Holly Hovan's blog

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

Moisture-associated skin damage (MASD) is sometimes accompanied by serous exudate, a denuded appearance of skin, or a secondary cutaneous infection. As the most common form of MASD, incontinence-associated dermatitis (IAD) is characterized by erythema and edema of the skin’s surface. IAD is a top-down injury, often presenting with inflammation, erosion, or denudation in the setting of fecal or urinary incontinence.

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

Health People 2030 (HP2030) define social determinants of health (SDOH) as conditions (nonmedical factors) within environments where people are born, reside, learn, work, play, worship, and grow old. These environments impact a wide range of health and quality of life outcomes and risks. Some examples of SDOH include social and community support, neighborhood and built environment, education and access to quality education, health care access and quality, and overall economic stability.

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

In chronic wound management, clinicians often see and treat both partial- and full-thickness wounds. These wounds may present as pressure injuries or other wound types, including, although not limited to burns, trauma wounds (skin tears, abrasions, lacerations), vascular wounds, diabetic wounds, and surgical wounds. It is vital to differentiate partial- versus full-thickness wounds for a multitude of reasons, such as to understand how they heal, guide treatment, and ensure clear accurate documentation, to name a few.

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

An important step in wound management is identifying wound etiology. Pinpointing the problem often helps guide patient treatment. Identifying the cause of the wound, employing evidence-based interventions, and initiating an appropriate topical therapy will help to stabilize and, oftentimes, heal the wound. However, the decisions patients make on a daily basis, along with activities (time spent in bed, chair, with legs dependent, etc), have a significant impact on healing outcomes, independent of the wound care professional. Patient-centered education is a huge piece of effective self-management and an essential component of the nursing plan of care. This blog will focus on the importance of initial and ongoing patient-centered education in chronic wound management.

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

Ideally, most wound care professionals may want to prevent surgical wound dehiscence before it occurs. If clinicians prevent dehiscence, the healing process and, subsequently, the patient's ability to return to normal daily activities is typically quicker. Some methods to prevent surgical wound dehiscence include supporting the abdomen when coughing, sneezing, or moving around/sitting up in bed, avoiding strain or pressure to the wound area (heavy lifting, exercise, coughing, constipation/straining with bowel movements), and maintaining a good diet and good oral intake to prevent dehydration. It is essential to practice good hygiene, keep the wound clean, dry, and intact, and follow the provider's specific instructions on wound care and any prescribed medications.

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

Chronic wounds impact more than 8 million Americans in a multitude of ways ranging from affecting quality of life along to creating a significant economic burden, with the estimated cost of care in the United States currently at 30 billion dollars. As technology and medicine continue to advance, our aging population continues to grow, and those impacted by chronic wounds are likely to increase. This blog will take it back to the basics—using our senses to guide wound assessment and management—while incorporating technology/telemedicine and wound photography to guide treatment and track progress.

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

Peristomal pyoderma gangrenosum (PPG) is a somewhat uncommon and challenging condition to diagnose and treat, as no evidence-based guidelines or standard treatments exist. PPG can occur after the surgical placement of an ostomy, impacting approximately 0.5 to 1.5 people per million annually, and accounts for 15% of pyoderma gangrenosum cases. Effective management of PPG requires local and often systemic immunosuppression and topical wound care, which is compatible with being applied beneath an ostomy pouch.

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

“Top-down skin injury” is an increasingly common term used to describe superficial cutaneous injury. These injuries result from damage beginning at the skin’s surface or soft tissue. In contrast, “bottom-up” injuries are often the result of ischemia. Top-down injuries are usually caused by mechanical forces, inflammation, or moisture. Medical adhesive-related skin injury (MARSI) is a frequently seen type of top-down skin injury that is almost always preventable. In this blog, I focus on preventing MARSI and describe the different techniques and adhesives (along with adhesive alternatives) available for use.¹

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.

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