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

Moisture-associated skin damage (MASD) is becoming increasingly prevalent in today’s health care system. Often associated with discomfort and pain, MASD ultimately negatively impacts quality of life. MASD is usually broken down into 3 or 4 categories, most commonly incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound dermatitis, and peristomal dermatitis. In this blog, I focus on the prevention and treatment of IAD and subsequent pressure injuries in critical care through a nurse-led approach.

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

Pressure injuries (PIs) typically are the result of unrelieved pressure, shear, or force. In an inpatient or hospital setting, interventions are put into place to prevent pressure injuries based on evidence and patient risk. However, PIs still develop in some patients despite interventions. Experts agree that most PIs are in fact avoidable; however, some patients may experience unavoidable skin breakdown at end of life (EoL).¹ Kennedy terminal ulcers (KTUs), skin changes at life’s end (SCALE), and Trombley-Brennan terminal tissue injuries (TB-TTIs) are some of the common terms used to describe unavoidable skin changes at EoL.¹

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

The literature suggests that patients with a high degree of adiposity are more at risk for inflammatory conditions, and the numbers of these patients continue to rise. Increased adipose tissue may impact activities of daily living, continence, and overall quality of life (QoL), among other complications. Abdominal (central) obesity may be associated with incontinence, mechanical and neurogenic changes (chronic strain or weakening of nerves in the pelvic area), and skinfold inflammation or irritation.

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

Standards of care and evidence-based guidelines should lead our wound care practice to ensure the best possible outcomes for our patients. There are often prewritten algorithms or first- and second-line therapies, along with outlined treatment plans and guidelines established based on evidence. These guidelines can be adjusted to meet each patient’s specific needs.

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

Pain has been a prevalent health care challenge in the United States for some time, with data from the Centers for Disease Control and Prevention showing that approximately 16% of men and 20% of women experience pain on most days or even every day.

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

Predominant pain pattern, ulcer location, ulcer appearance, type and amount of wound exudate, and vascular and sensorimotor assessment are some key factors used to determine the primary etiology of lower extremity ulcers.

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

Lower extremity wounds manifest in a multitude of ways, with numerous causative or trigger factors. These types of wounds are often costly to treat, are frequently refractory, and have a high risk for recurrence. A comprehensive assessment and an evidence-based treatment plan, along with ongoing patient education and routine follow-up, are essential components of an effective plan of care.

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

Intertriginous dermatitis (ITD), also referred to as intertrigo, is an inflammatory condition that affects opposing skin surfaces and can occur anywhere on the body where two surfaces are in contact. For example, the pannus or abdominal skin folds, inner gluteal cleft, and axillae are some common anatomical locations of ITD. Intertrigo is seen across care settings and is increasingly common in patients with diabetes, patients with obesity, and patients who need assistance with hygiene or self-care activities of daily living. ITD is thought to be caused by a combination of two factors: moisture trapping or overhydration of the skin and friction between opposing skin folds (skin rubbing against skin for a prolonged period of time). ITD may manifest as a linear tear at the base of a fold or a linear open area within an area of macerated skin. Tears may result from stretching of overhydrated or moist skin during routine skin assessments or from friction with cleansing.

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

Peripheral artery disease (PAD) is also known as lower extremity arterial disease (LEAD), peripheral arterial occlusive disease (PAOD), or arteriosclerosis obliterans. LEAD is a disease that impacts the circulatory system, specifically the arteries (narrowing, which can result in a decreased supply of blood flow to the limb), and can eventually lead to limb loss or amputations. It is important to bring awareness to LEAD and its diagnosis, treatment, and prevention to improve access to care and screenings and ultimately to prevent limb loss.

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

Refractory wounds comprise 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.

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