Ivy Razmus's blog

by Ivy Razmus, RN, PhD, CWOCN

As a nurse who works with vulnerable populations, I have seen how foot health affects homeless patients in the hospital setting. I often witnessed that foot health was rarely addressed in their care plan. Although distressing, this issue has not received much attention, in my opinion.

by Ivy Razmus, RN, PhD, CWOCN

Neonatal patients have unique skin properties compared with older patient populations. However, there is little evidence reported for neonates who receive pressure injury (PI) prevention interventions and the related occurrence of PIs compared with adults. The use of a pressure redistribution surface is intended to decrease pressure and thereby reduce PIs. The Institute for Healthcare Improvement guidelines recommend a support surface that meets the patient’s need for pressure redistribution based on the level of immobility and inactivity to reduce shear and change microclimate; additional factors for type of surface include size and weight of the patient and whether there are existing PIs. Consequently, knowledge about selection and use of pressure redistribution surfaces for neonatal patients is needed.

Neonates are widely known as a vulnerable patient population—especially critically ill and premature infants.¹ This vulnerability has limited clinicians’ knowledge of moisture management products in the neonatal population that prevent pressure injuries. Recently, a survey of neonatal nurses from across the United States was conducted to find out what is being used for moisture management.²

By Ivy Razmus, RN, PhD, CWOCN

The coronavirus disease 2019 (COVID-19) pandemic has left many people with free time on their hands as other activities are cut to avoid exposure to the virus. What if we used this time during the pandemic to strengthen screening for cancers? When later-stage cancers are discovered, patients often undergo surgery with open wounds, new stomas, and other risk factors for infection. These wounds may require wound vacuum devices, complex dressing changes, increased nursing time, and in some cases an increased length of hospital stay. After discharge, these patients often require care in a skilled nursing facility to help them transition to home care. Can we prevent ostomies and wounds by making screening more accessible? Further, the diagnosis of cancer can lead to hospitalization and an increased need for adjuvant therapy such as chemotherapy or radiation, which weakens the immune system.

By Ivy Razmus, RN, PhD, CWOCN

As we continue to develop our evidence on pediatric pressure injuries, more information has been reported about the risk factors nurses are using for clinical judgment. We know that the newborn skin can vary based on gestational age, and nurses use their clinical judgment frequently when compared with using a pressure injury risk assessment scale. It therefore is important to answer this question: “What are nurses using for clinical judgment for assessing pressure injury risk?”

By Ivy Razmus, RN, PhD, CWOCN

There remain many unanswered questions regarding pressure injury and prevention practices among neonatal patients. Guidelines for pressure injury prevention were initiated in 1992 by the U.S. Agency for Healthcare Research and Quality (AHRQ). Pressure injury prevention practices are based on these guidelines, which recently expanded to include pediatric patients.

By Ivy Razmus, RN, PhD, CWOCN

People in wheelchairs are limited in their mobility, sensory perception, and activity. These limitations can lead to increased temperature and moisture on the areas that are in contact with the wheelchair surface. These risk factors place wheelchair users at a higher risk for pressure injuries. A pressure injury is localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. Pressure from medical devices against the skin may also cause pressure injury. Patients with spinal cord injury (SCI) and its associated comorbidities are among the highest-risk population for developing pressure injuries. The incidence of pressure ulcers in patients with SCI is 25%–66%.

Ivy Razmus, RN, PhD, CWOCN

Moisture-associated dermatitis has been described as "inflammation and erosion of the skin due to prolonged exposure to moisture and its contents which include urine, stool, perspiration, wound exudate, mucus, or saliva." Incontinence dermatitis is caused by overhydration of the skin, maceration, prolonged contact with urine and feces, retained diaper soaps, and topical preparations. Indeed, diaper dermatitis has been used to describe an infant's skin breakdown related to moisture exposure.

By Ivy Razmus, RN, PhD, CWOCN

The very old and the very young are more alike than you might think when you consider risk for skin injuries. They are alike regarding their limited sensory perception, mobility, and activity. They are also alike in their potential for inadequate nutrition and their skin's supporting structures (muscle, collagen and elastin). These similarities place them at greater risk for pressure injuries.

by Ivy Razmus, RN, PhD, CWOCN

As we continually focus on improving our skills in prevention and management of skin and wounds, we are beginning to understand that one size does not fit all; or, in other words, prevention and management in wound care are dependent on the size and age of the patient. In wound care, one method of care does not fit all types of patients. Although those clinicians who work with younger populations know this to be true based on our personal experience, this can be a problem if the purchasing of products for younger patients' skin and wound care is decided without the input of the providers and caregivers who care for them.