Pressure Ulcers

By Thomas E. Serena, MD, and Khristina Harrell, RN

With apologies to Nietzsche: "What kills you makes you dead." The slow painful death of large and expensive in-person conferences has begun. Technological evolution has selected against these lumbering dinosaurs, but, rather than a massive asteroid, the parlous event came as a microscopic virus. Lockdowns and social distancing enacted in response to COVID-19 pushed us all deeper into a virtual world, a world that will persist long after COVID resolves.

By Heidi Cross, MSN, RN, FNP-BC, CWON

In the previous blog, I briefly went through the standards of care when it comes to nutrition and pressure injury (PI) prevention and development and discussed what a large role nutrition plays in PI litigation. Here are several instances: Punitive damages of $92 million, later lowered to $11,855,000, were imposed where malnutrition and dehydration were proven against a nursing home. A dietary manager for a nursing home told state surveyors that her nursing home had "dropped the ball" on a resident's nutrition needs when that resident had lost 17 pounds in 75 days; a $1,385,000 settlement was reached. Malnutrition with a loss of 27% of body weight in 15 months led to a $380,000 settlement just before trial. Shocking, isn't it? It literally "pays" to pay attention to nutrition standards of care.

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 Lauren Lazarevski RN, BSN, CWOCN

As I contemplate the current conversation around ventilators, I am encouraged to refresh my knowledge about mucosal pressure injuries. Pressure injuries on the mucous membranes present and are staged differently from cutaneous pressure ulcers, and they are usually attributed to a medical device or tube. Nasogastric or orogastric tubes, oxygen cannulas or masks, endotracheal tubes, and urinary and fecal containment devices pose a risk of causing local ischemia to tissue in the nose, mouth, genitals, or rectum, respectively. Once a mucosal injury occurs, the patient is at increased risk of other problems, including pain, infection (especially if injury occurs to the urinary tract), and even malnutrition, if pain from oral wounds makes it difficult to eat and drink. These hospital-acquired pressure injuries contribute to the physical burden on the patient, as well as the financial burden on the hospital because they do count as a nosocomial—and usually, preventable—ulcer.

By the WoundSource Editors

The World Health Organization declared COVID-19 a pandemic on March 11, 2020. Whether you are a provider or a frontline health care professional, we are experiencing a worldwide increase in “unavoidable” medical device–related pressure injuries (MDRPIs) during the current COVID-19 pandemic. Health care workers are challenged with a higher risk of pressure injury development secondary to prolonged wear time of the N95 mask, face shield, and goggle personal protective equipment (PPE). The intensity of one or more factors of pressure, moisture, shear, and friction influence pressure injury risk.

By Lauren Lazarevski RN, BSN, CWOCN

Calling the COVID-19 pandemic an "unprecedented time" is an understatement. In this time of uncertainty, predicting what to expect can provide some comfort via preparation for the future. We can presume several implications for wound care professionals, based on the clinical course and community response to our evolving situation. Wound care health professionals should be prepared for some unique circumstances on the other side of the curve.

By Becky Naughton, RN, MSN, FNP-C, WCC

Picture this: you've been seeing a patient in your wound center for the last several months to treat a slowly healing post-operative abdominal wound. The wound has been gradually responding to an assortment of treatments, including initial wound vacuum therapy after the surgery, followed by alginate and now a collagen dressing. The wound is getting smaller and has new granulation tissue at the base. You're actually a bit surprised that it's healing so nicely because the patient has multiple serious chronic illnesses, including severe chronic kidney disease that requires hemodialysis sessions three times per week, type 2 diabetes, morbid obesity, cardiovascular disease, and peripheral vascular disease.

By the WoundSource Editors

Scrotum injuries can be caused by one or more mechanisms of injury such as trauma, pressure, friction, and moisture. Minor injuries frequently result in pain to the afflicted area, swelling, or ecchymosis.

By the WoundSource Editors

Advanced wound care technologies have come a long way in treating chronic wounds. However, diabetic foot ulcers (DFUs) can be challenging, and not every patient should have identical treatment. Utilizing a patient-centered approach is necessary for selecting appropriate treatments and achieving best possible outcomes. Understanding the specific patient’s needs and understanding the pathophysiology of diabetic wound chronicity are key elements in DFU management. The primary goal should be wound closure, while also preventing recurrence. To achieve both goals, clinicians must incorporate ongoing education and clinical support. Health care professionals should keep up on latest evidence-based research and practices to select the best advanced treatment for each patient.

By the WoundSource Editors

Wound chronicity is defined as any wound that is physiologically impaired due to a disruption in the wound healing cascade: 1) hemostasis, 2) inflammation, 3) proliferation, and 4) maturation/remodeling. To effectively manage chronic wounds, we must understand the normal healing process and wound bed preparation (WBP). Wound chronicity can occur due to impaired angiogenesis, innervation, or cellular migration. The presence of biofilm and infection are the most common causes of delayed healing.