Skin Conditions/Skin Care

By the WoundSource Editors

Pressure injuries are a significant risk for patients and pose a tremendous clinical challenge to medical providers. Serious pressure injuries can present a substantial threat to patients' survival when comorbidities are present, and even less serious pressure injuries can negatively affect a patient's comfort and well-being. Although some pressure injuries are unavoidable, best practices in patient skin care can greatly reduce the risk in many circumstances, with some research demonstrating that up to 95% of pressure injuries are preventable.

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

Worldwide Pressure Ulcer/Injury Prevention & Awareness Day is November 21st. This day is considered pretty much a holiday at my home. I have Stop Pressure Ulcer tee shirts, and I order a cake or STOP sign cookies every year from the bakery in memory of my mother. To some it might sound crazy, but my life was strongly impacted forever in 1996 after my mother passed away in my arms at only 47 years old because of complications of diabetes and what was called at that time "multiple decubitus." The image and smell will never leave my mind. It changed my life forever as a daughter, a caregiver, and later as a wound nurse. I needed more answers to heal my heart. How could my mother acquire such horrible wounds while at the hospital to get better? My mind was twirling nonstop with the 5Ws. Who, what, when, where, why? So, then it began. I wanted to learn everything I could. This ended up being sort of my therapy, which transitioned into my passion and purpose.

By Heidi Cross, MSN, RN, FNP-BC, CWON

Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

By the WoundSource Editors

The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. When utilized on a regular basis, standardized assessment tools, along with consistent documentation, increase accuracy of pressure injury risk assessment, subsequently improving patient outcomes. Conversely, inconsistent and non-standardized assessment and poor documentation can contribute to negative patient outcomes, denial of reimbursement, and possibly wound-related litigation.

By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

As a Director of Nursing, your assessment skills must be tiptop. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? Have you given the staff the tools and time required to accomplish comprehensive and compassionate assessments?

By Margaret Heale, RN, MSc, CWOCN

Not very long ago, when working in an in-patient rehab center, I was shocked to discover patients calling the adult incontinence garments "hospital underwear." We were making good inroads into reducing the use of these products with the hope that if we used less it would be possible to acquire higher-quality products that would function optimally for patients who really needed them. It was of concern that some facilities had become diaper-free because many of our patients benefited from briefs, particularly as a "just in case security blanket" and we felt it was unrealistic for our patient population to be brief-free.

By Holly M. Hovan, MSN, RN-BC, APRN, CWOCN-AP

As someone who holds tricertification, I often feel as though my ostomy patients are the ones in whose lives I am making the biggest difference. Watching them progress, gain confidence in independent ostomy management, and enjoy their lives once again is one of the best feelings to me!

Holly M. Hovan MSN, RN-BC, APRN-CNS, CWOCN-AP

Not many people wake up one day and say, "Wow, I really want to be a continence nurse!" In fact, sometimes people don't even really understand what a continence nurse is, their role, or the specialty in general. I often tell nurses that although we may not all hold certification, every nurse should be a continence nurse, especially in the long-term care setting.

By Margaret Heale, RN, MSc, CWOCN

In the United Kingdom, we are well into spring. As I look at the garden, there are patterns of growth literally cut into rock. Old stones with beautiful mosses, and next to a stone step, one type of rock plant has thrown up five stems and atop each is a bright red flower. The path has some wild strawberries growing up through it, and there are two bunches of well-established chives. It is a small plot on the outskirts of Newcastle, and as you walk down the road there are other gardens with similar flowers and weeds.

Ivy Razmus, RN, PhD, CWOCN

Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.