Pressure Injuries

Charles Buscemi's picture

By Charles P. Buscemi, PhD, APRN, CWCN and Arturo Gonzalez, DNP, APRN, ANP-BC, CWCN-AP

Urinary catheters serve several purposes, including monitoring urine output, relieving urinary retention, and facilitating diagnosis of disease in the lower urinary tract. These catheters can be inserted easily and are universally available, which usually results in their continued and indiscriminate usage. Urinary catheters can be indwelling or external-condom types. The indwelling catheter can be either a suprapubic or a urethral catheter. The external catheter provides a safe alternative to an indwelling catheter for patients having urinary incontinence (UI). It comprises a sheath surrounding the penis with a tube situated at the tip linked to a collection bag. Conversely, the condom catheter seems an attractive option for patients with UI. About 40% of condom catheter users have urinary tract infections. Moreover, 15% of condom catheter users have necrosis, ulceration, inflammation, and constriction of the penile skin. There is also an additional risk of urine leakage and condom detachment. Furthermore, the use of the external catheter requires significant nursing time. Overall, the condom catheter cannot be satisfactorily used for managing UI; nevertheless, it is useful for the non-invasive measurement of bladder pressure.

Dianne Rudolph's picture

By Dianne Rudolph, APRN, GNP-BC, CWOCN, UTHSCSA

Pressure injuries (PIs) are defined by the National Pressure Injury Advisory Panel as “localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device.” Pressure injuries may present as intact skin or as an open ulcer. These wound may be painful. Pressure injuries occur after exposure to prolonged pressure or as a result of pressure in combination with shear. Other factors may affect soft tissue tolerance, such as nutrition, perfusion, microclimate, the presence of comorbidities, and the condition of the soft tissue.

Cheryl Carver's picture
Fairground

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

My approach to wound care education with patients, providers, and nursing staff the last 20+ years has always been to make learning fun while emphasizing that wounds are a serious topic. My strong passion drives me to motivate anyone and everyone who wants to learn. If they don’t want to learn, then I’ll figure out the best way to motivate them! Everyone learns differently; however, hands-on training with added fun usually wins. Education should be ongoing and engaging, and it should create fun ways to experience more of those “aha” moments. We want to impact that long-term memory storage! Every care setting has variances, but my blog will provide you with some ideas that you can alter to fit your needs.

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Cathy Wogamon's picture

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

Many questions arise and confusion develops when wound care providers mention Kennedy terminal ulcers (KTUs). Because these wounds are not frequently seen, and because they develop rapidly and observation ends abruptly with the death of the patient, wound care providers may have never observed a KTU, even in a long career in wound care. Although the literature reveals that there is a lack of knowledge regarding the exact cause of a KTU, let’s look at the facts currently known from published resources.

Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

Pressure injuries (PIs) are prevalent in facilities where many of the patients are bedridden or confined to a wheelchair. PIs, also referred to as pressure ulcers or even bedsores, are caused by insufficient blood circulation to areas that are exposed to unrelieved, prolonged pressure. PIs are staged using the National Pressure Injury Advisory Panel (NPIAP) staging system as stages 1 to 4, based on their severity. Throughout the paper, the authors referred to PI as pressure ulcer, which is the older terminology.

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Heidi Cross's picture

Since the advent of coronavirus disease 2019 (COVID-19), I haven’t done much flying, but I love travel and I love flying. One of my favorite experiences is a window seat at about 30,000 feet on a clear sunny day. The views can be spectacular – whether flying across the Rockies or the Plains or any of the stunning and varied scenery of this country or the world. A couple of my most memorable flights involved flying into New York City with views of the New York skyline with Lady Liberty in clear sight, or into Washington, DC with clear views of the Mall, the Jefferson Monument, and the Capitol. The Alps and the Rockies are incredibly awe-inspiring, beautiful, and breathtaking. From there, you get a good overall picture of the landscape.

WoundSource Practice Accelerator's picture

Chronic wounds of the lower extremities impose an increasing burden on health care providers and systems, and they can have a devastating impact on patients and their families. These wounds include diabetic ulcers, venous ulcers, arterial ulcers, and pressure injuries. The estimated socioeconomic cost of chronic wounds is 2% to 4% of the health budget in Western countries. Moreover, patient mortality in individuals with chronic wounds has been estimated at 28% over a two-year period, significantly higher than the 4% mortality rate reported for 75 to 79 year-olds without chronic wounds.

WoundSource Practice Accelerator's picture

Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that recurrence rates are high; nearly 40% of patients with an ulcer will develop a recurrence within one year of healing. This percentage is 60% at three years after healing and 65% at the five-year mark.

Temple University School of Podiatric Medicine's picture

By Temple University School of Podiatric Medicine Journal Review Club

Hard-to-heal wounds, such as diabetic foot ulcers, pressure injuries, and venous leg ulcers, comprise a significant portion of health care visits, and these wounds place a physical and economic burden on many patients. These hard-to-heal wounds are defined as wounds with stagnant or delayed stages of healing that fail to resolve within eight weeks. Finding ways to accelerate this healing process is of great importance because it can reduce the physical and economic burden on patients, as well as decreasing costs for health care facilities. Matrix metalloproteinases (MMPs) are endopeptidases, which are involved in many healing processes, including the cell signaling processes, migration processes, angiogenesis, and the degradation of extracellular proteins. These mechanisms are necessary for the wound healing process by breaking down damaged tissue. In the late stages of healing, when breaking down of tissue is no longer necessary, tissue inhibitors of metalloproteinases down-regulate MMPs. In hard-to-heal wounds, this process is thrown off balance, with delays in the subsequent stages of healing. In an attempt to restore this balance, MMPs have been investigated for their role in wound healing through MMP-inhibiting wound dressings. There have been a number of consequential reviews done using current market wound dressings, such as oxidized regenerated cellulose/collagen and Technology Lipido-Colloid with nano-oligosaccharide factor (TLC-NOSF).

Holly Hovan's picture
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.