When/how often...?? (new wound nurse)

[baygrl11]

1) When do I do a pre albumin level on a wound patient (upon admission, after wound won't heal???) Also how often should I do it after the initial one?

2) When should I do wound cultures? Do I need to do wound cultures on new patients with wounds, even though the wound does not seem infected? Should I do wound cultures on new pressure ulcers (stage 2 and above)...also when/how often after the initial culture should I repeat the culture?

Thanks guys :)

[tktjRN]

A pre albumin level is not usually ordered unless nutrition is an issue. A nutritional assessment should be conducted first. Any weight loss, how much is the patient eating at meals are they on nutritional supplements. Is the wound chronic, look at the patients comorbities and try to figure out the etiology of the wound first, before ordering labs.

Wound cultures are usually only performed when there's s/s of infection or a chronic wound that's not healing.

The etiology, of the wound, is the key to develop the plan of care

Hope this helped

[CWONgal]

Most often it seems that providers order albumin levels instead of prealbumins. There is a lot of literature out there that questions the validity of obtaining albumin levels as infection, acute stress, surgery, hydration status all can alter the results. Something I read recently stated it correlates w/ the severity of underlying disease, not nutritional status. Pre-albumin is not affected as much as albumin when a pt has inflammation. It's also for a shorter span of time and ordered if a patient has been inpatient for some time and not receiving calories. Surgeries are often delayed if possible when a pt has a low prealbumin because they are at increased risk of complications and poor wound healing. As bronze mentioned assess for weight loss, what the patient is eating, supplementation, glucose levels, etc. Wound cultures are typically ordered when a wound appears infected. However, if all other factors are evaluated and you have stalled wound healing you always have to consider wound bioburden. Some patients w/ vascular disease and diabetes may have wounds that don't appear outwardly infected and a culture and MRI can show a different picture (chronic toe wound, ex). I would say most often people don't even obtain cultures correctly and are treating surface microbes.