Parish Nurse Regional Meeting
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Transcript of Parish Nurse Regional Meeting
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Parish Nurse Parish Nurse Regional Regional MeetingMeeting
9-3-099-3-09Wound CareWound Care
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PreventionRecognize the risk factors: DiabetesVenous insufficiencyArterial insufficiencyMalnutritionDehydrationDeformityImmobility
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PreventionOther Risk Factors
RA
Alcoholism
Cigarettes
Gout
Factitial
Idiopathic Neuropathy
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PreventionHygiene
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PreventionMovement- Aids in creating collateral blood flow.- Activates calf muscle pump. - Helps control blood sugar
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PreventionMonitor risk factors:
Pulses
Sensation
Deformity
Atrophy
Callus
Integrity
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Prevention
Shoes
Do the shoes fit?
Diabetic shoes
Extra depth shoes
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PreventionSocks
Diabetic socks
Compression socks
Farrow wraps
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How Wounds Heal
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How Wounds HealChronic Wounds
Not 30% smaller at week 4 s/p injury
MMP’s
Senescent cells
Biofilm/Bioburden
Too few growth factors
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BiofilmBiofilm is a community of planktonic bacteria in the extracellular matrix. Infection = 10 to the 6th
Biofilm = 10 to the 5th or greater60% of chronic wounds have biofilms.
Source: Costerton, J William. SAWC presentation 2006
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Dressings for Bioburden
Silver dressings- bind and destroy cell walls of bacteria, yeast, fungi and viruses ON CONTACT (for colonized, critically colonized wounds)
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Cadexomer Iodine- kills bacteria, viruses and fungus. Removes sloughy tissue.
(For colonized wounds)
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Hydrofera Blue- methylene blue and crystal violet inhibit growth of bacteria.
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Combination TherapySystemic antibiotics – use when SOI extend
beyond ulcer margins.
Topical anti-microbials
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Types of UlcersPressure Ulcer
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Types of UlcersDiabetic Ulcer
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Types of UlcersVenous Ulcer
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Types of UlcersArterial Ulcers
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TreatmentLet the Punishment fit the Crime
Remove all necrotic tissue
Manage Infection
Understand patient’s lifestyle, goals and expectations.Wound Healing Society
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When to change treatment
10-15% reduction in wound size
per week is normal healing.
Source: Plasti Reconstructive surgery. Attinger CE, et al 2006 June: 117
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Treatment: Pressure Ulcers
Manage local or systemic infection
Manage Pain
Manage necrotic tissue
Offload pressure area
Cleanse
DressingsSource: European Pressure Ulcer Advisory Panel
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Treatment: Diabetic Ulcers
Manage local or systemic infection
Manage Pain
Manage Blood Glucose
Manage necrotic tissue
Offload pressure area
Cleanse
Dressings
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Treatment: Venous Ulcer
Vascular Studies
Topical wound management
Debridement
Leg Elevation
Compression- based on vascular studies
Source: Advances in Skin and Wound Care Vol 22 No.9
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Treatment: Arterial UlcerReperfusion- surgical or pharmacological
Moisture balance
Pain control
Wet Gangrene – Needs immediate sharp debridement
Dry Gangrene – Must be kept dry until reperfusion.
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Wound Care TeamNursePrimary Care PhysicianTrained wound care practitionerNutritionistInfectious Disease SpecialistVascular SpecialistSurgeonOrthotist/Prosthetist
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ResourcesAdvances in Skin and Wound Care- free
publication
EPUAP/NPUAP
Wound Healing Society
Wound Care Information Network
World Wide Wounds
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Thank You!Thank You!