What the Wound , Ostomy, Continence Nurse needs to know · 2017-03-29 · •WOC nurse, in...
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RESEARCH POSTER PRESENTATION DESIGN © 2011 www.PosterPresentations.com Illicit drug cutaneous outcomes- A Case Study: What the Wound , Ostomy, Continence Nurse needs to know Introduction Clinical Presentation Photos Clinical Approach/Outcomes Treatment Plan: • WOC nurse, in collaboration with surgical team recommended initial conservative topical approach with silver foam dressings • Extensive escharotic wounds evolved over following months requiring multiple surgical debridements • Autografting with negative pressure wound therapy by the Burn/Plastics surgical team. Outcomes: Initial grafting failed and patient continued to require advanced wound care with home health nursing. Subsequent grafting was successful and wounds healed after eight months. Conclusions Extensive intradisciplinary collaboration was required between • Certified Wound Ostomy Continence Nurse • Surgery, General and Plastics • Infectious Disease • Dermatology There are case studies and reports in the literature, but little is known about the optimal management and treatment of these cutaneous lesions. Wound Ostomy Continence Nurses’ early identification of Levamisole’s catastrophic cutaneous effects is paramount to tissue viability, skin/wound care management, and community related drug awareness interventions. References 1. Hennings, C., & Miller, J. (2013). Illicit drugs: What dermatologists need to know. Journal of the American Academy of Dermatology, 69(1), 135-142. 2. Lawrence, L.A., Jiron J.L., Lin, H.S., & Folbe, A.J. (2014) Levamisole-adulterated cocaine induced skin necrosis of nose, ears, and extremities: Case report. Journal of Allergy & Rhinology 5(3):e132-e136. http://dx.doi.org/10.2500%2Far.2014.5.0101. Cynthia Walker, MSN, APRN, CWON and Rachel Moseley, BSN, RN, CWON Contacts 43-year-old female with past medical history significant for polychondritis, rheumatoid arthritis, asthma and hepatitis C who came to the ER because of diffuse excruciating pain and hemorrhagic rash. Social History: The patient smokes up to 2 packs per day since the age of 11 and has cut down to 1/3rd of pack a day . She smokes marijuana every day and inhaled cocaine in the remote past, denies current use. Lives alone. Physical Findings: On the right and left upper extremity, most prominent on the dorsal hands, are retiform, stellate purpura with some hemorrhagic bullae. RLE: most prominent on the anterior thighs and dorsal feet are retiform purpuric plaques with hemorrhagic bullae and erosions . Pertinent Labs: WBC 4.86, Hgb 8.9, HCT 29.8, CRP 9.45, ESR 49, Albumin 2.1. Tox screen positive for cocaine Consults: WOCN, Dermatology, Rheumatology, Infectious Disease, Burn/Plastics Recently, rising numbers of cocaine users are presenting to local emergency rooms with atypical skin lesions with purpura, bullae and/or necrosis. Wound locations may be localized to nose or ears, or be generalized. Wound Ostomy Continence nurses are often consulted for wound management recommendations and care collaboration regarding skin and soft tissue involvement associated with this atypical presentation. These wounds may be similar in appearance to leukocytoclastic vasculitis, calciphylaxis, Coumadin necrosis, or even deep tissue injury pressure ulcers. Historically, intravenous drug users commonly experience cutaneous acute and chronic wounds ranging from • Puffy hand syndrome • Cellulitis • Superficial and deep abscesses • Necrotizing fasciitis • Chronic venous stasis ulcers 1 New skin issues have been associated with cocaine use. Levamisole is a veterinarian antiparasitic agent that was banned for human use in 1999 because of serious side effects of neutropenia, agranulocytosis and vasculitis. It is being used an adulterant that is cut into cocaine because it: • Promotes mood enhancement with antidepressant effects • Is inexpensive and widely available • Has similar appearance, taste, and melting point as cocaine It is estimated that over 70% of street cocaine is cut with Levamisole. 1,2 Rachel Moseley email [email protected] 410-550-6707 Cynthia Walker email [email protected] 410-550-5951 DX: Levamisole-induced vasculitis Statement of Clinical Problem
Transcript of What the Wound , Ostomy, Continence Nurse needs to know · 2017-03-29 · •WOC nurse, in...
RESEARCH POSTER PRESENTATION DESIGN © 2011
www.PosterPresentations.com
Illicit drug cutaneous outcomes- A Case Study:
What the Wound , Ostomy, Continence Nurse needs to know
Introduction Clinical Presentation
Photos
Clinical Approach/Outcomes
Treatment Plan:
• WOC nurse, in collaboration with surgical team recommended initial conservative topical approach with silver foam dressings
• Extensive escharotic wounds evolved over following months requiring multiple surgical debridements
• Autografting with negative pressure wound therapy by the Burn/Plastics surgical team.
Outcomes: Initial grafting failed and patient continued to require advanced wound care with home health nursing. Subsequent grafting was successful and wounds healed after eight months.
Conclusions
Extensive intradisciplinary collaboration was required between
• Certified Wound Ostomy Continence Nurse
• Surgery, General and Plastics
• Infectious Disease
• Dermatology
There are case studies and reports in the literature, but little is known about the optimal management and treatment of these cutaneous lesions. Wound Ostomy Continence Nurses’ early identification of Levamisole’s catastrophic cutaneous effects is paramount to tissue viability, skin/wound care management, and community related drug awareness interventions.
References1. Hennings, C., & Miller, J. (2013). Illicit drugs: What dermatologists need to know.
Journal of the American Academy of Dermatology, 69(1), 135-142.
2. Lawrence, L.A., Jiron J.L., Lin, H.S., & Folbe, A.J. (2014) Levamisole-adulterated cocaine induced skin necrosis of nose, ears, and extremities: Case report. Journal of Allergy & Rhinology 5(3):e132-e136. http://dx.doi.org/10.2500%2Far.2014.5.0101.
Cynthia Walker, MSN, APRN, CWON and Rachel Moseley, BSN, RN, CWON
Contacts
43-year-old female with past medical history significant for polychondritis, rheumatoid arthritis, asthma and hepatitis C who came to the ER because of diffuse excruciating
pain and hemorrhagic rash.
Social History: The patient smokes up to 2 packs per day since the age of 11 and has cut down to 1/3rd of pack a day . She smokes marijuana every day and inhaled cocaine in the
remote past, denies current use. Lives alone.
Physical Findings: On the right and left upper extremity, most prominent on the dorsal hands, are retiform, stellate purpura with some hemorrhagic bullae.RLE: most prominent on the anterior thighs and dorsal feet are retiform purpuric plaques with hemorrhagic bullae and erosions.
Pertinent Labs: WBC 4.86, Hgb 8.9, HCT 29.8, CRP 9.45, ESR 49, Albumin 2.1. Tox screen positive for cocaine
Consults: WOCN, Dermatology, Rheumatology, Infectious Disease, Burn/Plastics
Recently, rising numbers of cocaine users are presenting to local emergency rooms with atypical skin lesions with purpura, bullae and/or necrosis. Wound locations may be localized to nose or ears, or be generalized. Wound Ostomy Continence nurses are often consulted for wound management recommendations and care collaboration regarding skin and soft tissue involvement associated with this atypical presentation. These wounds may be similar in appearance to leukocytoclastic vasculitis, calciphylaxis, Coumadin necrosis, or even deep tissue injury pressure ulcers.
Historically, intravenous drug users commonly experience cutaneous acute and chronic wounds ranging from
• Puffy hand syndrome• Cellulitis • Superficial and deep abscesses• Necrotizing fasciitis• Chronic venous stasis ulcers1
New skin issues have been associated with cocaine use. Levamisole is a veterinarian antiparasitic agent that was banned for human use in 1999 because of serious side effects of neutropenia, agranulocytosis and vasculitis. It is being used an adulterant that is cut into cocaine because it:• Promotes mood enhancement with
antidepressant effects• Is inexpensive and widely available• Has similar appearance, taste, and melting
point as cocaine
It is estimated that over 70% of street cocaineis cut with Levamisole. 1,2 Rachel Moseley email [email protected] 410-550-6707
Cynthia Walker email [email protected] 410-550-5951
DX: Levamisole-induced vasculitis
Statement of Clinical Problem
