Ask the treatment expert
In addition to the change in terminology from pressure ulcer to injury, NPUAP's April 13, 2016, press release announced refined descriptions of pressure injury (ulcer) stages.
Ask the Treatment Expert about ... what NPUAP's new "pressure ulcer" definition means for providers?July 04, 2016
The National Pressure Ulcer Advisory Panel announced a number of changes in April, including replacing the term "pressure ulcer" with "pressure injury" and modifying stage definitions.
Information sharing is essential to promote quality wound care. Although there are no national, state or local regulations related to wound care documentation, individual skilled nursing facilities must have well thought-out and written policies and procedures.
I recently admitted my first resident with a surgical incision with staples intact in a hip wound. Do you have tips on how to care for this wound?
Are all blisters pressure ulcers and if they are, how should they be staged?
I have a colleague who would like to trial maggot therapy. Can you provide some information about it?
I am treating a resident who is receiving palliative care with a Stage III pressure ulcer on the right trochanter and a Stage IV pressure ulcer on the sacrum. How should I treat these pressure ulcers?
Do you have any guidance about the type of linen to use on support surfaces with a resident who is high-risk for pressure ulcer development?
Do you have any ideas on how to address the problem of pressure ulcers with my staff?
Are there any changes related to nutrition and wound healing we should know about?
What is the lower-extremity problem we're most likely to see?
How should we deal with what seems to be a deluge of foot ulcers?
How do you handle people obsessed with leg sores?
Turning, repositioning and mobilization are important interventions to assist in pressure ulcer prevention. Many clinicians continue to maintain an every two-hour turning intervention that has been indicated for years.
As a foundation to heading into the rest of 2015, here is a review of the basic wound care principles.
What can you tell us about the new 2014 edition of "Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines"?
Can you give some guidance on skin tears?
Does placing multiple pads and linens under residents who are incontinent protect their skin?
Have you heard that most clinicians are in agreement that there are unavoidable pressure ulcers?
While moisture promotes wound healing, what about those wounds that have a lot of drainage?
Did your mom or grandmother ever tell you to leave a wound open so it could get air?
What do you do when staff disagree about the stage of an ulcer?
What is your advice about measuring wounds?
Can you give me some guidelines regarding when I should start negative pressure wound therapy and when it should be discontinued?
I am a registered nurse and very interested in wound care. I understand that there are some general "wound healing principles." Can you explain?
Can you explain the purpose of a pressure map and the usefulness when evaluating the function of a therapeutic support surface?
Are wound cultures the best method to determine if a wound is infected?
Can you supply a good primer for aides and others to determine whether a wound is infected?
Should incontinence briefs be used in the long-term care setting?
I am treating a patient with two Stage IV pressure ulcers and he is complaining of extreme pain. What do you recommend?
How much do we have to document risk and implemented interventions to prevent pressure ulcer development?
Q: What are your thoughts on accelerating wound healing in chronic wounds with adjunctive therapies? A: With chronic wounds, the healing process is slowed or in some cases, completely stalled. Therefore, the healing time exceeds four weeks. Some examples of chronic wounds include pressure ulcers, vascular ulcers and ulcers related to inflammatory diseases.
How do you deal with the age-old question "Is it a pressure ulcer or not?" Many healthcare professionals are frequently faced with the dilemma of how to document a reddened area on the buttocks, peri-rectal area or perineal area. Is this a pressure ulcer or is the underlying etiology totally different?
I recently read an article addressing the movement of patients while in bed. It was conducted in the United Kingdom and contains valuable information.
What role does friction play in pressure ulcers?
We continue this month on how to manage painful wounds.
How can we best identify pain associated with wounds?
A useful resource, "Wound Care Made Incredibly Visual," offers an acronym that may be helpful in highlighting information that should be included when documenting about wounds: WOUNDD PICTURE
This is a question that often surfaces, so it may be useful to review the definition, causes, recognition and treatment of "yeast infections."
Prevalence is defined as a cross-sectional count of the number of cases at a specific point in time, or the number of people with pressures ulcers who exist in a patient population at a given point in time.
If you do not currently use Negative Pressure Wound Therapy (NPWT) you may want to investigate and consider this excellent option.
Xerosis, dry skin, can cause the skin to become scaly and crack, which increases the skin's exposure to bacteria. Many factors contribute to dry skin.
Years ago, this question wouldn't have even made our radar screen. However, now it seems a standard consideration since allergies have become increasingly prevalent.
Caregivers must be taught how to closely examine darkly pigmented skin in order to determine tissue damage. A purplish/blue discoloration may be seen.
I am definitely a proponent of education for treatment nurses. Continuing education is significantly important to all of us in long-term care, but especially for those directly involved in wound care.
A skin tear is a traumatic wound resulting from separation of the epidermis (top layer) from the dermis (underlying layer). The aging process causes older adults to be at high risk for skin tears.
This question is often asked. Wound care specialists debate among themselves as to when to use sterile technique and when to use clean technique.
Some of the risk factors that may contribute to development of these ulcers include atherosclerosis, hypertension, diabetes mellitus, smoking and dyslipidemia.
Risk factors that may contribute to development of venous stasis ulcers include history of leg swelling, varicose veins, history of blood clots, deep vein thrombosis, obesity, sedentary lifestyle, prolonged sitting or standing, increasing age and associated immobility, multiple pregnancies, congestive heart failure and smoking.
Susan Wickard, RN, BSN, CWCN, CWS, CLNC, Clinical Advisor, American Association for LTC Nursing