tamari07

I've been in wound care for 5 years and more recently ostomy care for 1 year. I received my CWON from Emory University last year. I began my wound care experience fresh from floor nursing 6 years ago. I worked in an outpatient wound care clinic for 5 years, which gave me invaluable experience. I then transitioned to the inpatient side about a year ago after receiving my certification. As an inpatient wound care nurse I am responsible for assessing inpatients, coming up with a wound care plan, working with surgeons, hospitalists, social workers, primary nurses, etc. to come up with a plan of care; there is definitely a case management aspect to it as well. I absolutely love inpatient wound care as I still have hands-on, bedside experience, but am not a full-time floor nurse working 12 hour shifts on a stressful unit. It's the best nursing job in my opinion. As far as wound certification goes, you must show at least 2-3 years experience of wound care to be eligible to sit for the certification exam. I don't know where you are located, but Emory University in Atlanta has a top-notch program, which is distance-learning based: Wound, Ostomy, and Continence Nursing Education Center | Nell Hodgson Woodruff School of Nursing | University | Atlanta GA. You must go to Atlanta for a one week "bridge week" for hands-on, clinical experience, but other than that it's done online. The instructors are amazing and have years and years of wound/ostomy experience. I HIGHLY recommend starting out in an outpatient clinic to gain a base knowledge of wound care. Wound care is highly specialized with endless dressings, treatments, and no two patients are the same. One patient may respond to a treatment that the other does not. I found that my 5 years of experience in an outpatient clinic gave me the foundation of knowledge I needed to succeed in an inpatient setting and to be able to obtain my certification. In an outpatient setting you basically are following the wound care MD/midlevel's orders for wound care. On the inpatient side you have much more autonomy and really need to have a good understanding of wound care to be able to formulate a plan (at least that's how things are set up where I work). I am not familiar with the programs that you linked in your post. But honestly, to really grasp and learn wound care it takes on-the-job experience and hands-on knowledge. Good luck in your endeavors. Wound care is truly a rewarding field. I will also put in a plug for ostomy care as well. I LOVE it and really love my ostomy patients. It's the most rewarding experience in my opinion. Wound and ostomy care tend to go hand in hand. Emory provides certification prep in wound/ostomy/continence, so you can work on both at the same time, which is what I did.

I would recommend quarter-strength Dakins solution dsgs BID. Depending on the severity of the wound I have used half-strength from time to time. From your post I'm assuming this patient is on Hospice care. If aggressive care was warranted then a sacral MRI would be needed to confirm osteo and the patient started on IV antibiotics.

Depends on what you classify as "infected". I've had nurses and even MDs see yellow slough and dead tissue in a wound bed and say it was "infected." Usually if a wound has excessive dead tissue and slough it is not ready for wound VAC. The wound needs be fairly clean before initiating a wound VAC and sometimes serial debridements are necessary to clean up a wound prior to starting a wound VAC. You would never initiate NPWT on a wound with large amounts of slough and dead tissue. In my experience if I have a pt in a wound VAC and there is blantant signs of infection (i.e. erythema, foul odor, purulent exudate, high WBCs), I hold the VAC, place them in a dakins dsg for bacterial management, and consult the MD about starting antibiotics. Our wound physician will go a step further sometimes and order an x-ray to r/o osteo (which osteo is a strict contraindication for NPWT). Regarding your comment about "sucking out infected exudate": that is not the purpose of NPWT. The negative pressure exerted by the wound VAC increases circulation and blood flow to the wound bed and aides in angiogensis and tissue granulation. Removing exudate is just the "side job" of the VAC, not the primary purpose. Hope this was helpful.

Obviously he/she has severe arterial disease that will not resolve and is an infection waiting to happen-- especially if the gangrene is wet. From your post it sounds the gangrene is pretty extensive. Any type of non-occlusive dsg (tegaderm) will trap too much moisture and create a soupy mess. I understand your logic in not wanting to use an occlusive dsg, but just plain dry gauze maybe the only way to go-- and use saline to moisten it before removal. I would also make sure the nursing staff is removing the dsg daily to inspect the gangrene to make sure it is not deteriorating. At this point wound care is palliative and the goal is to remain infection-free since the patient is not a surgical candidate.

In our clinic we use Remedy lotion (a Medline product) to intact skin on the leg. We use a moisture barrier cream to the periwound. So far good results with no maceration. ETA: if they have really dry, scaly skin on the ankles and heels we also use Urea 5% cream.

Kennedy ulcers were my first thought.

I work in an outpatient clinic and had a patient I was making casual conversation with. I was pregnant at the time with my baby girl. She asked me what I was planning on naming her and when I told her she said, "So what are you going to tell her after she grows up and tells you that she hates her name?" I can't even sometimes.

Agree with the previous poster. We use coloplast to help seal drape around crevices such as the perineum. Also I have used eakin rings to help with seals. Considering the fact that the dsg is contanstly losing a seal and having to be changed twice daily I don't see the patient getting much benefit from NPWT. If they came to our wound center presenting with this issue our MD would see if the patient would benefit from another type of dressing, such as a dakins wet-to-dry. I don't know the patient background or extent of the wound, but we have had patients that needed a temporary diverting colostomy until the wound closes. But much needs to be considered before pursing that option including age, co-morbidities and considering if the wound will actually heal once stool contamination is no longer an issue.

I at one point transferred to the Med-Surg ICU and quickly realized it just wasn't for me. I had 4 years of floor experience and decided to try something new. I found out that it just wasn't for me. Our hospital actually had an excellent orientation program for the ICU and treated each new hire/transfer as a new grad. We had classes in conjunction with time spent in the unit with our preceptor. The educator was wonderful and really knew the ins and outs of critical care nursing. With that being said, even with a great preceptor and orientation process I had big anxieties working in the ICU. I had done my senior year practicuum in the same ICU, so I knew what I was getting into. But once I got in, I realized how much I enjoyed my previous unit. I enjoyed talking and interacting with patients and watching them rehab and get better. Obviously in the unit the majority of your patients are intubated or non-verbal and their goal is stablization, not rehab. I spent almost two months in orientation and decided to transfer back to my previous unit. Fortunately the ICU director was understanding. I told her I didn't want to waste anymore of hospital dollars on my orientation when I knew I wasn't happy there and didn't see myself there long-term. It's okay to realize something may not be your jam. I'd much rather transfer back and be happy then stick it out and just be miserable. I'd do some soul-searching and see if this is somewhere you see yourself working for several more years. Do you think you'd enjoy it more with a different preceptor or orientation program? Do you think this just may not be your preferrerd specialty?

Before I had kids I would volunteer holidays, esp Christmas. I enjoyed the double time pay and didn't mind. Now I have two kids and am very fortunate enough to work in an outpatient setting. My clinic is closed major holidays and weekends. ?

We never have a second nurse listen to take a telephone order. The only time I have a second nurse to listen is for a DNR order. Fortunately we have CPOE and docs put in their orders on the computer. But I do get a lot of telephone orders. We just have to write 'read back and verified' next to our signature. It would be nice to have a second nurse listen so we have peace of mind that we wrote down the correct order, its just not feasible.

Fortunately where I work they do consider your experience level. I was not oriented to charge until I had about 2 years experience. If I was floated to another unit, I never charged. But unfortunately it sounds as if this is becoming more of the norm to throw new, inexperienced nurses into charge with unreal assignments. I agree with the previous posters. Always always protect your license. If you feel uncomfortable doing something, speak up! Good luck!

I am looking at enrolling in Walden soon. I refuse to stay a floor nurse forever I am unsure of which route to take though. I have my BSN so I am going to be on a BSN track. I have pros and cons of each program. Education: I'm not sure that I want to be teaching. Never thought of being a nursing instructor. Informatics: I would love love to work with the computer side of nursing and such, but I'm afraid the jobs aren't there. Leadership/Management: This is the one I'm leaning towards. It seems to be broad enough that I can move up easily. Not sure if I would be good in an administrative position, but who knows where I'd end up. I have a feeling I really would enjoy getting my degree online. I tend to be a self learner and work best on my own. So I'm not worried at all about the online component. I just have to figure out which program to settle on. Good luck in your studies!! I'm sure you will do great!

I'm interested in obtaining my Master's degree online. I have been looking around at different schools including Walden and Phoenix University. Problem is, there are sooo many different Master's programs and I'm not sure which one is best for me I know I'm not cut out for Nurse Practitioner. I would like to do something in administration versus bedside. I would love to do something in informatics. Problem is, I'm afraid the jobs aren't there. I've also considered either Health Administration or Leadership/Management. I just want to make sure that once I've finished my Master's I will find the right job. I guess I'm not sure how to narrow down the choices and find the right program for me. Anybody else with the same problem? Thanks!! :)

I'm going to start studying for the exam soon. I plan to take it sometime next year. From what I have heard the exam contains a lot of anatomy and rehab questions. I guess I'm really nervous because I am not sure what to study. I have not seen any study guides. I bought the AANN Core Curriculum for Neuroscience Nursing book, but I am thinking about buying the Hickey one because everyone seems to like that one best.