylene biguanide antimicrobial foam dressing-clinical trial results. Adv Skin Wound Care 2011 Feb;24(2):78-84. Sibbald RG et al., Increased bacterial burden and infection: The story of NERDS & STONES. Adv Skin Wound Care. 2006;19(4):47-61. Sibbald RG et al., Special considerations in wound bed preparation2011: an update. Adv Skin Wound Care 2011;24(9):415-36. White RJ, Cutting K, Kingsley A. Topical antimicrobials in the control of wound bioburden. Ostomy Wound Manage 2006 Aug;52(8):26-58. Woo K, Sibbald RG. A cross-sectional validation study of using NERDS and STONEES to assess bacterial burden. Ostomy Wound Manage 2009;55(8):40-8. Yager DR, Kulina RA, Gilman LA. Wound fluids: a window into the wound environment? Int J Low Extremity Wounds 2007 Dec;6(4):262-272 6