Holly Hovan's blog

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Causes of Incontinence

by Holly M. Hovan MSN, APRN, ACNS-BC, CWOCN-AP

With World Continence Week upon us, it is an appropriate time to discuss some types and causes along with treatment of urinary incontinence. The most common types of incontinence that we learn about are stress, urge, mixed (stress and urge), transient, neurogenic, and functional.

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Nurse Removing Adhesive Bandage to Prevent MARSI

by Holly M. Hovan MSN, APRN-ACNS-BC, CWOCN-AP

Medical adhesive-related skin injury, or MARSI, is a common type of skin injury, often seen in inpatient settings and in vulnerable populations with fragile skin such as older adults (decreased elasticity, usually multiple pre-existing comorbidities) or pediatric patients (skin is not fully developed). MARSI is caused by trauma to the skin from medical adhesives (think of things such as… tape used to secure a dressing after a blood draw, clear film dressings, ostomy pouches, external catheters in men, tube securement devices, surgical dressings, etc.). MARSI is not a pressure injury and is not caused by pressure.

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woundwound assessment - skin tear on arm assessment - skin tear on arm

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

After determining our goals of wound treatment (healing, maintaining, or comfort/palliative), we need to choose a treatment that meets the needs of the wound and the patient.

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The Importance of Palliative Care

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

As wound care clinicians, one of the first steps we take after meeting our patient and assessing their wound is identifying our treatment goals. Much like managing a complex medical problem, we need to identify if our goals of care are curative or palliative. This is important with all wounds, not just those present at end of life. There are many patients with vascular disease, diabetes, or other co-morbidities that may want to take a palliative approach versus aggressive debridement or amputation. You may have heard the term, “keeping it dry and stable.” This can work at times, but as with any wound, we need to keep an eye out for signs of an active infection and determine if/when we need to further intervene. Wounds can and do resolve with a palliative approach, but it is very important to understand, and explain to our patients, the difference.

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fistula management

By Holly Hovan MSN, APRN, CWOCN-AP

A fistula is an abnormal opening between two areas that typically shouldn't be connected, or with an epithelialized tract. An example is an opening from the bowel to the abdominal wall, termed enteroatmospheric or enterocutaneous (the terms are sometimes used interchangeably) because this fistula is exposed to the atmosphere, or is open from the abdomen to the skin, and typically needs to be pouched or some type of containment of the effluent.

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patient repositioning

By Holly Hovan MSN, APRN, CWOCN-AP

Friction and shear… what’s the difference and how do they cause pressure injuries? Are wounds caused by friction and shear classified as pressure injuries? What’s the easiest way to explain the differences between these critical components of the Braden Scale that are not always understood? How do I know if my patient is at risk?

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patient mobility and activity

By Holly Hovan MSN, APRN, CWOCN-AP

The Braden category of activity focuses on how much (or how little) the resident can move independently. A resident can score from 1 to 4 in this category, 1 being bedfast and 4 being no real limitations. It is important to keep in mind that residents who are chairfast or bedfast are almost always at risk for skin breakdown.

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enteral nutrition feeding

By Holly Hovan MSN, APRN, CWOCN-AP

A common misconception by nurses is sometimes predicting nutritional status based on a resident's weight. Weight is not always a good predictor of nutritional status. Nutritional status is determined by many factors and by looking at the big picture.

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Moisture on Skin

When nurses hear the term moisture, they usually almost always think of urinary or fecal incontinence, or both. There are actually several other reasons why a patient could be moist. Continued moisture breaks down the skin, especially when the pH of the aggravating agent is lower (urine, stomach contents—think fistula, stool). When there is too much moisture in contact with our skin for too long, we become vulnerable to this moisture, and our skin breaks down. Increased moisture places a patient at risk for a pressure injury as the skin is already in a fragile state.

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peroperative ostomy siting

By Holly Hovan MSN, APRN, CWOCN-AP

When marking a patient for a stoma, it is important to consider the practice based on evidence acquired by the WOC nurse during training and experience. Stoma siting procedures are based on evidence-based practices. As Mahoney (2015) discusses, a transparent film dressing, marker, and stoma location disks should be gathered prior to marking the patient.

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