Holly Hovan's blog

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

Wound care and healing require an evidenced-based, interprofessional approach, following standards of care, and treating the whole patient, not just the hole in the patient. Often, wound care clinicians are consulted for recommendations on the treatment of chronic or non-healing wounds, as well as other wound, ostomy, and continence issues. Treating a wound and successfully healing a wound require a holistic approach for the best outcomes.

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When assessing and documenting a wound, it is important to note the amount and type of wound exudate (drainage). Using our senses is a large part of the initial wound assessment, followed by accurate documentation. Wound exudate or drainage gives us significant information about what is going on with the wound, all the way down to a cellular level, and it is one of the wound components that guide our topical treatments. As mentioned in prior blogs, a dry cell is a dead cell, but a wound with too much moisture will also have delayed healing. Additionally, infection, poor nutrition, impaired mobility, impaired sensory perception, and even malignancy in the wound can impair the healing process.
In acute wounds, drainage typically decreases over several days while the wound heals, whereas in chronic wounds, a large amount of drainage is suggestive of prolonged inflammation with failure to move into the proliferative phase of wound healing. An increase in drainage with malodor can be an indication of infection and should be treated appropriately based on the overall picture and goals of wound care.
There are many different types, consistencies, colors, and characteristics of wound drainage. In this blog, we discuss the most common types and what they could mean.

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

“Top-down skin injuries” is an increasingly common term used to describe superficial cutaneous injuries. Top-down injuries result from damage beginning at the skin’s surface or the soft tissue. In contrast, “bottom-up injuries” are often the result of ischemia. Top-down injuries usually result from mechanical forces, inflammation, or moisture. Common top-down injuries are moisture-associated skin damage, skin tears, and medical adhesive–related skin injury (MARSI). In this blog, I focus on assessing, defining, and preventing MARSI.

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

We have all heard the saying: a dry cell is a dead cell… we know that a moist wound bed is most conducive to healing. If a wound is too dry, we add moisture… and if a wound is too wet, we try to absorb the drainage. There must be a balance of moist and dry to promote an optimal healing environment. Much like a dry cell is a dead cell, a wound that is too moist often has delayed wound healing.

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Wound Drainage

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

Wound assessment is one of the initial steps in determining the plan of care, changes in treatment, and the choice of key players in wound management. However, wound assessment needs to be accurately understood and documented by frontline staff to paint a true picture of what is happening with the wound.

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elderly patient skin tear prevention

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

Most of us are familiar with the terms "prednisone skin," "thin skin," "fragile skin," or "easily bruises." One or all of these phrases are commonly used to describe our geriatric population's aging skin. As we age, so does our skin. Older adults have older skin. Skin loses elasticity and often gains wrinkles. Skin conditions that may never have been present earlier in life can crop up with aging. Keep in mind that the environment and different exposures (to sunlight, smoking, and stress) can cause our skin to age differently. Additionally, certain drugs, obesity, diet or lifestyle, habits, exercise, repetitive movements, and family history can also influence how our skin ages. Exposure to radiation (for cancer treatment) can also cause skin changes several years after treatment is complete. Regardless of the reason, as we age, our skin composition changes, and undoubtedly the risk for skin tears increases.

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

The third Thursday in November is a highly recognized day within many hospital systems and wound care programs. This day is recognized nationally as World Wide Pressure Injury Prevention Day, highlighted by the National Pressure Injury Advisory Panel (NPIAP). The third Thursday in November is a time to bring awareness to pressure injury prevention, treatment, and research. Each year, we highlight this day a little bit differently, but this year definitely looked much different from years past.

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

Every year, on the first Saturday of October, we celebrate ostomy awareness day. This is a significant day. Ostomies truly are lifesavers for so many people, and it is important that we bring awareness, education, and support to our patients, peers, and community.

This year, the United Ostomy Associations of America (UOAA) is celebrated the 10th anniversary of National Ostomy Awareness Day (this event began in 2010). More information on this day and virtual events can be found here: https://www.ostomy.org/ostomy-awareness-day/

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neuropathy testing for sensory perception (Braden Scale)

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

As wound care professionals, the Braden Scale for Predicting Pressure Sore Risk® is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of Braden Scale use may contribute to a multitude of different scores. The resident behaves differently on different shifts, for example, being asleep on the night shift but up and about on days. What is the correct way to score these patients? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, during transfer, when receiving, and most importantly, with any change in condition.

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