Lindsay Andronaco's blog

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patient centered care

by Lindsay Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Medicine changes constantly, and we must stay up to date on the best options for our patients. However, being "better" doesn't always mean reading articles or attending national conferences. We can often become better wound care providers just by being present and taking a few minutes to actually listen to the patient, read the situation, and show compassion.

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surgical wound bandage and drainage

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Wound exudate and how to properly assess and manage it has been a long standing clinical challenge in wound care. Assessing the exudate color, odor, volume, viscosity, and if it is causing maceration of the periwound skin are all important to note when creating a care plan for the patient. If there is not proper management of the exudate, then the high protease levels and low growth factor levels will negatively impact wound healing time.

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Necrobiosis lipoidica

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

I had an interesting case come into the clinic and I wanted to share it with all of you. This is the first time in my clinical experience with a patient who has full-thickness ulcerations due to necrobiosis lipoidica. Necrobiosis lipoidica is a disorder of collagen degeneration with a granulomatous response, thickening of blood vessel walls, and fat deposition. The main complication of the disease is ulceration, usually occurring after trauma to a particular area. Although infections are rare, full-thickness ulcerations appear to be rarer from my literature search. This particular patient had full-thickness ulcerations with an active infection on presentation.

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depression

by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

I have been in wound care my entire nursing career. I have been in a variety of positions, but it always involved wound management. It wasn't until recently that I became more interested in pressure ulcers than I ever thought possible.

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Sudden hearing loss affects 5-20 individuals per 100,000, which equates to about 4,000 new cases each year in the U.S. Idiopathic Sudden Sensorineural Hearing Loss, or ISSHL, is spontaneous hearing loss in one or both ears with no apparent or known cause. This condition requires urgent medical attention.

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Many people do not realize that the two most common issues we see in hyperbaric oxygen (HBO) therapy patients are ear/barotraumas and a decrease in their blood glucose level. In general, HBO is very well tolerated and requires little other than a commitment to the treatment series.

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Patient safety is always of the utmost importance. Health care providers aim to improve the health of others. Having been in many settings during my career, I have been privileged to see the transition of how nursing has changed due to technological advances. Long gone are the days sitting in rural Vermont trying to decipher handwritten orders, counting drips on a dial control IV set and doing pediatric drug calculations while a parent hovers over you. Luckily, we have made strides to eliminate such frustrations, ways of frequent error, and time consuming tasks. Nursing has been forced to evolve as technology evolves.

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Is your facility taking hospital-acquired pressure ulcers, or HAPUs, seriously? This has become a hot button issue for CMS over the last five years. I must say that I hear constant complaints about staffing issues and that is why the patient ended up with a HAPU. I can see how this may be one piece of the puzzle, but overall there are many other factors to why one gets a HAPU. From my experience as a wound care specialist and consultant, I feel that the reasoning for HAPUs is multifaceted.

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Public policy is an aspect that affects every day practice for most wound, ostomy and continence nurses, but is something that we do not generally think about. One health policy topic that is in the forefront of my mind is how the Centers for Medicare and Medicaid Services (CMS) is looking to change the process for how patients access durable medical equipment, or DME products. This change in public policy would affect the access of these necessary products to our patients.

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by Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

The use of Hyperbaric Oxygen Therapy (HBOT), according to Medicare, is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure. HBOT is a CMS covered adjunctive therapy and should be used in conjunction with standard care, which include modalities like surgery, debridement, medications, topical wound care and offloading the wound. It is also important to have plans of care that include monitoring nutritional status and glucose control to help ensure a positive outcome for the patient.

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