This document provides guidance on wound management principles for pediatric patients. It discusses key differences in pediatric and neonatal skin that require special considerations in wound care. The causes of wounds in pediatric patients include trauma, medical devices, and certain skin conditions. A thorough assessment of the wound and any factors that could delay healing is important. Wound documentation and management should be tailored to the individual patient. Regular reassessment is needed to monitor progress and watch for signs of infection. Managing pain and anxiety is also a priority, given their impact on the healing process.
A stoma is a surgically created opening between the gastrointestinal or urinary tracts and the outside of the body, which can be created for various purposes like diverting bowel contents after resection or protecting areas from infection. Different types of stomas include colostomies, ileostomies, and urostomies, and proper care involves assessing the stoma, protecting the skin around it, emptying and changing collection pouches, and addressing any complications.
This document provides information about colostomy care presented by Ms. Sakun Rasaily. It includes an outline covering topics like anatomy of the gastrointestinal tract, types of colostomies, indications for colostomy, complications, guidelines for care, nursing assessment, and family teaching. The presentation covers the procedure for colostomy care including required supplies, steps to change the bag, monitoring the patient, and assessing for complications after surgery.
Glasgow coma scale evaluation and clinical considerationsZIKRULLAH MALLICK
The Glasgow Coma Scale (GCS) is a neurological scale used to assess level of consciousness. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. Though widely used, it has limitations like not assessing brainstem function or distinguishing mild injuries. Several other scales have been developed, like the FOUR score which also evaluates brainstem reflexes and eye movements, and the Glasgow Outcome Scale which measures long-term recovery. The GCS remains valuable for initial assessment, monitoring changes, and predicting outcomes in various conditions like traumatic brain injury and stroke.
This document provides information on burns, including definitions, types, classification, pathophysiology, assessment, and management. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First and second degree burns involve the epidermis and dermis, while third degree burns extend deeper. Burn severity is also classified according to percentage of total body surface area affected. Management involves fluid resuscitation, wound care, pain control, and nutrition support. Complications can impact various organ systems. The goal is to prevent infection, contractures, and other issues through proper acute care and rehabilitation.
This document discusses various types of skin infections including bacterial, fungal, and viral infections that commonly affect children. It provides detailed information on specific bacterial infections like impetigo, cellulitis, folliculitis, boils, and carbuncles. It also discusses fungal infections such as candidiasis, tinea infections (ringworm), and tinea versicolor. Finally, it covers some common viral skin infections in children like warts, molluscum contagiosum, and rubella. The document is intended to educate about the causes, symptoms, diagnosis, and treatment of various pediatric skin infections.
Stevens-Johnson syndrome is a severe mucocutaneous reaction typically caused by drugs involving skin and mucous membranes. It begins with flu-like symptoms followed by distinctive target lesions. Complications can include blindness, infections, and death. Treatment focuses on stopping the causative agent, supportive care, corticosteroids, IVIG, and antibiotics for secondary infections.
This document provides information about various skin diseases and infections. It begins with an introduction to pathological skin changes and then discusses different types of primary and secondary skin infections. Specific bacterial infections caused by Staphylococcus aureus and group A streptococci are examined. Common skin infections and their symptoms are defined, including impetigo, ecthyma, folliculitis, furuncles, carbuncles, cellulitis, and acne. Diagnosis and treatment of bacterial skin infections is also covered. The document concludes with information about fungal infections such as tinea.
A stoma is a surgically created opening between the gastrointestinal or urinary tracts and the outside of the body, which can be created for various purposes like diverting bowel contents after resection or protecting areas from infection. Different types of stomas include colostomies, ileostomies, and urostomies, and proper care involves assessing the stoma, protecting the skin around it, emptying and changing collection pouches, and addressing any complications.
This document provides information about colostomy care presented by Ms. Sakun Rasaily. It includes an outline covering topics like anatomy of the gastrointestinal tract, types of colostomies, indications for colostomy, complications, guidelines for care, nursing assessment, and family teaching. The presentation covers the procedure for colostomy care including required supplies, steps to change the bag, monitoring the patient, and assessing for complications after surgery.
Glasgow coma scale evaluation and clinical considerationsZIKRULLAH MALLICK
The Glasgow Coma Scale (GCS) is a neurological scale used to assess level of consciousness. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. Though widely used, it has limitations like not assessing brainstem function or distinguishing mild injuries. Several other scales have been developed, like the FOUR score which also evaluates brainstem reflexes and eye movements, and the Glasgow Outcome Scale which measures long-term recovery. The GCS remains valuable for initial assessment, monitoring changes, and predicting outcomes in various conditions like traumatic brain injury and stroke.
This document provides information on burns, including definitions, types, classification, pathophysiology, assessment, and management. It defines burns as thermal injuries to the skin and tissues. Burns are classified based on depth and extent of damage. First and second degree burns involve the epidermis and dermis, while third degree burns extend deeper. Burn severity is also classified according to percentage of total body surface area affected. Management involves fluid resuscitation, wound care, pain control, and nutrition support. Complications can impact various organ systems. The goal is to prevent infection, contractures, and other issues through proper acute care and rehabilitation.
This document discusses various types of skin infections including bacterial, fungal, and viral infections that commonly affect children. It provides detailed information on specific bacterial infections like impetigo, cellulitis, folliculitis, boils, and carbuncles. It also discusses fungal infections such as candidiasis, tinea infections (ringworm), and tinea versicolor. Finally, it covers some common viral skin infections in children like warts, molluscum contagiosum, and rubella. The document is intended to educate about the causes, symptoms, diagnosis, and treatment of various pediatric skin infections.
Stevens-Johnson syndrome is a severe mucocutaneous reaction typically caused by drugs involving skin and mucous membranes. It begins with flu-like symptoms followed by distinctive target lesions. Complications can include blindness, infections, and death. Treatment focuses on stopping the causative agent, supportive care, corticosteroids, IVIG, and antibiotics for secondary infections.
This document provides information about various skin diseases and infections. It begins with an introduction to pathological skin changes and then discusses different types of primary and secondary skin infections. Specific bacterial infections caused by Staphylococcus aureus and group A streptococci are examined. Common skin infections and their symptoms are defined, including impetigo, ecthyma, folliculitis, furuncles, carbuncles, cellulitis, and acne. Diagnosis and treatment of bacterial skin infections is also covered. The document concludes with information about fungal infections such as tinea.
The document discusses stoma care, including definitions, indications for ostomy surgery, types of stomas, and how to care for a stoma. Some key points include:
- A stoma is a surgically created opening that allows stool or urine to exit the body. Common reasons for ostomy surgery in children include birth defects and inflammatory bowel disease.
- There are three main types of stomas - colostomy, ileostomy, and urostomy - depending on where in the digestive or urinary system the opening is created.
- Proper stoma care involves using pouches and barriers to collect waste, changing pouches regularly, and techniques like irrigation for some colostomies. Managing
Burns are injuries caused by heat, cold, electricity, chemicals, friction or radiation. There are different types of burns including thermal, chemical, electrical and radiation burns. Burns are classified by depth from superficial to full thickness. Management of burns involves three phases - emergent, intermediate and rehabilitative. The emergent phase focuses on fluid resuscitation while the intermediate phase involves wound care and the rehabilitative phase aims to return the patient to their normal activities. Nursing plays an important role in assessing burns, providing wound care, pain management and rehabilitation.
The skin is the largest organ of the body. It protects the body from microbes, regulates temperature, and allows for sensation. The skin has three layers - the epidermis, dermis, and subcutaneous tissue. Burns are injuries caused by heat, chemicals, electricity or radiation and are classified based on depth and extent of damage. Burn management involves emergent care to address life threats, the acute phase during wound healing, and rehabilitation to address scarring and return the patient to normal activities.
Asthma is a chronic inflammatory disease of the airways characterized by episodic obstruction, bronchial hyperresponsiveness, and reversibility of airflow obstruction. It affects 9.6 million US children and is more common in boys, children in poor families, and those with onset before age 6. Treatment involves assessment, education, trigger identification, and medications to reduce inflammation and bronchoconstriction. The goal is optimal asthma control through a stepwise treatment approach based on severity. Prognosis depends on severity, with milder cases often improving over time. Prevention focuses on avoiding tobacco smoke, prolonged breastfeeding, active lifestyles, and immunizations.
Head injury types, clinical manifestations, diagnosis and managementVibha Amblihalli
Head injuries can range from minor scalp lacerations to major brain trauma. Common causes include motor vehicle accidents, falls, and sports injuries. Diagnosis involves CT or MRI imaging to identify fractures and intracranial bleeding. Treatment depends on injury severity but may include reducing intracranial pressure, surgical evacuation of hematomas, and preventing complications like seizures. Outcomes range from full recovery to permanent disability or death depending on the nature and extent of brain damage.
This document provides an overview of the management of head injuries. It defines different types of head injuries from scalp lacerations to traumatic brain injuries. It describes the most common causes of head injuries and explains the layers of the head. It then details different types of head injuries including concussions, skull fractures, and intracranial hemorrhages. It outlines the clinical presentation, diagnostic tools, and management approaches for various head injuries.
Children's skin problems span nearly two decades from birth through adolescence. Several common pediatric skin conditions will be discussed including: diaper dermatitis, atopic dermatitis, warts, and acne.
follow me on my YouTube channel :- medic o mania
Croup is a common respiratory illness in young children caused by viruses such as parainfluenza. It causes barking cough, hoarseness, and stridor. Symptoms typically worsen at night. Diagnosis is clinical based on symptoms and appearance of the steeple sign on chest x-ray. Treatment involves corticosteroids which reduce symptoms, and nebulized epinephrine for more severe cases. Most children recover without complications, though a small percentage require hospitalization for respiratory support.
This document discusses pressure sores (also known as decubitus ulcers or bed sores), which are areas of damaged skin and underlying tissue that typically form over bony prominences of the body due to prolonged pressure. The document covers the definition, risk factors, pathogenesis, staging, clinical features, complications, and treatment of pressure sores. Common sites for pressure sores include the occiput, scapula, ischium, sacrum, and heel. Prevention is important through good skin care, use of an alpha bed, and management of incontinence. Treatment involves frequent repositioning, wound debridement, dressings, and sometimes skin grafts or flaps.
The document discusses wound dressings and wound healing. It defines a wound as a break in the epithelial integrity of the skin that disrupts normal tissue structure and function. Wound healing involves complex, overlapping phases of hemostasis, inflammation, proliferation, and remodeling. Proper wound dressing is crucial to maintain moisture balance and prevent infection while the wound heals. A variety of dressing types are described, including hydrocolloids, hydrogels, calcium alginates, foams, and enzymatic debriding agents. Selecting the appropriate dressing depends on factors like a wound's drainage and healing stage.
Skin grafts and skin flaps are surgical procedures used to repair skin defects and promote wound healing. In a skin graft, healthy skin is removed from a donor site and transplanted to a recipient site, but does not maintain its original blood supply. A skin flap retains part or all of its original blood supply after being moved from a donor to recipient site. Common donor sites include the thigh, arm, and buttocks. Skin grafts and flaps are used to treat burns, wounds, and reconstructive procedures. Care of the graft and donor site is needed to promote healing.
Impetigo is a common bacterial skin infection that affects the superficial layers of the epidermis. It is highly contagious and most often caused by Staphylococcus aureus or Streptococcus pyogenes bacteria. Impetigo commonly affects children in developing countries and the incidence in India is approximately 6%. It presents as vesicles or pustules that rupture and form honey-colored crusts. Treatment involves topical or oral antibiotics like mupirocin, retapamulin, cephalexin, or amoxicillin-clavulanic acid. Proper hygiene and wound care are also important to prevent the spread of impetigo.
BURN - Presented By Mohammed Haroon Rashid Haroon Rashid
Subject is Medical Surgical Nursing - II & Topic is Burn, Presented by Mohammed Haroon Rashid Basci B.Sc Nursing 3rd Year in Florence College of Nursing
The document provides guidance on the emergency management of burns. It discusses the pathophysiology of burns and the Jackson burn wound model. It outlines the ABCDE approach for initial assessment and management, focusing on airway, breathing, circulation, disability, exposure, and fluids. Specific attention is given to fluid resuscitation using the Parkland formula. The document also addresses monitoring for signs of compromised circulation in limbs and the potential need for escharotomy procedures.
This document provides information on burns, including causes, assessment, treatment and prevention. Burns are injuries caused by heat, chemicals, electricity or radiation. Assessment involves checking the airway, breathing, circulation, disability and exposure. Treatment depends on the severity and depth of the burn, and may include cleaning, dressing and fluid replacement. Deeper burns require specialist care. Prevention strategies include smoke alarms, fire safety education, and safe cooking and electrical practices.
This document discusses colostomy care, including:
1. Defining a colostomy as an opening in the large intestine brought to the surface of the abdomen for bowel evacuation.
2. Describing the different types of colostomies based on duration, stoma site, and number/type.
3. Explaining the purpose and importance of proper colostomy care for skin protection, drainage collection, and patient acceptance of self-care.
- Skin traction involves applying traction directly to the skin to immobilize a body part. It can be used for short or extended periods using adhesive or non-adhesive devices.
- The purposes of skin traction include reducing fractures and dislocations, maintaining skeletal alignment, relieving muscle spasms, and immobilizing injured areas.
- Common types of skin traction include Buck's traction for femoral fractures, forearm skin traction, and head halter traction for neck injuries. Close monitoring is needed to prevent complications like skin breakdown, neurological issues, and deep vein thrombosis.
It contains detailed description of which kind of dressings to be used in burns. Newer concepts in burns dressings. Very helpful for plastic and general surgeons practicing burns.
Best Practice Statement Compression hosieryGNEAUPP.
The document provides guidance on best practices for compression hosiery. It summarizes key areas including full holistic assessment, hosiery classification and selection, application and removal, disease and service management, and roles and competencies. The full holistic assessment section emphasizes the importance of accurately diagnosing the underlying cause of edema through a qualified practitioner's initial assessment of the patient's condition, signs and symptoms, and risk factors. This assessment informs both the differential diagnosis and appropriate hosiery selection and treatment pathway.
Holistic Management of Venous Leg UlcerationGNEAUPP.
The document provides guidance on holistic management of venous leg ulcers. It discusses assessment and diagnosis of venous leg ulcers, classification of compression products, holistic management including compression therapy, and prevention of ulcer recurrence. A thorough assessment is crucial to accurate diagnosis and treatment planning, and should include general health history, leg examination including arterial assessment, and wound/skin assessment. Appropriate compression therapy is emphasized as the standard treatment for venous leg ulcers.
The document discusses stoma care, including definitions, indications for ostomy surgery, types of stomas, and how to care for a stoma. Some key points include:
- A stoma is a surgically created opening that allows stool or urine to exit the body. Common reasons for ostomy surgery in children include birth defects and inflammatory bowel disease.
- There are three main types of stomas - colostomy, ileostomy, and urostomy - depending on where in the digestive or urinary system the opening is created.
- Proper stoma care involves using pouches and barriers to collect waste, changing pouches regularly, and techniques like irrigation for some colostomies. Managing
Burns are injuries caused by heat, cold, electricity, chemicals, friction or radiation. There are different types of burns including thermal, chemical, electrical and radiation burns. Burns are classified by depth from superficial to full thickness. Management of burns involves three phases - emergent, intermediate and rehabilitative. The emergent phase focuses on fluid resuscitation while the intermediate phase involves wound care and the rehabilitative phase aims to return the patient to their normal activities. Nursing plays an important role in assessing burns, providing wound care, pain management and rehabilitation.
The skin is the largest organ of the body. It protects the body from microbes, regulates temperature, and allows for sensation. The skin has three layers - the epidermis, dermis, and subcutaneous tissue. Burns are injuries caused by heat, chemicals, electricity or radiation and are classified based on depth and extent of damage. Burn management involves emergent care to address life threats, the acute phase during wound healing, and rehabilitation to address scarring and return the patient to normal activities.
Asthma is a chronic inflammatory disease of the airways characterized by episodic obstruction, bronchial hyperresponsiveness, and reversibility of airflow obstruction. It affects 9.6 million US children and is more common in boys, children in poor families, and those with onset before age 6. Treatment involves assessment, education, trigger identification, and medications to reduce inflammation and bronchoconstriction. The goal is optimal asthma control through a stepwise treatment approach based on severity. Prognosis depends on severity, with milder cases often improving over time. Prevention focuses on avoiding tobacco smoke, prolonged breastfeeding, active lifestyles, and immunizations.
Head injury types, clinical manifestations, diagnosis and managementVibha Amblihalli
Head injuries can range from minor scalp lacerations to major brain trauma. Common causes include motor vehicle accidents, falls, and sports injuries. Diagnosis involves CT or MRI imaging to identify fractures and intracranial bleeding. Treatment depends on injury severity but may include reducing intracranial pressure, surgical evacuation of hematomas, and preventing complications like seizures. Outcomes range from full recovery to permanent disability or death depending on the nature and extent of brain damage.
This document provides an overview of the management of head injuries. It defines different types of head injuries from scalp lacerations to traumatic brain injuries. It describes the most common causes of head injuries and explains the layers of the head. It then details different types of head injuries including concussions, skull fractures, and intracranial hemorrhages. It outlines the clinical presentation, diagnostic tools, and management approaches for various head injuries.
Children's skin problems span nearly two decades from birth through adolescence. Several common pediatric skin conditions will be discussed including: diaper dermatitis, atopic dermatitis, warts, and acne.
follow me on my YouTube channel :- medic o mania
Croup is a common respiratory illness in young children caused by viruses such as parainfluenza. It causes barking cough, hoarseness, and stridor. Symptoms typically worsen at night. Diagnosis is clinical based on symptoms and appearance of the steeple sign on chest x-ray. Treatment involves corticosteroids which reduce symptoms, and nebulized epinephrine for more severe cases. Most children recover without complications, though a small percentage require hospitalization for respiratory support.
This document discusses pressure sores (also known as decubitus ulcers or bed sores), which are areas of damaged skin and underlying tissue that typically form over bony prominences of the body due to prolonged pressure. The document covers the definition, risk factors, pathogenesis, staging, clinical features, complications, and treatment of pressure sores. Common sites for pressure sores include the occiput, scapula, ischium, sacrum, and heel. Prevention is important through good skin care, use of an alpha bed, and management of incontinence. Treatment involves frequent repositioning, wound debridement, dressings, and sometimes skin grafts or flaps.
The document discusses wound dressings and wound healing. It defines a wound as a break in the epithelial integrity of the skin that disrupts normal tissue structure and function. Wound healing involves complex, overlapping phases of hemostasis, inflammation, proliferation, and remodeling. Proper wound dressing is crucial to maintain moisture balance and prevent infection while the wound heals. A variety of dressing types are described, including hydrocolloids, hydrogels, calcium alginates, foams, and enzymatic debriding agents. Selecting the appropriate dressing depends on factors like a wound's drainage and healing stage.
Skin grafts and skin flaps are surgical procedures used to repair skin defects and promote wound healing. In a skin graft, healthy skin is removed from a donor site and transplanted to a recipient site, but does not maintain its original blood supply. A skin flap retains part or all of its original blood supply after being moved from a donor to recipient site. Common donor sites include the thigh, arm, and buttocks. Skin grafts and flaps are used to treat burns, wounds, and reconstructive procedures. Care of the graft and donor site is needed to promote healing.
Impetigo is a common bacterial skin infection that affects the superficial layers of the epidermis. It is highly contagious and most often caused by Staphylococcus aureus or Streptococcus pyogenes bacteria. Impetigo commonly affects children in developing countries and the incidence in India is approximately 6%. It presents as vesicles or pustules that rupture and form honey-colored crusts. Treatment involves topical or oral antibiotics like mupirocin, retapamulin, cephalexin, or amoxicillin-clavulanic acid. Proper hygiene and wound care are also important to prevent the spread of impetigo.
BURN - Presented By Mohammed Haroon Rashid Haroon Rashid
Subject is Medical Surgical Nursing - II & Topic is Burn, Presented by Mohammed Haroon Rashid Basci B.Sc Nursing 3rd Year in Florence College of Nursing
The document provides guidance on the emergency management of burns. It discusses the pathophysiology of burns and the Jackson burn wound model. It outlines the ABCDE approach for initial assessment and management, focusing on airway, breathing, circulation, disability, exposure, and fluids. Specific attention is given to fluid resuscitation using the Parkland formula. The document also addresses monitoring for signs of compromised circulation in limbs and the potential need for escharotomy procedures.
This document provides information on burns, including causes, assessment, treatment and prevention. Burns are injuries caused by heat, chemicals, electricity or radiation. Assessment involves checking the airway, breathing, circulation, disability and exposure. Treatment depends on the severity and depth of the burn, and may include cleaning, dressing and fluid replacement. Deeper burns require specialist care. Prevention strategies include smoke alarms, fire safety education, and safe cooking and electrical practices.
This document discusses colostomy care, including:
1. Defining a colostomy as an opening in the large intestine brought to the surface of the abdomen for bowel evacuation.
2. Describing the different types of colostomies based on duration, stoma site, and number/type.
3. Explaining the purpose and importance of proper colostomy care for skin protection, drainage collection, and patient acceptance of self-care.
- Skin traction involves applying traction directly to the skin to immobilize a body part. It can be used for short or extended periods using adhesive or non-adhesive devices.
- The purposes of skin traction include reducing fractures and dislocations, maintaining skeletal alignment, relieving muscle spasms, and immobilizing injured areas.
- Common types of skin traction include Buck's traction for femoral fractures, forearm skin traction, and head halter traction for neck injuries. Close monitoring is needed to prevent complications like skin breakdown, neurological issues, and deep vein thrombosis.
It contains detailed description of which kind of dressings to be used in burns. Newer concepts in burns dressings. Very helpful for plastic and general surgeons practicing burns.
Best Practice Statement Compression hosieryGNEAUPP.
The document provides guidance on best practices for compression hosiery. It summarizes key areas including full holistic assessment, hosiery classification and selection, application and removal, disease and service management, and roles and competencies. The full holistic assessment section emphasizes the importance of accurately diagnosing the underlying cause of edema through a qualified practitioner's initial assessment of the patient's condition, signs and symptoms, and risk factors. This assessment informs both the differential diagnosis and appropriate hosiery selection and treatment pathway.
Holistic Management of Venous Leg UlcerationGNEAUPP.
The document provides guidance on holistic management of venous leg ulcers. It discusses assessment and diagnosis of venous leg ulcers, classification of compression products, holistic management including compression therapy, and prevention of ulcer recurrence. A thorough assessment is crucial to accurate diagnosis and treatment planning, and should include general health history, leg examination including arterial assessment, and wound/skin assessment. Appropriate compression therapy is emphasized as the standard treatment for venous leg ulcers.
This document provides an overview of negative pressure wound therapy (NPWT), including its principles, evidence base, treatment applications, and perspectives. NPWT uses subatmospheric pressure to promote wound healing by removing excess fluid, stimulating blood flow, and encouraging granulation tissue formation. The evidence for NPWT comes primarily from case studies and randomized controlled trials showing improved healing outcomes for various acute and chronic wounds compared to standard care. Future developments may include more portable single-use devices and systems that integrate sensors for remote monitoring. Overall, NPWT is a valuable tool for managing hard-to-heal wounds, but its use and cost-effectiveness require careful consideration.
Este documento propone la figura de la enfermera consultora en heridas crónicas, con un perfil de enfermera de práctica avanzada. Define a esta enfermera como un profesional especializado con amplios conocimientos para la toma de decisiones clínicas sobre heridas crónicas. También describe los principales espacios de actuación para estas enfermeras, como unidades de heridas y equipos multidisciplinarios de apoyo.
Doc. posicionamiento 14 - Herramientas para cuidadorasGNEAUPP.
Este documento describe las herramientas necesarias para cuidadores de pacientes con heridas crónicas, con el objetivo de empoderarlos en la prevención de estas lesiones. Señala que los cuidadores son un elemento clave en la prevención y que dotarlos de conocimientos y habilidades para el cuidado preventivo es vital para evitar la sobrecarga. Además, propone que las enfermeras deben proporcionar información y apoyo continuo a los cuidadores, reconociéndolos como agentes activos y responsables en el proceso de cuidado.
Heridas de dificil cicatrizacion - un enfoque integralGNEAUPP.
Este documento discute la complejidad de las heridas que tardan en cicatrizar y el enfoque integral necesario para abordarlas. Explora cómo factores físicos, bacteriológicos, bioquímicos, psicosociales y económicos pueden afectar la cicatrización. También examina cómo la interacción entre el paciente, la herida, los conocimientos del personal sanitario y los recursos disponibles determinan la complejidad de la herida y los riesgos de cicatrización retardada. El documento concluye que para
Este documento presenta una guía para cuidadores de personas dependientes. Explica conceptos clave como los tipos de dependencia, cuidadores y derechos de los cuidadores. También cubre temas técnicos como estimular la autonomía y autoestima del dependiente, así como su higiene, alimentación, eliminación y seguridad. Finalmente, incluye información sobre recursos sociosanitarios disponibles.
The document provides an overview of eHealth and telemedicine in wound care. It defines key terms like eHealth, mHealth, telehealth, and telemedicine. The document also reviews literature on the use of eHealth in wound care and evaluates solutions based on the MAST framework. While evidence is still limited, studies show benefits like improved access to care and increased job satisfaction for clinicians. The document provides guidance for clinicians considering implementing eHealth applications and recommends evaluating outcomes to ensure efficient use.
Management of patients_with_venous_leg_ulcers_final_2016GNEAUPP.
This document provides clinical practice statements for the management of patients with venous leg ulcers. It aims to identify barriers and facilitators to implementing best practices based on guidelines. The document was created by an international expert working group to account for differences in healthcare systems worldwide and address gaps in current guidelines. Clinical practice statements cover the differential diagnosis and assessment of leg ulcers, treatment delivery including dressings and invasive options, referral structures, secondary prevention after healing, and outcome monitoring. The goal is to improve leg ulcer management and enhance the patient experience.
This document discusses the challenges of pediatric wound care. It notes that wounds are a significant issue for children, especially those in critical care, and that most pediatric wounds are caused by medical devices rather than conventional pressure ulcers. It also highlights specific challenges like adapting products for smaller pediatric patients and managing fragile skin. The document advocates for a multidisciplinary team approach to wound care and describes programs developed at Cincinnati Children's Hospital and Texas Children's Hospital that have centralized wound care services and focus on prevention, standards, and research to address the unique needs in pediatric wound management.
The document is a summary report of findings from the National Diabetes Footcare Audit (NDFA) in England and Wales for 2014-2015. Some key findings from the NDFA include:
- Over 5,000 people with diabetic foot ulcers were included in the audit. About 10% had more than one ulcer and 5% had Charcot foot disease. Over 80% had lost sensation in their feet.
- People with diabetic foot ulcers were just as likely to have received an annual foot check as other people with diabetes according to the NDFA findings.
- The report provides recommendations to healthcare professionals and people with diabetes to improve foot care services and self-management based on the audit results.
Este documento describe la dermatitis del pañal, incluyendo su definición como una erupción en el área del pañal causada por contacto prolongado con orina y heces, factores etiológicos como la irritación y Candida albicans, signos clínicos como la forma de W, diagnóstico diferencial y tratamiento enfocado en mantener la piel seca, protegida y libre de infecciones.
Incontinence Associated Dermatitis by Prof Dr Mikel GrayAdlizz Medic
- IAD is skin damage caused by exposure to urine and/or stool, and is exacerbated by the use of absorbent containment products. It affects 5.6-50% of long-term care residents and 10.9-54% of incontinent hospital patients.
- Urine and stool impact the skin's moisture barrier, increasing pH and promoting bacterial/fungal growth. Absorbent products further overhydrate the skin.
- IAD is diagnosed by inspecting the skin for redness,
BOLETÍN CANARIO DE USO RACIONAL DEL MEDICAMENTO DEL SCS. USO RACIONAL DEL MAT...GNEAUPP.
Este documento proporciona recomendaciones sobre el uso racional del material de curas para diferentes tipos de úlceras, incluyendo úlceras por presión, úlceras del pie diabético y úlceras vasculares. Se enfatiza la importancia de una evaluación integral del paciente y la úlcera para seleccionar el tratamiento apropiado. Se proveen pautas detalladas sobre técnicas de desbridamiento, control del exudado, hidratación de los bordes y tipo de apósito según las características de la her
This document discusses bowel and bladder incontinence in elderly patients and its effects on skin health. It defines incontinence and provides epidemiology data. Issues associated with incontinence management include skin maceration, breakdown from moisture, and infections from prolonged catheter or diaper use. Specific skin conditions that can result include incontinence associated dermatitis, moisture associated skin damage from maceration, shear and friction erosions, and unstageable pressure ulcers in immobile patients. The document recommends frequent skin checks, pad changes, and skin protection methods like creams and moisture barriers to prevent and manage incontinence-related skin issues.
Funcion de las proteasas en el diagnóstico de heridasGNEAUPP.
Este documento presenta un resumen del consenso de un grupo de trabajo internacional de expertos sobre la función de las proteasas en el diagnóstico de heridas. 1) Las proteasas desempeñan un papel clave en la cicatrización normal al descomponer proteínas dañadas, pero un exceso de actividad de proteasas puede alterar la cicatrización. 2) Los estudios sugieren que altos niveles de actividad de proteasas, especialmente metaloproteinasas de la matriz y elastasa leucocitaria humana, se asocian con her
Optimising wellbeing in people living with a woundGNEAUPP.
This document discusses optimizing wellbeing in people living with wounds. It defines wellbeing as having physical, mental, social, and spiritual/cultural components. Living with a wound can negatively impact wellbeing in many ways, such as through physical pain/odor, psychological issues like anxiety/depression, social isolation, and cultural/spiritual conflicts with treatment. The document advocates for a patient-centered approach that considers an individual's overall wellbeing, not just wound healing, and encourages shared decision making between clinicians and patients.
This document provides an updated international consensus on wound infection in clinical practice from experts in the field. It defines key terms related to wound infection and chronicity. It presents an updated wound infection continuum that includes biofilm and removes the term "critical colonization". It describes the signs and symptoms associated with different stages of infection from contamination to systemic infection. It also discusses the biofilm cycle and emphasizes the importance of biofilm-based wound care to prevent, interrupt, and delay biofilm formation and reformation.
Este documento trata sobre la terapia compresiva y sus principios. Explica que la terapia compresiva es efectiva para tratar úlceras venosas al contrarrestar la filtración de líquido hacia los tejidos mediante el aumento de la presión tisular y la mejora de la reabsorción hacia las venas y vasos linfáticos. También analiza los efectos fisiológicos de la compresión en el sistema venoso y cómo reduce el diámetro venoso para mejorar el flujo sanguíneo.
Making the case for cost-effective wound managementGNEAUPP.
This document discusses cost-effective wound management and making the case for it. It begins by explaining the challenges in wound management, including increasing prevalence of wounds and difficulty collecting data on clinical efficacy, effectiveness, and costs. It then discusses common myths around cost-effectiveness, clarifying that cost-effective does not mean cheaper but provides benefits at a reasonable cost compared to alternatives. The document outlines different types of economic analyses used in healthcare, particularly cost-effectiveness analysis, and discusses understanding costs from various perspectives.
The management of pediatric polytrauma -a simple reviewEmergency Live
This Clinical review, published by Libertas Academica, is an interesting commentary about the management of pediatric polytrauma.
This research was realized by
H. Mevius, M. van Dijk, A. Numanogluand A.B. van As between the MC-Sophia Childen's Hospital, Rotterdam, and the Red Cross War memorial Children's Hospital in Cape Town, South Africa.
H. Mevius1, M. van Dijk2–4, A. Numanoglu2,3 and A.B. van As2,3
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
1Medical Student, Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands. 2Department
of Paediatric Surgery, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. 3University of Cape Town, Cape Town,
South Africa. 4Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.
ABSTRACT: Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. The primary goal of this review is to provide a comprehensive overview on current knowledge in the management of pediatric polytrauma patients (PPPs). A database review was conducted based on a search in the Embase, Medline OVID-SP, Web of Science, Cochrane central, and Pubmed databases. Only studies with “paediatric population” and “polytrauma” as criteria were included. A total of 3310 citations were retrieved. Of these, 3271 were excluded after screening, based on title and abstract. The full texts of 39 articles were assessed; further selection left 25 articles to be included in this review. The most crucial point in the
management of PPPs is preparedness of the staff and an emergency room furnished with age-appropriate drugs and equipment combined with a systemic
approach.
KEY WORDS: pediatric population, polytrauma, multiple injuries, current management, review
Introduction
Polytrauma is a medical term that describes the condition of a patient subjected to multiple traumatic injuries and can be a life-threatening condition. These (life threatening) injuries typically affect two or more body regions and present a challenge for diagnosis and treatment.1,2 However, there is no consensus yet about the term polytrauma in both literature and practice.3
Polytrauma is a major cause of mortality and morbidity in both developed and developing countries. Despite its preventability, trauma remains the most common cause of death and disability in children.2 In fact, all over the world, more than 700,000 children under the age of 15 years die each year due to accidental injury.4 Leading causes of polytrauma are road traffic crashes, falls from heights, and
International standards-for-children-in-emergency-departments-v2.0-june-2014-1gerajasso
This document outlines several key challenges facing pediatric emergency medicine globally and in developed countries. Common issues include overcrowding, poor facilities for children, long wait times, limited pediatric beds and equipment, insufficient staff training, difficulties accessing specialty services, and a lack of pediatric-specific policies and guidelines. Even in developed nations, studies show pediatric emergency care is often uneven, with missing infant-sized equipment and medications in many emergency departments.
This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.
ADVANCES IN WOUND CARE: THE TRIANGLE OF WOUND ASSESSMENTGNEAUPP.
This document introduces the Triangle of Wound Assessment, a new framework for comprehensive wound assessment. It consists of separately evaluating the wound bed, wound edge, and periwound skin. This addresses limitations of prior tools by integrating assessment of the periwound skin and providing guidance on goals, care planning, and interventions. The Triangle of Wound Assessment facilitates early identification and treatment of issues in all three zones to improve patient outcomes. It provides a simple, intuitive way to consistently include periwound skin in wound assessment and document wound status over time.
The document discusses evidence-based medicine (EBM) and functional medicine. It notes that EBM aims to provide optimal health rather than just treat disease, taking a patient-centered rather than disease-centered approach. Functional medicine uses a systems-based approach and considers lifestyle, environmental, and genetic factors to identify the underlying causes of disease. It factors in influences like genomics, epigenomics, and the microbiome to build on previous paradigms and improve disease prediction and prevention strategies.
Article Type: Editorial
Title: Patient Safety: Paradigm shift of modern healthcare delivery and research
Year: 2022; Volume: 2; Issue: 1; Page No: 1 – 2
Author: Dr. Mohammed Imran
10.55349/ijmsnr.20222112
Affiliation: Associate Professor, Medical Pharmacology, College of Medicine and Health Sciences, Sohar, National University of Science and Technology, Sultanate of Oman.
Email ID: imran@nu.edu.om
Article Summary:
Submitted : 10-February-2022
Revised : 26-February-2022
Accepted : 12-March-2022
Published : 31-March-2022
Australian Clinical Consensus Guideline: The diagnosis and acute management o...Carmenlahiffjenkins
This document presents guidelines for the diagnosis and acute management of childhood stroke in Australia. It was developed by an expert panel and is based on a systematic review of evidence from 2007-2017. The guidelines provide over 60 evidence-based recommendations to help clinicians rapidly identify, diagnose, determine the cause of, and treat childhood strokes. Key recommendations include rapid neuroimaging to confirm diagnosis, investigations to identify the cause, treatments like intravenous thrombolysis to restore blood flow to the brain, and management of conditions like raised intracranial pressure. Implementing the guidelines would help minimize delays in care, improve access to treatments, and allow for benchmarking outcomes of childhood strokes in Australia.
Capstone Project Topic Selection And Approval.docx4934bk
The document discusses a proposed capstone project topic on preventing pressure ulcers in elderly hospitalized patients. Specifically:
- The problem is pressure ulcers developing in elderly patients with limited mobility during hospitalization.
- The setting is an acute care facility where many elderly orthopedic surgery patients are admitted.
- The proposed solution is to implement pressure relieving mattresses, heel protectors, staff education, and a pressure ulcer prevention team to monitor patients and decrease pressure ulcer incidence.
Treatment Planning in Paediatric Dentistry - a Structured Approach.pdfAinaBalqis8
This document summarizes the key steps in developing a structured treatment plan for pediatric dental patients. It discusses assessing caries risk, evaluating a child's coping ability, selecting appropriate behavior management strategies, and determining treatment options and sequencing. A thorough treatment plan considers the child's age, risk status, psychological factors, and available treatments to provide safe, effective, and evidence-based care tailored to each individual patient.
Controladores y estrategias para evitar la sobreutilización sanitaria en Aten...Javier González de Dios
Objectives: Identify the sources of overuse from the point of view of the Spanish primary care professionals, and
analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals
face these demands.
Design: A cross-sectional study.
Setting: Primary care in Spain.
Participants: A non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was
recruited during the survey.
Primary and secondary outcome measures: The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.
Results: In all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments
that patients could find on printed and digital media, contributed to the professional’s inability to adequately
counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x2 =88.8, P<0.001,
percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x2 =175.7,
P<0.001, PD=12.3).
Conclusion: Satisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.
1. A children's hospital developed a systematic protocol to improve identification of victims of non-accidental trauma (NAT), also known as child abuse.
2. A review found the hospital previously missed important social and family history in initial evaluations of NAT cases. Patients with perineal bruising had higher mortality and need for surgery.
3. The new protocol includes a screening tool with NAT red flags, a structured electronic medical record note, and mandated discharge planning meetings. It aims to standardize NAT identification, documentation, and management.
The document discusses improving patient safety in intensive care medicine. It describes launching a major initiative through the European Society of Intensive Care Medicine (ESICM) to bring together representatives from critical care societies around the world. The goal is to pledge efforts to improving patient care and outcomes. Key areas of focus include changing medical culture and priorities to better address patient safety issues, and evaluating patient safety at both the individual patient level and collective level to maximize benefits and minimize harms. The initiative aims to raise awareness of patient safety and help transform daily practice to improve quality of care for all patients.
- A study was conducted at Green Pastures Hospital in Nepal to assess woundcare practices for pressure ulcers in leprosy patients and evaluate knowledge of wound prevention and treatment.
- A review of patient records from 2009-2014 showed reductions in ulcer healing time, readmissions for ulcers, and severe ulcers requiring surgery, suggesting improved care. However, current woundcare practices did not fully follow protocols.
- Focus groups and interviews with patients and staff found generally good knowledge of leprosy, ulcer causes, and prevention measures, but identified opportunities to strengthen woundcare and self-care management.
This document discusses a study on supporting children's adherence to anti-retroviral (ART) therapy in Malawi. The study followed 47 HIV-positive children on ART over 6 months to a year. 72% of children never missed a dose according to caregiver reports. Clinic attendance was also good, with over 80% of visits either on time or within a week of the scheduled date. Focus groups and interviews with caregivers provided insights into challenges of supporting children's adherence, such as costs of medication and transport as well as caregiver responsibilities, but also motivations like seeing children's health improve. The findings highlight the need for more affordable and less complex ART regimes as well as tools to help caregivers support children's adherence
1) A quality improvement project in a remote African village found that improving children's compliance with a malaria treatment plan by concealing the bad taste of medication increased compliance from 48% to 70%.
2) Quality improvement techniques can work in developing countries with limited resources by setting goals, studying processes, testing changes, measuring progress, and building skills in teamwork and measurement.
3) Initiatives like the Integrated Management of Childhood Illnesses program aim to improve health systems in developing countries by measuring quality of services and using that data to identify successful and unsuccessful innovations for improving care.
This document describes the development of an evidence-based position statement on medical device-related hospital-acquired pressure ulcers (HAPUs) within a large healthcare system. A task force used the Iowa Model of Evidence-Based Practice to identify device-related HAPUs as an issue, review the literature, and define device-related HAPUs as injuries caused by external medical devices. They developed a position statement to standardize identification and reporting. Implementation involved disseminating the statement to various groups. Initial results showed improved identification and a 33% reduction in overall HAPU rates.
Assessment Of Communication And Interpersonal Skills CompetenciesRick Vogel
This document discusses the assessment of communication and interpersonal skills competencies for emergency medicine residents. It defines 10 specific communication competencies that were agreed upon at a consensus conference. The conference aimed to define the communication competency for emergency medicine, review assessment methods used in other specialties, identify methods suggested by the Accreditation Council for Graduate Medical Education, and analyze the applicability of these methods to emergency medicine. Standardized patients and direct observation were identified as the best assessment methods, but other methods like checklists, skills rating forms, and multi-source feedback were also discussed. The document concludes that while no single method can fully assess communication skills, these various approaches can provide formative or summative evaluation of residents' compet
Similar to Best Practice Statement Principles of wound management in paediatric patients (20)
Este documento proporciona recomendaciones sobre prácticas que no deben realizarse en el manejo de heridas crónicas basadas en la evidencia científica. Se elaboró por un panel de expertos y contiene recomendaciones sobre diagnóstico, lesiones relacionadas con la dependencia, lesiones de extremidades inferiores, control de infección y tratamiento local. El objetivo es mejorar la atención de pacientes con heridas crónicas evitando prácticas inseguras e inefectivas.
Este documento presenta recomendaciones para la toma de muestras microbiológicas de heridas crónicas. Explica que las heridas crónicas a menudo están colonizadas por bacterias formando biofilms, lo que requiere métodos específicos de muestreo. Describe los procedimientos recomendados para la toma de muestras con hisopo, punción-aspiración y biopsia de tejido para identificar microorganismos planctónicos y de biofilm. El objetivo es proporcionar pautas que permitan diagnosticar
Este documento técnico proporciona recomendaciones actualizadas sobre el manejo local de úlceras y heridas. Se dividen las recomendaciones en secciones como el cuidado de la piel, limpieza de heridas, desbridamiento, manejo de la carga bacteriana, facilitación de la cicatrización y terapias avanzadas. Para cada sección, se describen conceptos clave, recomendaciones de uso y productos específicos respaldados por evidencia científica. El objetivo es guiar a profesionales en la selección segura
Valoración y manejo de las lesiones por presión para equipos interprofesional...GNEAUPP.
Este documento presenta la tercera edición de las Guías de buenas prácticas para la valoración y manejo de las lesiones por presión para equipos interprofesionales. Incluye recomendaciones para la práctica clínica, la formación, el sistema de salud, las organizaciones y las políticas, así como estrategias para la implantación de las guías. El objetivo es proporcionar una atención de calidad para prevenir y tratar las lesiones por presión de forma segura y eficaz.
Este documento resume la actualización de la guía de prevención y tratamiento de las úlceras por presión en las Islas Baleares. La guía actualizada incluye recomendaciones basadas en evidencia científica para ayudar a los profesionales a prevenir y tratar estas úlceras de manera segura. Fue desarrollada por un grupo multidisciplinario de expertos y revisada por otros profesionales, con el objetivo de mejorar la atención a los pacientes.
Este documento presenta las conclusiones de la Conferencia Nacional de Consenso sobre las Úlceras de la Extremidad Inferior de 2018. Se revisan conceptos clave sobre úlceras, su clasificación, epidemiología, etiología, evaluación, criterios de cicatrización e infección, tratamiento local y factores que influyen en la cronicidad. Además, se analizan estrategias terapéuticas avanzadas, el impacto en la calidad de vida, el uso de telemedicina y consideraciones económicas sobre este problema de
CONFERENCIA NACIONAL DE CONSENSO SOBRE LAS ÚLCERAS DE LA EXTREMIDAD INFERIOR ...GNEAUPP.
Este documento presenta el resumen del Documento de Consenso 2018 de la Conferencia Nacional de Consenso sobre las Úlceras de la Extremidad Inferior. El documento está estructurado en cinco apartados que abordan las úlceras en función de su etiología y ofrece recomendaciones para el diagnóstico y tratamiento optimizados de los pacientes. Veintidós expertos participaron en la revisión y actualización del documento original de 2008 para mejorar la atención a los pacientes con úlceras en las extremidades inferiores.
Guía de actuación Pie diabético en CanariasGNEAUPP.
Este documento presenta una guía de actuación sobre el pie diabético en Canarias. Incluye información sobre la epidemiología, factores de riesgo y objetivos de prevención y tratamiento del pie diabético en personas con diabetes. Detalla los procedimientos de exploración, clasificación, tratamiento de úlceras y derivación a otros servicios. El objetivo final es mejorar la atención y reducir las tasas de amputación a través de la detección precoz, educación y coordinación entre los diferentes niveles asistenciales.
This document provides a summary of the Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury. The guideline was developed by an international team to provide evidence-based recommendations for assessing and preventing pressure injuries across various healthcare settings. It aims to optimize pressure injury prevention, assessment, and management. The guideline includes recommendations on risk assessment, prevention interventions like support surfaces and positioning, wound assessment and monitoring, pain management, and treatment interventions.
Guías de Práctica Clínica en Enfermedad Venosa CrónicaGNEAUPP.
Este documento presenta las guías de práctica clínica en enfermedad venosa crónica desarrolladas por expertos españoles. El documento describe la fisiopatología de la enfermedad venosa crónica, incluidos los cambios en el sistema venoso superficial y profundo, y explica que la hipertensión venosa producida por el reflujo y la obstrucción de las venas es el principal factor fisiopatológico. También cubre temas como la epidemiología, clasificación, diagnóstico, tratamiento médico, qu
DOCUMENTO DE POSICIONAMENTO GNEAUPP Nº 13 “Enfermeiras Consultoras em Feridas...GNEAUPP.
Este documento define e justifica o papel da enfermeira consultora em feridas crónicas. Argumenta que as feridas crónicas complexas requerem uma abordagem especializada e multidisciplinar. Define a enfermeira consultora como uma enfermeira com competências avançadas para fornecer cuidados de qualidade a pacientes com feridas crónicas. Discute as competências, áreas de atuação e modelos de equipas de apoio para enfermeiras consultoras em feridas crónicas.
DOCUMENTO DE POSICIONAMENTO GNEAUPP Nº 13 “Enfermeiras Consultoras em Feridas...GNEAUPP.
1) O documento discute a importância da criação da figura da enfermeira consultora em feridas crônicas para melhorar os cuidados a pacientes com este tipo de ferida.
2) É definida a enfermeira consultora como um profissional com amplos conhecimentos e habilidades para tomar decisões clínicas, preventivas e terapêuticas baseadas em evidências para o tratamento de feridas crônicas.
3) As principais competências de uma enfermeira consultora incluem liderança, consultoria, otimização de
Best Practice Statement Holistic Management of Venous Leg UlcerationGNEAUPP.
This document provides guidance on holistically managing venous leg ulcers. It emphasizes the importance of thorough assessment to accurately diagnose and treat patients. Assessment should consider potential risk factors and identify any signs of venous disease so appropriate management can begin promptly. The goal is to start treatment for all patients with lower limb wounds to prevent ulcer development and reduce the patient and healthcare burden. Ongoing management and prevention of recurrence are also priorities given ulcer recurrence rates of 18-28% within a year.
Best Practice Statement Holistic Management of Venous Leg UlcerationGNEAUPP.
The document provides guidance on holistic management of venous leg ulcers. It discusses assessment and diagnosis of venous leg ulcers, classification of compression products, holistic management including compression therapy, and prevention of ulcer recurrence. A thorough assessment is crucial to accurate diagnosis and treatment planning, and should include general health history, leg examination including arterial assessment, and wound/skin assessment. Appropriate compression therapy is emphasized as the standard treatment for venous leg ulcers.
GUÍA DE ACTUACIÓN PARA LA PREVENCIÓN Y CUIDADOS DE LAS ÚLCERAS POR PRESIÓNGNEAUPP.
Este documento presenta una guía para la prevención y cuidado de úlceras por presión. Explica la definición, clasificación y factores de riesgo de úlceras por presión, así como estrategias para la prevención incluyendo la evaluación del riesgo, nutrición, cuidado de la piel, control de humedad y manejo de la presión. También cubre el tratamiento de úlceras por presión existentes, incluyendo la monitorización, cuidados de la herida, terapias adicionales y situaciones especiales.
Role of multi-layer foam dressings with Safetac in the prevention of pressure...GNEAUPP.
This document reviews evidence from clinical and laboratory studies on the use of multi-layer foam dressings with Safetac in preventing pressure ulcers. It finds that:
1) Randomized controlled trials and other clinical studies show these dressings can reduce pressure ulcers on areas like the sacrum and heels when used prophylactically.
2) Laboratory studies indicate these dressings can mediate the effects of pressure, friction, and shear on the skin through their multilayer structure and composition.
3) Taken together, the evidence suggests these dressings may be beneficial for clinicians, healthcare providers, and patients when used as part of standard prevention strategies.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
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Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Best Practice Statement Principles of wound management in paediatric patients
1. Best Practice Statement
Principles of wound management
in paediatric patients
Wound aetiology,
assessment
and diagnosis in
paediatric patients
Child- and young
person-centred
wound management
Napkin-associated
dermatitis prevention
and management
2014
wuk bps
3. 1PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS
There is a need for clear and concise guid-
ance for UK clinicians as to how to deliver
optimal care to paediatric patients with
wounds. There are no existing UK guide-
lines in this area for healthcare profession-
als who work with paediatric patients.
Paediatric care is particularly challenging, as
there is a lack of research available to guide
practice; a lack of tools for standardising
assessment, which can lead to inappropri-
ate treatment choices; and a lack of product
standardisation across formularies, along
with a poor understanding of which of these
products can be used in paediatric patients.
One method of supporting clincians is
through the development of a best practice
statement (BPS). In developing this Wounds
UK BPS, the relevant research has been
reviewed, and expert opinion and clini-
cal guidance have been sought. The key
principles of best practice ensure increased
clinician awareness, letting them exercise
due care and process to promote delivery of
the highest standards of care across all care
settings, by all healthcare professionals.
BPSs are intended to guide practice and
promote a consistent and cohesive approach
to care. BPSs are primarily intended for use
by registered nurses, midwives and the staff
who support them, but can contribute to
multidisciplinary working and guide other
members of the healthcare team.
This document will draw from a wide
range of informational sources to help
standardise care of paediatric patients with
wounds. Statements are derived from the
best available evidence — including cur-
rent literature, existing or previous initia-
tives at local or national levels, and expert
opinion — at the time of development.
This is the first edition of Best practice
statement: Principles of wound manage-
ment in paediatric patients. It seeks to
explain, in accessible and meaningful
language, the rationale for application
of wound care knowledge in paediatric
patients with wounds. During the peer-
review process, a panel of paediatric tissue
viability nurses has convened, discussed
and commented on drafts in order to pro-
duce a document that provides practical
advice to support clinical decision-making.
This BPS seeks to provide clinicians with
a best practice guide covering several
areas of wound management in paediatric
patients:
n Wound aetiology, assessment and
diagnosis in paediatric patients (p2)
n Child- and young person-centred
wound management (p5)
n Napkin-associated dermatitis
prevention and management (p10)
Angela Rodgers
Chair
FOREWORD
Developing best practice for
wound management in paediatric patients
GUIDE TO USING THIS
DOCUMENT
Each of the sections that
follow offer advice about
caring for the skin and
wounds of paediatric
patients. The best practice
statements, their rationale,
and how to demonstrate
best practice for all
sections have been
compiled in the appendix
on page 12.
4. WOUNDs UK BEST PRACTICE STATEMENT 20142
AETIOLOGY OF
WOUNDS
SECTION 1: WOUND AETIOLOGY, ASSESSMENT
AND DIAGNOSIS IN PAEDIATRIC PATIENTS
Although a full-term baby’s skin is structurally
comparable to that of adults, it possesses only
60% of the epidermal and dermal thickness,
and a much more fragile epidermal-to-dermal
junction (Campbell and Banta-Wright, 2000).
As children grow, their skin layers thicken,
but paediatric patients generally have more
vulnerable skin than adults. A number of
other considerations (Box 1) mean that the
approach to wound management in paediatric
patients must differ from that in adults.
Regardless of age, wound healing follows the
same physiological processes (Rodgers, 2010).
Just as in adults, wounds in paediatric patients
heal in three phases: the inflammatory phase
(the body’s normal response to injury), the
proliferative phase (when the body structures
regenerate and healing begins) and the
maturation phase (when the scar tissue is
formed) (RCHM, 2012). Special care must
be taken to create the right environment for
healing through all phases, regardless of the
mechanism of wound healing (e.g. primary
intention, secondary intention, skin graft/
flap), while considering the physiological
differences in neonatal and paediatric skin
(Table 1, p3).
Aetiology of paediatric wounds
The causes of wounds in infants and children
may differ from those in adults. Acute
wounds occur from trauma such as road
traffic accidents, dog bites, lacerations, burns
and scalds, or from surgical interventions.
Chronic wounds such as pressure ulcers
are largely caused by medical device-related
pressure, friction and shear; invasive lines/
tubes (e.g. gastrostomy/tracheostomy
tubes) can give rise to hypergranulation
or skin excoriation (Butler, 2006). Other
causes include purpura fulminans due to
meningococcal sepsis, epidermolysis bullosa,
myelomeningocele, ulcerated haemangioma
and vascular anomalies (Rodgers, 2010; White
and Butcher, 2006). For neonates and young
infants, invasive lines can lead to extravasation
or emboli-induced ischaemic injuries.
If a wound fails to progress towards healing
according to the expected trajectory
(depending on comorbidities), the wound
may be considered a chronic wound, or there
may be an underlying condition that needs to
be diagnosed and treated. When this occurs,
refer the patient to a specialist member of
the multidisciplinary team in line with local
guidelines.
Wounds resulting from maltreatment
Keep in mind that not all wounds are a result
of medical/clinical issues. Maltreatment of a
child can result in wounds that present in a
typical way (e.g. abrasion, bruise, laceration,
burn/scald, bite). Skin signs of maltreatment
are often accompanied by other physical
injuries, as well as other signs of abuse (e.g.
neglect, emotional abuse) (NICE, 2009).
A concise history must be obtained of how an
injury/wound occurred. Suspicion should be
raised if:
■ Accounts of the mechanism of injury keep
changing, differ, or are implausible or
inconsistent with the injury
■ The mechanism of injury is inconsistent
with the child’s age/developmental stage,
normal activities and existing medical
conditions
■ Delay in seeking medical attention
■ Lack of concern from parent/guardian
■ Demeanour/behaviour of child causes
concern (NICE, 2009).
Concerns about maltreatment must be
documented accurately and reported
immediately according to local child
protection policies (NICE, 2009).
Documentation
Accurate documentation is essential to safe
and effective care, and integral to deter-
mining the patient-centred plan of care in
paediatric patients with wounds. Docu-
mentation should be performed as per the
Nursing and Midwifery Council and Royal
College of Nursing Guidelines (NMC, 2009;
RCN, 2012).
Key points:
1. The approach to wound
management in children
must differ from that in
adults
2. Record baseline data
as part of a holistic
assessment of both the
patient and wound, and
reassess and monitor
treatment on a regular,
ongoing basis
3. Consult a specialist
member of the
multidisciplinary team in
line with local guidelines
the event of suspected/
confirmed infection or if
the wound fails to heal
4. Ensure the special needs
of paediatric patients and
their parents/guardians
are accommodated
■■ Reduced ability to
thermoregulate
■■ Increased body
surface-to-weight ratio
■■ Increased
transepidermal water
loss
■■ Propensity towards
epidermal stripping
■■ Immature immune,
renal and hepatic
systems, which
increase risk of
infection
■■ Limited mobility (e.g.
in babies)
■■ Inability to verbally
communicate
■■ Different ways of
expressing pain
Box 1: Wound care
considerations in
paediatric patients (Patel
and Tomic-Canic, 2014)
5. 3PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS 3
AETIOLOGY OF
WOUNDS
Table 1: Key differences in neonatal and paediatric skin (IMAG, 2004; White and Butcher,
2006; Visscher et al, 2013)
Neonatal skin Factors affected Considerations
Stratum corneum
2–3 cells thick (may be
absent in very pre-term
infants*), compared to
~20–30 cells in an adult
Reduced barrier functions leaving
skin more prone to chemical absorp-
tion, bacterial colonisation and
infection
Transepidermal water loss is in-
creased, affecting fluid balance
Avoid topical application of
potentially toxic chemicals (e.g.
iodine, alcohol)
Good hand hygiene
Consider fluid losses +/- nursing
in humidity
Fibrils that connect
dermis to epidermis are
reduced in numbers
and widely spaced
Prone to damage from skin stripping
(especially during removal of adhe-
sives) and shearing forces (e.g. from
poor moving/handling techniques,
nails, hand jewellery, equipment with
surface contact)
Minimise use of adhesives
Use sterile silicone adhesive
removers
Minimise handling
Remove all hand/wrist jewellery,
keep nails short
Subcutaneous fat may
be reduced or even
absent in very pre-term
infants
Reduced energy stores, less ‘shock
absorption’, temperature regulation
poor
Increased calorific intake (as per
dietician)
Reposition as handling allows to
prevent pressure ulcers
Minimise occasions where cool-
ing could occur (e.g. handling,
bathing, excessive exposure)
Increased levels of type
III collagen
Increased tensile strength and ability
to repair damaged tissue faster and
more effectively
Faster wound healing (depen-
dent on other factors affecting
wound healing)
Increased sebaceous
secretions in newborn
infants
Can lead to spots on face/nose Reassure parents it is normal
and will not last beyond a few
weeks once hormone activity
regulates postnatally
*After birth, skin of a premature infant weighing >1000g will mature to that of a term baby within
2–4 weeks and 4–8 weeks if weighing <1000g (Atherton, 2010)
Box 2: Factors that could
delay wound healing*
Adapted from NHS QIS
(2009) and Wounds UK
Best Practice Statement
(2013)
Medications/treatments
■■ Antibiotics
■■ Anticoagulants
■■ Chemotherapy
■■ Glucocorticoid steroids
■■ Inotropes
Comorbid conditions
■■ Anaemia
■■ Allergies/sensitivities
■■ Diabetes
■■ Immunocompromise
■■ Infection
■■ Incontinence
■■ Obesity
■■ Oedema
■■ Respiratory/circulatory
disease
■■ Wound infection
Contributing factors
■■ Concordance
■■ Immobility
■■ Poor nutrition
■■ Social isolation
■■ Socioeconomic status
*Not exhaustive
Written information about the dressing
and treatment plan should be provided to
parents/guardians in accessible language
that lets them understand and participate to
the extent needed. Patient education should
be delivered at an age-appropriate level. For
example, education of adolescents is ideally
provided on a one-to-one basis with respect
for their privacy (Baharestani, 2007).
Assessment
A thorough assessment begins with record-
ing baseline data. If a photograph is taken,
consent in line with local policy must be
obtained from the parent/guardian. Record
any factors that could delay healing (Box 2),
along with the results of wound assessment
(Box 3, p4).
Management goals (e.g. moisture balance, de-
bridement, reduction of microbial load) and
the care plan of care should be set based on
this assessment. Wounds should be reassessed
(and re-documented) regularly and examined
for signs of progress, delayed healing and
infection. All wounds will have a degree of
colonisation; if critical colonisation or infec-
tion is suspected, consider the use of ap-
6. WOUNDs UK BEST PRACTICE STATEMENT 20144
ASSESSING AND
DOCUMENTING
Box 3: Wound assessment
Pain and anxiety
■■ Pain and anxiety levels
■■ Analgesia requirements
(e.g. regular/ongoing, at
dressing change)
Wound dimensions
■■ Length, width, depth
■■ Tracking/undermining
■■ Photograph
Tissue type
(specify percentages)
■■ Necrotic
■■ Sloughy
■■ Granulating
■■ Epithelialising
■■ Hypergranulating
■■ Haematoma
■■ Exposed bone/tendon
■■ Presence of foreign body
Exudate
■■ Levels (e.g. low,
moderate, high)
■■ Consistency (e.g. serous,
haemoserous, purulent)
Periwound skin
■■ Dry/scaling
■■ Erythema
■■ Excoriation
■■ Fragile
■■ Maceration
■■ Oedema
■■ Healthy/intact
Potential signs of infection
■■ Heat
■■ Wound bed deterioration
(e.g. new slough or
necrosis)
■■ Pain (e.g. increased
intensity, new triggers)
■■ Increasing exudate
■■ Increasing odour
■■ Friable granulation tissue
Adapted from NHS QIS
(2009) and Wounds UK Best
Practice Statement (2013)
propriate antimicrobial wound management
products and/or consult a relevant specialist
member of the multidisciplinary team in
line with local guidelines (NHS QIS, 2009).
Review and revise the plan of care accord-
ingly, based on the most recent assessment of
the patient and wound. Document the clinical
rationale for any changes in management.
When a patient has more than one wound,
each one should be assessed separately and
have a separate, documented plan of care
(NHS QIS, 2009).
Pain/anxiety assessment
Pain is whatever the child says it is and must
be taken seriously by the clinician (McCaf-
frey and Beebe, 1989). Fear and anxiety can
increase pain intensity, disability, emotional
distress and the need for increased doses/use
of medications (Vervoot et al, 2006). There-
fore the clinician should not separate the two,
and must manage them as a whole.
Commonly encountered pain in relation to
wound care can typically be categorised as
acute rather than chronic. Acute pain may
be associated with the wound itself or occur
during wound management procedures (e.g.
cleansing, dressing change). Chronic pain in
children tends to present as abdominal pain,
limb pain or headache (Reaney and Trower,
2010). It occurs persistently or recurrently (at
least three times over the course of 3 months)
and is not usually associated with minor in-
jury (Schechter, 2006). However, chronic pain
can occur due to hypertrophic/keloid scar
tissue or contractures caused by tight scars.
Paediatric patients tend to report ‘pain all
over’, so it is critical that pain be adequately
assessed to rule out systemic causes, but not
to the extent it increases anxiety.
Assessment should involve explaining, to the
child’s level of understanding, the distinction
between hurt and harm (Schechter, 2006).
It is also helpful to ask the child to use one
finger to point to where the pain originates.
Pain should be assessed on an ongoing basis,
throughout wound management: ideally,
before, during and after a procedure (e.g.
dressing removal, cleansing, dressing applica-
tion) (WUWHS, 2004).
Pain assessment scales (Table 2) can be used
as a guide in conjunction with ongoing holis-
tic assessment of the child, his/her behaviour
and the family (Baulch, 2010). This assess-
ment must take into account the cause(s) of
the pain (physical and psychological), whether
it is acute, chronic or acute on chronic, where
it is coming from, how intense it is and what
makes it better/worse (APAGBI, 2012).
In a sedated or unconscious infant/child,
monitoring of vital signs may be useful to
detect pain. Children with limited cognitive or
physical function may have a typical expressor
of pain such as a facial twitch; it is important
to listen to the parent/carer, who knows the
child best, as this can help identify these indi-
cators (Baulch, 2010).
Table 2: Recommended pain assessment scales according to age (APAGBI, 2012)
Child’s age (with normal or assumed normal
cognitive development)
Measure
Newborn–3 years old
Intensive-care setting
Sedated/unconscious patient
COMFORT Scale or Face, Legs, Activity,
Cry, Consolability (FLACC) Scale
4 years old Faces Pain Scale-Revised (FPS-R),
COMFORT or FLACC
5–7 years old FPS-R
7 years old+ Visual Analogue Scale (VAS), NRS, FPS-R
7. 5PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS
Section 2: CHILD- and young person-CENTRED
WOUND MANAGEMENT
CHILD-CENTRED
WOUND
MANAGEMENT
The key goals of holistic wound manage-
ment in children are to alleviate/minimise
pain, lessen emotional distress and mini-
mise scarring (Box 1). Care of the paediatric
patient with a wound should be holistic and
child-centred. The treatment plan should
consider the whole child, not simply the
wound being treated, and be concerned
with the overall experience of the child and
family. Children, young people and parents
should be viewed as partners in care, to
shape and plan treatment, with services
coordinated around the child’s and family’s
particular needs (Young, 2006). An age-ap-
propriate approach to care is also essential;
for example, children and adolescents can
be encouraged to self-report pain (Wounds
UK Expert Working Group, 2013).
This section will cover the principles of four
key areas of child-centred wound manage-
ment in paediatric patients:
■ Analgesia/pain management
■ Epidermal blistering and stripping
■ Wound cleansing and debridement
■ Dressing selection.
Analgesia/pain management
Decisions regarding the type of analgesia
to be used must be carried out by a suit-
ably qualified healthcare practitioner before
prescription and administration (Table 1,
p6). Doses must be carefully calculated,
usually based on the patient’s weight. The
time from administration to effect depends
on the type of drug, route of administra-
tion and the patient’s ability to metabolise
the drug; therefore, it must be administered
and given enough time to take effect before
commencing the procedure. Relevant moni-
toring must be used with some analgesics
(e.g. nitrous oxide or opiates) per local
guidelines (APAGBI, 2012).
Anxiety can increase the perception and
intensity of pain. As such, nonpharmalogical
methods of pain management should also be
employed (Box 2, p6). The bedside is consid-
ered a ‘safe space’ for the child, so dressing
change should be carried out in a treatment
room (if possible), to allow psychological
separation from the safe space. By the same
token, mealtimes should not be interrupted.
Parents/guardians should be present dur-
ing dressing change, and cradle the child if
possible, to reduce pain levels by alleviating
anxiety (Reaney and Trower, 2010). Other in-
terventions include distraction, play therapy,
hypnosis, breast-feeding (neonate/infant)
and use of familiar comforter/toy.
Epidermal blistering and stripping
Epidermal skin is loosely bound to the
dermis in infants, making them susceptible
to blisters and epidermal tears. When there
is increased friction and/or tension at the
interface between the skin and the wound
dressing (e.g. due to use of adhesives), shear
forces loosen the connections between the
epidermis and dermis, leading to separation
of the skin layers and resulting in skin blister-
ing (where fluid seeps between the layers) or
stripping (where the epidermis is removed)
(Johansson et al, 2012) (Figure 1, p6).
The presence of wound exudate, even at
normal healing levels, can exacerbate the
risk of skin blistering and stripping as mois-
ture increases friction forces and softens
the skin which, in turn, weakens the outer
layers (Johansson et al, 2012). Paediatric
patients in general have immature and more
fragile skin than adults, which also puts
them at risk (Box 3, p7).
Epidermal blistering and stripping in pa-
tients with wounds tends to occur second-
ary to the use of adhesive dressings and
adhesive tape used to secure tubes and
lines. Blistering and stripping are the pri-
mary causes of skin breakdown in neonatal
intensive care units (Lund et al, 2001).
Epidermal stripping can be avoided by car-
rying out good skin hygiene, using silicone
tapes and non-adhesive dressings where
possible, and properly and gently applying
adhesive tapes and dressings and remov-
Box 1: Aims of wound care
(Rodgers, 2010; Bale and
Jones, 2006)
The main objectives when
caring for a wound are
to restore the function of
injured tissue and do no
harm. Treatment should:
■■ Minimise pain and
trauma
■■ Minimise scarring
■■ Lessen emotional
distress, and promote
dignity, comfort and
wellbeing
■■ Create the optimum en-
vironment for the healing
process to take place
■■ Promote a moist wound
healing environment
■■ Prevent temperature
fluctuations
■■ Remove devitalised tissue
and excess exudate
■■ Prevent/treat infection
■■ Restore skin barrier
function
■■ Ensure cost-effectiveness
Key points:
1. Prevent and manage pain
and anxiety in paediatric
patients
2. Prevent epidermal
blistering and stripping
3. Cleanse only after
thoroughly assessing the
patient and wound
4. Adapt dressing selection
to the special needs of
paediatric patients with
wounds
8. WOUNDs UK BEST PRACTICE STATEMENT 20146
CHILD-CENTRED
WOUND
MANAGEMENT
ing them with a sterile silicone adhesive
remover when they are used (Butler, 2006)
(Box 4, p9).
Wound cleansing and debridement
Wound cleansing is the process of using
fluid/gel to remove loose wound debris and
remnants of dressings (NATVNS, 2012). Al-
though not all wounds need to be cleansed,
it is important because it can help manage
the microbial load, allow better visualisa-
tion of wound tissue and help prepare the
wound bed for further management and
application of dressings.
The decision to proceed with wound
cleansing — and which solution to use —
should be based on a holistic assessment
of both the patient and the wound (Figure
2, p7). Keep in mind that some dressings
have wound-cleansing properties or may
be contraindicated with certain cleansing
solutions; check manufacturer instructions
before initiating cleansing.
When cleansing a wound, adhere to the
principles of standard infection control
precautions. To avoid damage to the wound
bed and periwound skin, do not undertake
Table 1: Commonly used analgesics*
Simple oral analgesics (e.g. paracetamol and
ibuprofen)
Very effective for procedural pain, especially
when given together. The analgesic dose of pa-
racetamol is higher than the anti-pyretic one.
(Ibuprofen not suitable for patients <6 months
or for whom NSAIDs are contraindicated)
Opiates Very effective, quick-acting analgesics for
more severe pain, with morphine being the
most widely used in children. Can be admin-
istered orally, transmucosally, nasally and
intravenously. Intravenous morphine doses
can be titrated during long procedures to al-
low for continual effect
Nitrous oxide Provides rapid-onset and -recovery analgesic
effects for procedural pain. Tends to be used
(per local guidelines) in patients older than
5–6 years with ‘normal’ cognitive and physical
function due to need for self-administration.
Repeated dosage can lead to bone marrow
toxicity; appropriately monitor patients
Sucrose Provides an effective analgesic effect in ne-
onates. Can be administered directly into the
mouth or by applying solution to a dummy.
Very small amounts are recommended. Can be
repeated during long procedures
General anaesthetic May be required for some patients undergo-
ing extremely painful or complex procedures
(e.g. perianal wound management, wound
debridement, burn and scald assessment and
management)
*BasedonAPAGBI,2012;Kanagasundaram,2001;ReaneyandTrower,2010;Rogersetal,2006;Taddioetal,2008)
Box 2: Supplementary
approaches to pain
management
■■ Allow appropriate time
and preparation, pre-
arranging time for care
with parents/guardians
when possible
■■ Address anxiety as well
as pain, and ensure
adequate pain relief is
given in addition to any
routine analgesia
■■ Allow the child an age-
and status-appropriate
degree of control and
participation
■■ Employ play therapy
involvement/distraction
■■ Use of a familiar
comforter/toy
■■ Hypnosis
■■ Breast-feeding (neonate/
infant)
■■ Involve the parent/
guardian in care
■■ Remember that care in
taking the dressing off is
as important as in putting
it on
■■ Safeguard the patient
to make sure they are
safe and secure during
wound assessment and
treatment
■■ Keep the patient warm
■■ Use a calm, quiet
environment
Figure 1: Epidermal stripping
9. 7PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS
cleansing using a high-pressure method
(e.g. irrigation, showering). For patient
comfort and to aid wound healing, cleans-
ing solutions should be at body temperature
(NATVNS, 2012).
Wound cleansing may be contraindicated
in neonates and unstable paediatric patients
because of the risk of core-temperature fluc-
tuation. Cleansing should also be avoided in
wounds with a high risk of bleeding (e.g. ulcer-
ated haemangioma); in these cases, a polyhexa-
methylene biguanide gel can be applied directly
to the dressing, to aid cleansing in these fragile
wounds, but may not be required for dressings
containing wound-cleansing properties.
For babies, toddlers or children with re-
stricted mobility, bathing may be required
to facilitate dressing removal and wound
cleansing, and to minimise pain and trauma.
In these cases, saline should be used. If plain
tap water is to be used, the tap should be
allowed to run for 5 minutes (to discharge
the microbial load in the plumbing system)
before filling the bathtub. Be sure to be espe-
cially conscious of privacy and dignity issues
in older children and adolescents when pro-
ceeding with bathing (Baharestani, 2007).
Debridement may be safely carried out
in a wide range of paediatric wounds to
help prepare the wound bed, promote
CHILD-CENTRED
WOUND
MANAGEMENT
Box 3: Causes of/risk
factors for skin blistering
and stripping (Ousey et al,
2011; Koval et al, 2007)
■■ Movement at the wound
site
■■ Choice of dressing
■■ Adhesive tape/dressing
use
■■ Poor adhesive-removal
technique
■■ Size of wound (larger
wounds)
■■ Anatomical location (e.g.
near a bony prominence)
■■ Medications (e.g.
corticosteroids)
■■ Comorbidities (e.g.
eczema)
■■ Excessive oedema
Consider the age of the patient and whether the
clinical condition permits bathing/showering.
Can the patient bathe or shower?
Has debris or exudate adhered to the peri-
wound area?
Does the wound dressing have cleansing
properties (e.g. surfactant, honey)?
Consider these three issues before proceeding:
❑ Is the wound heavily colonised or infected?
❑ Is there residual dressing or debris present?
❑ Is the patient immunocompromised, or is the
wound at high risk of contamination due to
location on the body?
If dressing change is scheduled, remove the
dressing with sterile silicone adhesive remover
before bathing in potable tap water. If no ad-
hesives were used, remove the dressing in the
bath or shower
No need to cleanse
No need to cleanse; reapply dressing
Is the wound healthy, clean, granulating and
epithelialising?
Cleanse the periwound area with potable tap
water
Consider using a cleansing solution that
reflects the wound/patient requirements*
(e.g. containing polyhexamethylene
biguanide [PHMB], octenidine)
If the wound has a high risk of bleeding and/or
the child is experiencing severe pain, a
PHMB-containing gel can be applied to the
dressing before application
NO
YES
*Not for regular use in neonates. Sterile saline is recommended
Figure 2: Paediatric wound cleansing flowchart
NO
NO
NO
NO
YES
YES
YES
YES
10. WOUNDs UK BEST PRACTICE STATEMENT 20148
CHILD-CENTRED
WOUND
MANAGEMENT
Table 2: Wound products commonly used in paediatric patients
Type Actions Indications/use Precautions/contraindications
Alginates/CMC Absorb fluid
Promote autolytic
debridement
Moisture control
Conformability to wound
bed
Moderately to highly exuding wounds
Special cavity presentations in the form of
rope or ribbon
Combined presentation with silver for
antimicrobial activity
Do not use on dry/necrotic wounds
Use with caution on friable tissue
(may cause bleeding)
Do not pack cavity wounds tightly
Foams Absorb fluid
Moisture control
Conformability to wound
bed
Moderately to highly exuding wounds
Special cavity presentations in the form of
strips or ribbon
Low adherent versions available for patients
with fragile skin
Combined presentation with silver or
PHMB for antimicrobial activity
Do not use on dry/necrotic wounds or
those with minimal exudate
Honey Rehydrate wound bed
Promote autolytic
debridement
Antimicrobial action
Sloughy, low to moderately exuding wounds
Critically colonised wounds or clinical signs
of infection
May cause 'drawing' pain (osmotic
effect)
Known sensitivity
Hydrocolloids Absorb fluid
Promote autolytic
debridement
Clean, granulating/epithelialising, low- to
moderate-exuding wounds
Thicker versions can be used to debride
sloughy/necrotic wounds
Do not use on highly exuding wounds
May encourage overgranulation
May cause maceration
Hydrogels Rehydrate wound bed
Moisture control
Promoteautolyticdebridement
Cooling
Dry/low to moderately exuding wounds Do not use on highly exuding wounds
or where anaerobic infection is suspected
May cause maceration
Iodine Antimicrobial action Critically colonised wounds or clinical signs
of infection
Low to moderately exuding wounds
Use under specialist supervision only
Do not use on dry necrotic tissue
Known sensitivity to iodine
Do not use on children <6 months
Low-adherent
wound contact
layer (e.g. lipido-
colloid, silicone)
Protectnewtissuegrowth
Atraumatictoperiwoundskin
Conformabletobodycontours
Low to highly exuding wounds
Can be used as a carrier for topical
preparations (e.g. honey)
May dry out if left in place for too long
Known sensitivity to silicone
Non-alcohol-
based barrier
film
Prevent epidermal stripping of
periwound skin secondary to
adhesive removal
Protect against skin erosion
from wound exudate or other
moisture
Skin at risk of epidermal stripping
Wounds with high levels of exudate or ex-
posure to other moisture (e.g. moisture- or
napkin-associated dermatitis)
Sensitive periwound skin
Known sensitivity to silicone (if a
silicone-based product)
Activated
charcoal
Odour absorption Malodorous wounds
Combine presentation with silver for
antimicrobial activity
Do not use on dry wounds
Polyhexa-
methylene
biguanide
(PHMB)
Antimicrobial action Low to highly exuding wounds (depending
on dressing presentation)
Critically colonised wounds or clinical signs
of infection
May require secondary dressing
Known sensitivity to PHMB
Silver Antimicrobial action Critically colonised wounds or clinical signs
of infection
Low to highly exuding wounds (depending
on dressing presentation)
Use under specialist supervision only
Some may cause discolouration
Known sensitivity to silver
Prolonged use (e.g. longer than 2–4
weeks)
Polyurethane
film
Moisture control
Breathable bacterial barrier
Transparent (allow wound
visualisation)
Primary dressing over superficial low exud-
ing wounds
Secondary dressing over honey or hydrogel
for rehydration of wound bed
Do not use on patients with fragile/
compromised periwound skin
Do not use on moderately to highly
exuding wounds
11. 9PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS
structural restoration and regeneration of
damaged tissue, remove necrotic tissue,
and reduce the bacterial load and factors
that result in a wound’s becoming stuck
in the inflammatory stage of healing
(Patel and Tomic-Canic, 2014). Autolytic
debridement is the method typically used in
paediatric patients, along with conservative
sharp, surgical and biosurgical (larval)
debridement (Durante, 2014).
When choosing a method of debridement ,
clinicians should consider the patient’s age,
size of the wound, type of wound, location
of the wound, selectivity of the method,
the pain management that will be required
and the length of the procedure, as well
as the clinician’s level of competence with
debridement methods (Patel and Tomic-
Canic, 2014; Durante, 2014).
For example, surgical debridement is suited
to patients with larger wounds (e.g. burns)
who are not contraindicated for general
anaesthesia (McCord, 2006). Autolytic
debridement is a good choice for small
wounds where the patient is not immuno-
compromised or does not have other risk
factors for developing a chronic wound
(McCord, 2006; Quigley and Curley, 1996).
First-hand experience has found that auto-
lytic debridement is ideal for paediatric and
neonatal wounds as, quite often, the area of
demarcation between viable and non-viable
tissue exceeds expectation.
Dressing selection
Historically, dressing products are devel-
oped and indications determined based on
adult research studies (McCord and Levy,
2006). As a result, the practitioner usually
must adapt the products available for use
in children to reduce risk of surrounding
skin damage by avoiding covering more
body surface than necessary. In addition,
clinicians need to ensure that the dressing
products selected have been shown to be
safe and effective for the intended indica-
tion and population (Baharestani, 2007)
(Table 2, p8).
The dressing chosen should optimise the
environment for moist wound healing to
take place; prevent infection; minimise
pain and trauma; prevent cooling; and be
cost-effective (Box 5). Dressing selection
in paediatric patients should be based on
the wound-healing phase, wound location,
amount of exudate, tissue type, age of the
child and signs of wound colonisation (Mc-
Cord and Levy, 2006).
All open wounds are contaminated with
microbes; however, the presence of non-
multiplying microorganisms is not of clini-
cal concern. If a wound shows signs of local
infection, manage as per local protocol. If
the wound becomes infected, consult with a
specialist member of the multidisciplinary
team in line with local guidelines.
In general, prophylactic use of antimicrobi-
als is strongly discouraged (Wounds UK
Best Practice Statement, 2013). Refer to
local guidelines regarding the management
of burns and scalds, as antimicrobials may
be recommended to prevent complications
such as Toxic Shock Syndrome.
CHILD-CENTRED
WOUND
MANAGEMENT
Box 4: Interventions to
prevent epidermal
blistering and stripping
■■ Alcohol-free liquid skin
barrier film on the skin
under adhesive dressings
in neonates >30 days old
■■ Clear film dressings to
secure intravenous sites
■■ Pad splints and padded
hook-and-loop-closure
straps over splints rather
than tape
■■ Soft silicone or lipidocol-
loid dressings to treat
areas of denudation
secured with tubular
latex-free stretchy gauze
netting
■■ Adhesive dressing/tape
removal with a sterile sili-
cone adhesive remover,
which renders removal
of an adhesive dressing
atraumatic
Box 5: Special considerations in paediatric dressing selection
Size
■■ Many dressings come in suitable sizes for adults
■■ Many can be cut to size; ensure that cutting the dressing does not reduce effectiveness of
the product or deposit debris in the wound
Irritants
■■ Paediatric skin may be more sensitive to product ingredients
■■ Care should be taken to identify irritants (e.g. fragrance, alcohol, iodine and lanolin)
■■ Alcohol-based adhesive removers, chlorhexidine and povidone-iodine may cause chemical
burns and should be avoided, particularly in patients younger than 6 months
■■ Use alcohol-free adhesive removers and barrier films
12. WOUNDs UK BEST PRACTICE STATEMENT 201410
NAPKIN-
ASSOCIATED
DERMATITIS
Napkin-associated dermatitis (NAD), or
nappy rash, generally describes inflamma-
tory changes to the skin due to exposure
to moisture or colonisation with Candida
albicans, often under a nappy or incontinence
pad (NICE, 2013). NAD is one of the most
common skin complaints in infants (Longhi et
al 1992). This type of skin breakdown can oc-
cur in patients who are continent or who are
not wearing a napkin/absorbent pad; there-
fore, older children can be at risk and should
be treated in an age-appropriate manner
(Baharestani, 2007). If NAD is not managed
appropriately, it can lead to pain and anxiety
for the patient and parents/guardians. Clini-
cians must know how to prevent and man-
age skin breakdown in this area, according to
the severity of the damage (Figure 1).
Section 3: NAPKIN-ASSOCIATED DERMATITIS
PREVENTION AND MANAGEMENT
Erythema of skin, no
broken areas
Erythema with small
areas of broken skin
Erythema with large
broken areas or areas of
ulceration (not pressure
ulcers)
Bright red rash with
satellite lesions/pustules
at margins that may
extend into groins and
skin folds; may occur
along with NAD
Passing frequent
stools
■■ Cleanse with water
and soft cotton wipe
■■ Pat skin dry
■■ Use a gel-core
nappy; change
frequently or as
soon as possible
after soiling
n Cleanse by irrigating with warm water +/- an emollient and a 20ml syringe
n Pat dry intact skin
■■ Apply a no-sting
barrier film daily
■■ Apply thinly a bar-
rier preparation
per local formu-
lary
■■ Use a gel-core
nappy; change
frequently or as
soon as possible
after soiling
■■ Apply a no-sting barrier film daily
■■ Apply a barrier preparation per local
formulary/manufacturer’s instructions
■■ Use a gel-core nappy; change frequently
or as soon as possible after soiling
■■ If skin does not improve after 72 hours or
rapidly deteriorates, contact a specialist
member of the multidisciplinary team
(e.g. tissue viability nurse, dermatology,
stoma specialist nurse)
■■ Do not apply a barrier
film
■■ Apply clotrimazole 1%
3x daily to clean skin
■■ Apply barrier prepara-
tion over clotrimazole
according to mild/
moderate/severe guid-
ance as appropriate
■■ Consider oral
antifungal treatment
■■ Continue clotrimazole
1% for 3 weeks, even
if symptoms have
resolved
■■ If skin condition does
not improve, reassess
for underlying health
problems with an ap-
propriate member of
the multidisciplinary
team
Special considerations
■■ If mild NAD deteriorates, use the moderate/severe regimen
■■ If the patient has undergone/is preparing for transplant, commence moderate/severe regimen for prevention
■■ If the patient has undergone reversal of ileostomy/colostomy, commence moderate/severe regimen
■■ If the patient has an underlying skin condition, refer to dermatology for advice on immune status and
prevention of Candida sepsis
No NAD Mild NAD Moderate NAD Severe NAD Candidiasis
YES
NO
Figure 1: Guidelines for prevention and care of napkin-associated dermatits (NAD)
Key point:
1. Clinicians must know
how to prevent napkin-
associated dermatitis
(informally known as
nappy rash) and how to
best manage it if skin does
break down, depending
on the severity of the
damage
13. 11PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS
NAPKIN-
ASSOCIATED
DERMATITIS
Causes and risk factors
The interaction of urine and faeces under a
nappy increases ammonia production, which
raises skin pH in the area. The higher skin
pH reduces skin’s barrier function, leaving it
more susceptible to damage from the proteo-
lytic and lipolytic enzymes present in faeces.
Repeated or prolonged exposure to these
irritants, combined with increased hydration,
maceration and friction to the skin under the
nappy will likely result in NAD (Stamatas et
al, 2011; Rowe et al, 2008; Buckingham and
Berg 1986). The occurrence and severity can
be influenced by age of the child, volume,
consistency and frequency of stooling, diet,
medication, underlying disease, existing skin
conditions and poor hygiene (Dorko et al,
2003; Longhi et al 1992) (Box 1).
Caring for NAD
Parents and carers must be educated on how
to clean the skin and apply barrier prepara-
tions (Wondergem, 2010; Gupta and Skin-
ner, 2004). They should be discouraged from
bringing in and applying their own prepa-
rations if NAD is present. However, if the
preparation is not causing damage or prevent-
ing skin from healing, the regimen may be
continued. Document the preparation being
used to ensure there are no contraindications
with other aspects of the care plan, which
should follow good practice.
Barrier preparations
Barrier preparations are used to prevent
faeces coming into contact with the skin,
reduce humidity and maceration, and
minimise transepidermal water loss (Ratliff
and Dixon, 2007; Wolf et al, 2000). A no-
sting occlusive barrier spray, film, cream
or ointment should be applied according
to manufacturer instructions in line with
the local formulary. For patients at higher
risk or those with moderate to severe NAD,
a paste containing a water-impermeable
substance should be used, to better protect
the underlying skin from moisture (Heimall
et al, 2012; Neild and Kamat, 2007). Barrier
preparations should not contain perfumes
and have a low paraben content.
Nappies and incontinence pads
Although a Cochrane review concluded
there was insufficient evidence to support
or refute the use of disposable nappies for
preventing NAD, many researchers agree
that their superabsorbent properties, in
combination with frequent nappy changes,
are helpful for preventing and managing
NAD (Baer et al, 2006; Nield and Kamat,
2007; Heimall et al, 2012; Atherton, 2005;
Gupta and Skinner, 2004).
Disposable nappies contain cellulose pulp
and superabsorbent polymers that lock
moisture away from the skin, keeping skin
dry and clean and maintaining optimal pH.
The fasteners, back sheets and stretch abil-
ity help reduce leakage. Disposable nappies
also are non-toxic and biologically inert,
and do not contain allergens (e.g. natural
rubber latex, disperse dyes) (Oakley, 2014).
In addition, they are available in different
shapes and sizes, depending on age and
gender of the child.
In a hospital setting, reusable nappies are
not recommended (Oakley, 2014; Baer et
al, 2006; Nield and Kamat, 2007; Heimall
et al, 2012; Atherton 2005; Gupta and
Skinner, 2004). It is also suggested they can
contribute to NAD, in particular, papulo-
nodular NAD (Maruani et al, 2013).
Special considerations
Commence a moderate to severe regimen
if the patient is:
■ Passing frequent loose/watery stools
■ Receiving chemotherapy
■ Has undergone/is preparing for trans-
plant of any kind
■ Is immunosuppressed
■ Has undergone reversal of ileostomy/
colostomy.
Whenever possible, manage the cause of
loose stools (e.g. alter diet, refer to dieti-
cian for assessment if required, limit/
change antibiotics). If the patient has
an underlying skin condition, refer to
dermatology.
Box 2: Practical tips for
managing NAD
Good practice:
■■ Whenever possible bathe
or shower the child once
or twice daily, especially
in moderate to severe
cases (Atherton, 2001)
■■ Use of emollients to
cleanse and further
protect the skin (Blume-
Peytavi et al, 2009)
■■ Encourage consistency
in care between staff and
parents/carers
■■ Always change a nappy
as soon after soiling as
possible
■■ Use disposable gel-core
nappies
■■ At home, reusable
nappies can be used but
are not advised in cases
of moderate to severe/
recurrent NAD
Things to avoid:
■■ Baby wipes of any kind
for neonates (Ratliff and
Dixon, 2007)
■■ Strongly perfumed soaps,
moisturisers and wipes
(Sarkar et al, 2010)
■■ Re-usable nappies
■■ Stopping/changing a
regimen before 48 hours
unless skin condition is
deteriorating
Box 1: Some risk factors
for development of NAD
■■ Antibiotic therapy
■■ Chemotherapy
■■ Immunosuppression
■■ Diarrhoea (persistent)
■■ Reversal of stoma
■■ Short gut syndrome
■■ Underlying skin condi-
tions (e.g. psoriasis,
eczema, epidermolysis
bullosa)
■■ Zinc deficiency
14. WOUNDs UK BEST PRACTICE STATEMENT 201412
APPENDIX 1: BPS APPLICATION TO
PRACTICE: PRINCIPLES FOR THE CARE AND
TREATMENT OF PAEDIATRIC WOUNDS
APPENDIX
Best practice statement Reason for best practice statement How to demonstrate best practice
The approach to wound management in
children must differ from that in adults
The causes of wounds in children may
differ from those in adults, and there are
important differences in the physiology
and skin of children
Create a guide for wound management in
paediatric patients that accounts for the
physiologic and aetiologic differences
Record baseline data as part of a holistic
assessment of both the patient and wound,
and reassess and monitor treatment on a
regular, ongoing basis
To create a historical record that will guide
treatment decisions and provide clinical
rationale for changes in the plan of care.
To ensure the patient is concordant with
treatment and the wound is responding to
treatment
Clearly document the assessment and
reassessment processes, including factors
that could delay healing, tissue and wound
characteristics, whether the wound is
progressing towards healing and whether a
change in treatment is required
Consult a specialist member of the multi-
disciplinary team in line with local guide-
lines the event of suspected/confirmed
infection or if the wound fails to heal
To confirm infection status and to prevent
inappropriate product or medication use,
and to determine why the wound has failed
to progress towards healing
Clearly document the rationale, date and
team member to whom the patient was
referred
All reasonable steps should be taken to
prevent and manage pain and anxiety in
paediatric patients
Pain is whatever the child says it is, and
needs to be taken seriously. Anxiety can
increase the perception of pain, which can
have negative psychological effects on the
child and the child’s reaction to treatment
Assess pain using an age-appropriate scale.
Select analgesia and dosage in consultation
with a suitably qualified healthcare profes-
sional. Employ non-pharmacologic pain/
anxiety management
Prevent epidermal blistering/stripping by
carrying out good skin hygiene (including
alcohol-free liquid skin barrier under ad-
hesive dressings), using silicone tapes and
non-adhesive dressings where possible,
and removing adhesive tapes and dressings
using a sterile silicone adhesive remover
Paediatric patients have immature and
more fragile skin than adults, which puts
them at risk. Epidermal stripping and
blistering are a preventable complication
that can cause pain and anxiety related to
wound management
Enact a plan for skin hygiene, and dress-
ing and tape application and removal that
incorporates best practices
Cleanse only after thorough assessment of
patient and wound
To ensure wound cleansing is carried out
only when appropriate, using the appropri-
ate method
Clearly document the assessment and
cleansing process using a clinical decision-
making pathway such as that in Section 2,
Figure 1 (p7)
Adapt dressing selection and use to the
needs of paediatric patients with wounds.
Dressings may have to be adapted to
reduce risk of surrounding skin damage by
avoiding covering more body surface than
necessary
Some dressing types are contraindicated
or should be used with precaution in chil-
dren, infants and neonates. Dressings may
not be available in sizes small enough for
paediatric patient
Enact a guide for dressing selection that
incorporates the special physiological
needs of paediatric patients while address-
ing factors associated with the wound type
and clinical indications, such as in Section
2, Table 2 (p8)
Clinicians must know how to prevent
napkin-associated dermatitis and how to
best manage it if skin does break down,
depending on the severity of the damage
Napkin skin care in paediatric patients
can pose many challenges for healthcare
providers and parents/guardians and, if
not managed appropriately, can increase
infection risk and lead to pain and anxiety
for the patient and parents/guardians
Enact a protocol that incorporates assess-
ment of skin status, prevention efforts and
treatment with appropriate barrier prepa-
rations using a clinical decision-making
pathway such as that in Section 3, Figure
1 (p10)
Ensure the special needs of paediatric
patients and their parents/guardians are
accommodated
Paediatric patients have special psycho-
social needs, and their parents/guardians
may react differently to the child’s care
than they would their own
Consider the whole child, not simply the
wound being treated, as well as the experi-
ence of the child and family when integrat-
ing and coordinating services
15. 13PRINCIPLES OF WOUND MANAGEMENT IN PAEDIATRIC PATIENTS
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