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Parish Nurse Regional Meeting 9-3-09 Wound Care
Prevention <ul><li>Recognize the risk factors:  </li></ul><ul><li>Diabetes </li></ul><ul><li>Venous insufficiency </li></u...
Prevention <ul><li>Other Risk Factors </li></ul><ul><li>RA </li></ul><ul><li>Alcoholism </li></ul><ul><li>Cigarettes </li>...
Prevention <ul><li>Hygiene </li></ul>
Prevention <ul><li>Movement </li></ul><ul><li>Aids in creating collateral blood flow. </li></ul><ul><li>Activates calf mus...
Prevention <ul><li>Monitor risk factors:  </li></ul><ul><li>Pulses </li></ul><ul><li>Sensation </li></ul><ul><li>Deformity...
 
Prevention <ul><li>Shoes </li></ul><ul><li>Do the shoes fit?  </li></ul><ul><li>Diabetic shoes </li></ul><ul><li>Extra dep...
Prevention <ul><li>Socks </li></ul><ul><li>Diabetic socks </li></ul><ul><li>Compression socks </li></ul><ul><li>Farrow wra...
How Wounds Heal
How Wounds Heal <ul><li>Chronic Wounds </li></ul><ul><li>Not 30% smaller at week 4 s/p injury </li></ul><ul><li>MMP’s  </l...
 
Biofilm <ul><li>Biofilm is a community of planktonic bacteria in the extracellular matrix.  </li></ul><ul><li>Infection = ...
Dressings for Bioburden <ul><li>Silver dressings- bind and destroy cell walls of bacteria, yeast, fungi and viruses ON CON...
<ul><li>Cadexomer Iodine- kills bacteria, viruses and fungus. Removes sloughy tissue. </li></ul><ul><li>(For colonized wou...
<ul><li>Hydrofera Blue- methylene blue and crystal violet inhibit growth of bacteria. </li></ul>
Combination Therapy <ul><li>Systemic antibiotics – use when SOI extend beyond ulcer margins.  </li></ul><ul><li>Topical an...
Types of Ulcers <ul><li>Pressure Ulcer </li></ul>
Types of Ulcers <ul><li>Diabetic Ulcer </li></ul>
Types of Ulcers <ul><li>Venous Ulcer </li></ul>
Types of Ulcers <ul><li>Arterial Ulcers </li></ul>
Treatment <ul><li>Let the Punishment fit the Crime </li></ul><ul><li>Remove all necrotic tissue </li></ul><ul><li>Manage I...
When to change treatment <ul><li>10-15% reduction in wound size  </li></ul><ul><li>per week is normal healing. </li></ul><...
Treatment: Pressure Ulcers <ul><li>Manage local or systemic infection </li></ul><ul><li>Manage Pain </li></ul><ul><li>Mana...
Treatment: Diabetic Ulcers <ul><li>Manage local or systemic infection </li></ul><ul><li>Manage Pain </li></ul><ul><li>Mana...
Treatment: Venous Ulcer <ul><li>Vascular Studies </li></ul><ul><li>Topical wound management </li></ul><ul><li>Debridement ...
Treatment: Arterial Ulcer <ul><li>Reperfusion- surgical or pharmacological </li></ul><ul><li>Moisture balance  </li></ul><...
Wound Care Team <ul><li>Nurse </li></ul><ul><li>Primary Care Physician </li></ul><ul><li>Trained wound care practitioner <...
Resources <ul><li>Advances in Skin and Wound Care- free publication </li></ul><ul><li>EPUAP/NPUAP </li></ul><ul><li>Wound ...
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Parish Nurse Regional Meeting

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Transcript of "Parish Nurse Regional Meeting"

  1. 1. Parish Nurse Regional Meeting 9-3-09 Wound Care
  2. 2. Prevention <ul><li>Recognize the risk factors: </li></ul><ul><li>Diabetes </li></ul><ul><li>Venous insufficiency </li></ul><ul><li>Arterial insufficiency </li></ul><ul><li>Malnutrition </li></ul><ul><li>Dehydration </li></ul><ul><li>Deformity </li></ul><ul><li>Immobility </li></ul>
  3. 3. Prevention <ul><li>Other Risk Factors </li></ul><ul><li>RA </li></ul><ul><li>Alcoholism </li></ul><ul><li>Cigarettes </li></ul><ul><li>Gout </li></ul><ul><li>Factitial </li></ul><ul><li>Idiopathic Neuropathy </li></ul>
  4. 4. Prevention <ul><li>Hygiene </li></ul>
  5. 5. Prevention <ul><li>Movement </li></ul><ul><li>Aids in creating collateral blood flow. </li></ul><ul><li>Activates calf muscle pump. </li></ul><ul><li>Helps control blood sugar </li></ul>
  6. 6. Prevention <ul><li>Monitor risk factors: </li></ul><ul><li>Pulses </li></ul><ul><li>Sensation </li></ul><ul><li>Deformity </li></ul><ul><li>Atrophy </li></ul><ul><li>Callus </li></ul><ul><li>Integrity </li></ul>
  7. 8. Prevention <ul><li>Shoes </li></ul><ul><li>Do the shoes fit? </li></ul><ul><li>Diabetic shoes </li></ul><ul><li>Extra depth shoes </li></ul>
  8. 9. Prevention <ul><li>Socks </li></ul><ul><li>Diabetic socks </li></ul><ul><li>Compression socks </li></ul><ul><li>Farrow wraps </li></ul>
  9. 10. How Wounds Heal
  10. 11. How Wounds Heal <ul><li>Chronic Wounds </li></ul><ul><li>Not 30% smaller at week 4 s/p injury </li></ul><ul><li>MMP’s </li></ul><ul><li>Senescent cells </li></ul><ul><li>Biofilm/Bioburden </li></ul><ul><li>Too few growth factors </li></ul>
  11. 13. Biofilm <ul><li>Biofilm is a community of planktonic bacteria in the extracellular matrix. </li></ul><ul><li>Infection = 10 to the 6 th </li></ul><ul><li>Biofilm = 10 to the 5 th or greater </li></ul><ul><li>60% of chronic wounds have biofilms. </li></ul><ul><li>Source: Costerton, J William. SAWC presentation 2006 </li></ul>
  12. 14. Dressings for Bioburden <ul><li>Silver dressings- bind and destroy cell walls of bacteria, yeast, fungi and viruses ON CONTACT (for colonized, critically colonized wounds) </li></ul>
  13. 15. <ul><li>Cadexomer Iodine- kills bacteria, viruses and fungus. Removes sloughy tissue. </li></ul><ul><li>(For colonized wounds) </li></ul>
  14. 16. <ul><li>Hydrofera Blue- methylene blue and crystal violet inhibit growth of bacteria. </li></ul>
  15. 17. Combination Therapy <ul><li>Systemic antibiotics – use when SOI extend beyond ulcer margins. </li></ul><ul><li>Topical anti-microbials </li></ul>
  16. 18. Types of Ulcers <ul><li>Pressure Ulcer </li></ul>
  17. 19. Types of Ulcers <ul><li>Diabetic Ulcer </li></ul>
  18. 20. Types of Ulcers <ul><li>Venous Ulcer </li></ul>
  19. 21. Types of Ulcers <ul><li>Arterial Ulcers </li></ul>
  20. 22. Treatment <ul><li>Let the Punishment fit the Crime </li></ul><ul><li>Remove all necrotic tissue </li></ul><ul><li>Manage Infection </li></ul><ul><li>Understand patient’s lifestyle, goals and expectations. </li></ul><ul><li>Wound Healing Society </li></ul>
  21. 23. When to change treatment <ul><li>10-15% reduction in wound size </li></ul><ul><li>per week is normal healing. </li></ul><ul><li>Source: Plasti Reconstructive surgery. Attinger CE, et al 2006 June: 117 </li></ul>
  22. 24. Treatment: Pressure Ulcers <ul><li>Manage local or systemic infection </li></ul><ul><li>Manage Pain </li></ul><ul><li>Manage necrotic tissue </li></ul><ul><li>Offload pressure area </li></ul><ul><li>Cleanse </li></ul><ul><li>Dressings </li></ul><ul><li>Source: European Pressure Ulcer Advisory Panel </li></ul>
  23. 25. Treatment: Diabetic Ulcers <ul><li>Manage local or systemic infection </li></ul><ul><li>Manage Pain </li></ul><ul><li>Manage Blood Glucose </li></ul><ul><li>Manage necrotic tissue </li></ul><ul><li>Offload pressure area </li></ul><ul><li>Cleanse </li></ul><ul><li>Dressings </li></ul>
  24. 26. Treatment: Venous Ulcer <ul><li>Vascular Studies </li></ul><ul><li>Topical wound management </li></ul><ul><li>Debridement </li></ul><ul><li>Leg Elevation </li></ul><ul><li>Compression- based on vascular studies </li></ul><ul><li>Source: Advances in Skin and Wound Care Vol 22 No.9 </li></ul>
  25. 27. Treatment: Arterial Ulcer <ul><li>Reperfusion- surgical or pharmacological </li></ul><ul><li>Moisture balance </li></ul><ul><li>Pain control </li></ul><ul><li>Wet Gangrene – Needs immediate sharp debridement </li></ul><ul><li>Dry Gangrene – Must be kept dry until reperfusion. </li></ul>
  26. 28. Wound Care Team <ul><li>Nurse </li></ul><ul><li>Primary Care Physician </li></ul><ul><li>Trained wound care practitioner </li></ul><ul><li>Nutritionist </li></ul><ul><li>Infectious Disease Specialist </li></ul><ul><li>Vascular Specialist </li></ul><ul><li>Surgeon </li></ul><ul><li>Orthotist/Prosthetist </li></ul>
  27. 29. Resources <ul><li>Advances in Skin and Wound Care- free publication </li></ul><ul><li>EPUAP/NPUAP </li></ul><ul><li>Wound Healing Society </li></ul><ul><li>Wound Care Information Network </li></ul><ul><li>World Wide Wounds </li></ul>
  28. 30. Thank You!
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