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Catherine Milne's picture
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Catherine T. Milne, MSN, APRN, ANP/ACNS-BC, CWOCN-AP; Editor, WoundSource

The Boston Marathon, a grueling 26.2-mile trek from Hopkinton, Massachusetts, to downtown Boston, features the notorious Heartbreak Hill at mile 20 – a half-mile climb up a steep 3.3% grade that follows on the heels of three smaller, successive inclines. Once you scale it, you still have another 6.2 miles to go. It’s broken more than a few runners over the years.

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WoundSource Practice Accelerator's picture

Wounds typically heal in four sequential but overlapping phases — hemostasis, inflammatory, proliferative and remodeling — ultimately leading to tissue regeneration. Healing sometimes stalls for various reasons, a key one being extensive inflammation, which disrupts the normal cascade of healing and leads to chronic and hard-to-heal wounds. A vicious cycle of ongoing inflammation, pain and poor quality of life often follows. Understanding how to break this cycle is essential for wound care clinicians who want to optimize healing outcomes and patient quality of life.

WoundSource Practice Accelerator's picture

Wound healing can stall for a number of reasons. Wounds that have not healed or significantly reduced in size after four to six weeks are considered chronic. They are characterized by a multitude of impeding factors including biofilm, excess matrix metalloproteinases (MMPs) and extracellular matrix degradation, inflammation, fibrosis, unresponsive keratinocytes and fibroblasts, and atypical growth factor signaling.

Charles Buscemi's picture

By Charles P. Buscemi, PhD, APRN, CWCN and Arturo Gonzalez, DNP, APRN, ANP-BC, CWCN-AP

Urinary catheters serve several purposes, including monitoring urine output, relieving urinary retention, and facilitating diagnosis of disease in the lower urinary tract. These catheters can be inserted easily and are universally available, which usually results in their continued and indiscriminate usage. Urinary catheters can be indwelling or external-condom types. The indwelling catheter can be either a suprapubic or a urethral catheter. The external catheter provides a safe alternative to an indwelling catheter for patients having urinary incontinence (UI). It comprises a sheath surrounding the penis with a tube situated at the tip linked to a collection bag. Conversely, the condom catheter seems an attractive option for patients with UI. About 40% of condom catheter users have urinary tract infections. Moreover, 15% of condom catheter users have necrosis, ulceration, inflammation, and constriction of the penile skin. There is also an additional risk of urine leakage and condom detachment. Furthermore, the use of the external catheter requires significant nursing time. Overall, the condom catheter cannot be satisfactorily used for managing UI; nevertheless, it is useful for the non-invasive measurement of bladder pressure.

WoundSource Practice Accelerator's picture

Biofilm: Colonies of multiphenotype, free-floating bacteria that secrete a polysaccharide matrix that protects the bacteria from immune response and antibiotics.

Chronic wounds: Wounds that stall in the inflammation phase and fail to progress toward healing within 3 months are considered chronic or hard to heal.

Continuous inflammation: When wound healing becomes stalled in the inflammatory phase because of the presence of bacteria and their endotoxins, the wound is unable to move out of the inflammatory phase and into the repair phase.

WoundSource Practice Accelerator's picture

As scientists and researchers have delved deeper into the causes of wounds and wound chronicity, matrix metalloproteinases, or MMPs, have come into sharper focus. MMPs are not just present in chronic wounds — they also play an essential role in acute wounds.

WoundSource Practice Accelerator's picture

An injury to the human body initiates a wound healing chain reaction that occurs in four sequential but overlapping phases: hemostasis, inflammatory, proliferative and maturation. This post focuses on the second (inflammatory) phase, which begins after blood flow stops (i.e., hemostasis) and defender white blood cells, or leukocytes, migrate to the site of the injury — a process known as chemotaxis.

Ryan Cummings's picture

By Ryan Cummings, FNP, CWS

Appropriately balanced nutrition is a cornerstone of high-quality wound care, and this isn’t a new revelation. Nearly all modern wound centers include some version of nutritional screening, along with ever-expanding recommendations regarding overall protein intake, complex carbohydrate needs, and micronutrient supplementation as clinical evidence for these is presented.

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Holly Hovan's picture

Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Refractory wounds are a significant worldwide health problem, affecting 5 to 7 million people per year in the United States alone, as discussed in previous blogs. Wounds that fail to heal not only impact quality of life, but also impose a significant physical, psychosocial, and financial burden. Additionally, individuals with refractory wounds often experience significant morbidity, and sometimes mortality. Wound infections and amputations are common in this population, and chronic conditions often exist as well.

The Alliance of Wound Care Stakeholders's picture

By Catherine D’Andrea, RDN, LDN, and Marcia Nusgart, RPh

Malnutrition is a leading cause of morbidity and mortality, especially among older hospitalized adults, yet it often goes undiagnosed and therefore untreated. It has been established that malnourished hospitalized patients experience slower wound healing, higher risks of infection, and longer length of stay. Malnutrition is a burdensome condition associated with a 34% higher cost for a hospital stay compared with a non-malnourished patient. Sufficient macronutrients (carbohydrates, protein, fats, and water) and micronutrients (vitamins and minerals) are vital for the body to support tissue integrity and prevent breakdown. Research supports that weight loss and difficulties with eating can increase the incidence of pressure injuries.

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