CWONgal

I can see your point from the LTC perspective. Inpatient assessment and documentation, especially upon admission, is important.

I don't know that I'd agree with that David. We can't always determine the etiology but we are still expected to document it's presence because it is an abnormality. Describing what you see (erythema, exudate type, exudate amount, odor, location, etc.) helps to paint a better picture of what is going on (unfortunately nurses often don't know the terminology). Following it up with a plan of care is key. If you found something, what is your plan to fix the situation?

Several other observations. I don't think the silver granufoam is all that and a bag of chips. Personal experience is it seems to trigger an increase in debris. Also, when you have a compromised limb multiple layers of drape (people either don't have experience or go overboard thinking a little bit more is better) can cause a deterioration in the extremity....have seen volatile feet where TMA's and/or wounds have been debrided and then the layers of drape caused increased moisture beneath and caused more damage requiring even more debridement.

Yep, have never heard of using that terminology. I would think a "defect" would be something like a keloid or scar tissue formation. Wonder if that wound is critically colonized and that's why it won't heal? Also, even though the wound may re-epithelialize it's not truly "healed"....can take up to a year.

Marathon is a great product, agreed...pricey and from what I understand it is not considered a standard ostomy product and may not be covered by insurance. Lots of folks use paste as though it's a glue and when they plaster it onto that peristomal skin it can be a challenge to get off. I only use paste to fill in crevices and visible gaps and I put it in a syringe first before applying. Eakin rings need to be warmed and if the peristomal tissue is weeping it can be hard to get the ring to stick. Brava rings get a gummy consistency over time but they really do seem to stick well. I have had a lot of folks complain about burning with Hollister paste...I THINK it does have alcohol?

Emory all the way (although I am sure Cleveland Clinic has a good program). Meggie is spot on with her statement, too. I loved their instructors and they are very friendly and approachable. Magnet hospitals seem to be some of the bigger advocates of hiring CWOCN's. I would recommend getting your continence certification at some point in time. It's actually a very interesting specialty and the education provided (at least by Emory) really helped solidify how important but often overlooked continence is in determining patient care.

If you add the adjective "linear" (if it is) with excoriation it helps paint a better picture of what you are trying to share with other staff. Excoriation is often used incorrectly and using it when describing a scratch is appropriate, as Tammy stated. You can document this using a clock...."Linear excoriation extending horizontally at 0300 measured 2.5cm in length". Any idea of the etiology? I know you said it was to the side...I would be careful with trachs in general because they often cause device related pressure ulcers that can deepen quickly.

Effective Management Strategies for Negative Pressure Wound Therapy | WoundSource This is a good article discussing NPWT and slough within the wound bed. It also mentions the use of a collagenase in combo with NPWT which I hear is used more and more now (haven't done it personally).

Slough isn't always easily debrided with CTA's, ergo the term "adherent slough".

There is a demand....check out a site like indeed.com. Best job move I ever made was getting into this field, highly recommend it!

Dry gangrene should stay dry. If a person has gangrenous toes we should look at the big picture. Why does he have gangrene? Likely, poor perfusion. Painting the toe with betadine is the most appropriate tx....what often happens is xeroform is thrown on everything. Yes, it has antimicrobial properties but it can cause a dry wound to become moist = wet gangrene which can spread infection rapidly. I've always been taught with folks in this situation (and with diabetics which often goes hand in hand) keep the toe web spaces dry.

Zinc oxide can have a drying effect if it's applied thinly (thick white paste formulation). Is the breakdown r/t urine, fecal incontinence, or perspiration? All? Any chance there is a co-existing yeast infection? We often get calls about "mysterious" lesions on genitalia and I often ask for a dermatology consult if I can't gleam anything definitive from the hx. If it's urine that caused it a petrolatum based skin protectant is usually sufficient.

Barrier rings, like Eakin work well when you conform them around the wound and in difficult crevices. (Besides feet the rings are helpful in areas within the gluteal fold where you tend to have moisture from sweating).They help prevent excess moisture on the skin and give you a nice base to fit your drape. Be careful not to use too much drape and don't place tape between the other toes in an attempt to secure the dressing. A lot of these folks have underlying circulatory issues and the excess drape can break down the skin further, despite using a skin sealant for protection. And like the others said you definitely want to bridge over onto the dorsum of the foot and ensure you have a bolster to protect from tracpad pressure.

Did the WOCNCB route and highly recommend it although it is a best pricey. Several programs offer distance learning. For each specialty you choose you will be expected to complete 40 hours of clinical time (Wound, Ostomy, Continence) and then possibly a week at the school. Check out the program available at Emory University. It's great.

You have a good start with what you've already mentioned and believe it or not you have written more than what I typically see for wound documentation. Measurements are important. Probably should elaborate a bit more on the no s/s of infection. Any odor? Exudate? Amount of exudate? Appearance? Erythema? If so, how far does it extend from the wound? Any edema or induration? What type of dressing did you apply?