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CWON - Certified Wound and Ostomy Nurse
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CWONgal has 12 years experience and specializes in CWON - Certified Wound and Ostomy Nurse.

CWONgal's Latest Activity

  1. CWONgal

    charting advice

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

    How Good are You at Staging Ulcers?

    Ok, I will say there was a pic there that was a bit unusual (and wish I had a larger pic). I think it was on slide 4...said stage II. What appears to be the base has hair and the tissue beneath looks like there aren't any issue? Do I need to put some glasses on? Be honest!LOL
  3. CWONgal

    charting advice

    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?
  4. CWONgal

    Wound bed appearance with a wound vac?

    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.
  5. CWONgal

    Is this correct practice?

    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.
  6. CWONgal

    Denuded Peristomal Skin

    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?
  7. CWONgal

    Online WOCN training

    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.
  8. CWONgal

    charting advice

    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.
  9. CWONgal

    Wounds and contractures

    Sounds more like intertriginous dermatitis/candidiasis because it is within the skin fold.
  10. CWONgal

    Wound bed appearance with a wound vac?

    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).
  11. CWONgal

    Wound bed appearance with a wound vac?

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

    Is there really a demand?

    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!
  13. CWONgal

    Necrotic toes wound care

    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.
  14. CWONgal

    Penile ulcer..HELP!

    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.
  15. CWONgal

    Decub care in the developing world

    Standard moist to dry dressings I suppose if that's all you have. Ama's idea on Dakin's is good and you can find instructions online to make it yourself. Of course it depends on the type of pressure ulcer you have and you shouldn't need to routinely use it on all PU's. Dakin's can be good for odor and debridement/softening of slough and eschar. The periwound tissue has to be protected though with a petrolatum or comparable product. People in general without wound care experience often make a soupy wet dressing with gauze and saline which often damages the wound edges.
  16. CWONgal

    WOCN preceptorship

    Talk to your employer and see if they will give you admin/education leave so you don't have to use your own vacation time. It can be difficult depending on where you live to find WOCN's working on the weekends to fulfill that requirement. I unfortunately, had to use my own PTO.