followyourbliss

Wounds, wound healing, and lack of healing are wonderful opportunities to sink our teeth into more education, etiologies, and the extrinsic and intrinsic factors that accompany wounds. After 2 years in the " wound realm" I find that this knowledge and skills are utilized in many areas of nursing care. Considering that there are Master's Degree in wound science out there ( I work with an R.N with this degree) I know that wounds are a continuous dynamic learning curve!

Hi Everyone, I am interested in how many Canadian foot care nurses are on here? I am in B.C, and, just finished my foot care course. I am interested in what people are using drills besides dremmels, and why? Thank-you in advance, Follow your Bliss

Nettie01, Re: Malodorous wounds: It is in an atypical location: how long has it been there, and, has it been biopsied? Does it present with signs and symptoms of a Neoplastic process? ( cancerous). ie Friable, painful, raised, atypical borders, foul odour, lost of exudate, increased size, etc etc. How deep is it as well? That steers dressing changes and selection. The combination of a barrier cream to peri wound to protect from excess drainage may be incorporated in addition to using both a charcoal dressing for odour and absorption, along with a broad spectrum anti microbial such as Iodosorb, Inadine, a Silver based dressing etc. An absorbent pad as well. Perhaps a consultation with the Dr again.... when wounds fail to respond to a course of antibiotics, various treatments such as creams, etc we want to look at what pathology is underscoring the wound. Keep us posted! I know dealing with wounds when people are affected by dementia poses its own challenges :) Warm regards, Follow Your Bliss

Hi Swiss Miss28, Glad you posted! Skin tears, and the treatment of them is a particular interest to me. In addition to working in a Outpatient Wound Clinic I also work LTC. I have some easy, fast, and cost effective ways to approach skin tears that are not traumatic to the skin. There are some great PDF's on Wounds International called " Skin Tears Made Easy"- very helpful and informative. When addressing skin tears, and the elderly we know we are dealing with compromised thin fragile skin, and run the risk of stripping the skin and causing secondary damage by improper application of, and removal of products. In many places in regard to Wound Care policy and procedures Steri Strips are contraindicated except for use on the face only. The premise of this is that although it may " seem" like a good approach at the time they are extremely adhesive, skin stripping, and can cause secondary trauma when removed; they are also a barrier to wound healing as the area needs to be moist and the skin and cells need to be able to migrate across and close. Whether the location is the arm, leg, or elsewhere you want to : protect and maintain that balance of moist and covered. The first layer you can apply is : A) A non adherent such as Jelonet, Mepitel, Adaptic layed over the tear. Using a antimicrobial such as Inadine or Restore is considered this as well. B) a NON adhesive foam dressing such as Mepilex with NO adhesive borders, this is the protection layer. c) wrapping cast padding, profore, or similar around the arm, leg etc for protection; you can make a cast pad " pillow" to lay over for extra safety. d) use a mild stretch such as blue or yellow line to secure. You have a cheap, easy, fast, and effective dressing that 1) protects and you can address infection, 2) can allow exudate to be absorbed and not be held against skin contributing to maceration 3) maintain moist healing, and 4) change it with no further traumatic skin stripping/affecting friable/ and healing tissue etc. Also Viscopaste is amazing as a step 1 or 2 over non adherent- let's you secure step 1, zinc is soothing and healing to skin, and again no adhesives!! Hope this helps! We have seen so many nasty skin tears that we have had to soak off stuck on steri strips, which are caked with crap read " bacterial buffet" and never should be on fragile skin. Keep us posted- there are many great articles on " Best Practice" regarding Skin Tears now. Perhaps you can be the one to start a new and healthy Skin Tear policy where you work :) Take Care, Followyourbliss

Hi Fannies's Mom, I am glad you found the post helpful; I work in a teaching outpatient Wound clinic and recognize the value and importance of education and resources :) What I found helpful, and what was great for networking is shadowing: Ask to shadow at the Burn Unit, Wound Care unit, the Enterostomal Nurse, etc; it exposes you to a wide variety of etiologies, presentations, and treatments. Also any Ortho and Vascular Unit dealing with pre and post op surgeries for amputations and rehab services. Check out any specialized Skin clinics if you can as well ie Psoriasis etc...a whole world of dermatitis's out there! Also getting to know Lab Values associated with infection, inflammation, and the clinical markers of those. IE CRP etc. A few things that are also huge are : edema control through compression and the pathology of edema ie Lymphodema, organ involvement, and, when compression is contraindicated due to arterial compromise. Check out Coban wraps, Modifies Unna's Boots, and the parameters. Very cool once you start linking your assessments with treatments re: Ankle Brachial Index, resting Duplex Ultrasounds, Peripheral Arterial Disease with diabetes etc. Keep us posted :) I loved reading " Burn Unit" by Barbara Ravage, I read it before I trained on the Burn Unit- very good look into Burn Nursing. Follow Your Bliss

dbella24, Hi :) How exciting for you! I work in a specialized wound care clinic and it has changed me as a Nurse, and my practice- dramatically. Read up on the etiology and treatment of these ulcers: Arterial; venous; diabetic; pressure; neuropathic; mixed; trauma; and atypical. Read up on the difference between infection and inflammation- super important. Offloading, and Aircasts, etc. Get a really solid grasp of PVD and PAD- I would recommend buying a good wound care text, checking out sites that are reputable such as Wounds International, and Uk etc. In addition start checking out products used in Wound care and why; meaning that we tend to use products with good research behind it and efficacy. Ie Iodosorb, Silver products etc. Read up on doing a Vascular Assessment complete with Doppler Us, and doing ABI's. This includes resting Dopplers and Toe Pressures. I found reading about Osteomyelitis and Charcot Foot very interesting: and the tests used to differentiate clinically of great value. Keep us posted: what a GREAT opportunity; this will strengthen your practice hugely and definitely affect all areas of nursing you explore! Enjoy and Good Luck :) Follow Your Bliss

I encourage you to read the research and efficacy around using clean vs sterile technique and well as using regular tap water for cleaning as opposed to n/s etc. The Johanna Briggs Institute has the research and articles re potable water for wound cleaning. Check out the Cochrane Review and other reputable resources. Happy reading.

Hi jmn126, When addressing ulcers with an etiology of PAD there are a handful of very important things to address: 1) offloading, offloading dressing, and footwear review with an Orthotist or pedorthist. ( accomodative footwear and orthoses) 2) OT assessment for support surfaces: mattress, assistive devices ie w/c, transfers, offloading etc 3) tight glycemic control if diabetic; smoking cessation if smoker. 4) probing the wound to see if you have bone or covered bone and if so: Bloodwork and xray to query infection re: osteomyelitis etc. When addressing maceration using a barrier cream to peri wound is needed, secondly more frequent dressing changes, products that absorb while maintaining a moist wound, and protective is key. Frequently the exudate flows to an area of dependence: ie if they sleep on their right, or spend their days in a dependent position. At the specialized Ulcer clinic that I work in we use offloading dressing with a high success rate and with a lot of efficacy behind the research. In this case a " padded heel " dressing would be appropriate. It consists of 4- 5 layers of products: a) 1st layer: a broad spectrum antimicrobial such as Iodosorb to address "slough" which absorbs the exudate, gets in all the nooks and crannies, and cleans up the wound. b) 2nd layer: a small Viscopaste "patch" which is a zinc impregnated gauze which allows fluid/exudate to pass through, is healing, soothing, and is also a protection layer. c) 3rd layer: a cast padding pillow for offloading, protection, and absorb. D) a classic pad to absorb and protect, followed by a cast padding wrap around the foot E) a type of stocking tubing like Blue or Yellow line to secure. This may sound confusing and complicated, however it is safe, effective, coast efficient, and comfortable. If you are interested in PM'ing me I can find the actual care plan ( somewhere in my files!) I hope this helps! We see and treat a tremendous amount of ulcers from PAD, PVD, neuropathic, diabetic, venous etc etc.... Wit this type of dressing, and maceration, a dressing change every 2/3 days as per drainage is recommended. I look forward to your response! Follow Your Bliss

Hi All, I am in B.C and looking at the program as well :) Nice to know a pod of us are all going through AU! I would love to keep in touch; I have not yet applied due to a general hesitancy I am having around the program. The more info I have the more informed decision I can make. Thanks in advance, Follow Your Bliss

Hi kwest99, I am an LPN that works in LTC, Neuro Rehab, and a Specialized Wound Care Clinic. My advice as to how to deepen your knowledge, experience, and confidence around wounds is a combination of all above with the addition of shadowing at a Wound Clinic/Unit. It is a wonderful way to network, increase your exposure to different wounds with different etiologies, as well as testing out who has LPN's and what the Scope is for that Clinic. For me, the challenge of Wound Care and learning is EXPOSURE! You need to keep the volume up to: learn, differentiate, and build competencies around wounds. Once I took several wound care courses I shadowed at a wound clinic at the Hospital and was eventually hired :) The learning curve is huge, and very interesting. The ladies I work with have A Maters's in Wound Science in addition to R.N BSN. I trained on a Burn Unit and Vascular surgery, that is another very cool area to shadow: a Burn UNit. There are wonderful sites such as Wounds International, Wounds UK etc, amongst many other reputable resources. In the meantime may I suggest a few areas that will really benefit your Nursing practice around wounds? * Diabetic Ulcers, and Neuropathy * Venous Ulcers and Arterial * the difference between infection and inflammation: in particular in chronic wounds * Edema and wounds * pressure ulcers!! Keep us posted, and good luck :)

Hi Tarryn, I am also in B.C; where are you? PM me!

Hi Everyone, Wow- I think that we have really gotten away from Confidentiality! Where I work, at a Wound Clinic, the patient has to sign a consent form; this is regardless of it being " just the wound". If " we" as Nurses and Clinicians can identify the Wounds so can others. We have a special camera and the images are only allowed to be kept within our system. We accept pictures and communication with images, this is very strictly monitored and tight parameters. Great topic! Follow Your Bliss

Hi tariq_ze, Can you please clarify if you mean aseptic, sterile, or clean? Are you asking about the protocol for dressing changes? May I ask: What information are you seeking; and then perhaps we can help direct a bit further. Are you a Nurse? A few details with regard to situation, and background would be very helpful. Follow Your Bliss

Hi mymarie, How long have the stage 2 been there, and, are they getting worse or staying the same? Is she incontinent, or cathed? Is she mobile or w/c dependent? Has o/t been involved to evaluate for offloading? How is her diet? For me, what we are putting on the wound is a part of the wound puzzle, as wounds and their etiology are so complex. Silver needs to interact with fluid; if there is not a lot of drainage you may re assess cutting back to 2x/week as per drainage, we want to maintain moist wound healing in concert with addressing the bioburden, which silver does, and Polymem. Is she on Predinisone or any other corticosteroids? Diabetic? Being autoimmune compromised blunts infection presentation as well... That is a difficult area to treat: I would re evaluate at 4 weeks, after that if things are not improving I would augment the Wound Care plan. Are you measuring the area? How often is she showering? That is another challenge: wounds need to be in good balance with not over drying the skin and over changing the area. Keep us posted; once we know more that will help us all chime in with more info! MS peeps usually have lots going on :) Regards, Follow Your Bliss

Hi Everyone, I am new to Neuro Nursing,in fact, I am just orientating as well. To add to that I am also dealing with my hubby having a TBI Left Hemi; it happened a month ago. My question is, What pain meds are you seen being used to treat moderate to severe head pain, headache, and post concussive syndrome with a closed brain injury? We were in the ER last night, again, and he was prescribed Ativan, Gravol, and given Morphine; all with good effect for the first time in a month. THank-you in advance, Follow Your Bliss