Pressure Ulcers

Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

How many of you know how knowledgeable you are about wounds? Keeping up with the latest articles and treatments is difficult. This is especially true for a staff nurse that only encounters patient wounds occasionally. Larger facilities and home health agencies have wound nurses, but smaller facilities do not. Pressure ulcer knowledge has been examined for Registered Nurses across the United States using the Pieper Pressure Ulcer Knowledge Test. When urban versus rural nurses' knowledge was examined between rural Montana nurses and urban New York City nurses all scored at a "C" level. Similar testing at a Florida VA found nurses score 77% and only improved to 81% after education programs. Registered nurses that participated in the New Jersey Hospital Association pressure ulcer collaborative scored slightly higher on the Pressure Ulcer Knowledge test at 83%. However, percent correct is still a "B-" average. Certified wound care nurses scored at 93%.

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Laurie Swezey's picture

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

Pressure mapping has traditionally been used by physiotherapists, occupational therapists, chiropractors, orthotists and other health professionals to determine where pressure might become an issue for a patient and how to redistribute skin-damaging pressure for the prevention of pressure ulcers.

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Aletha Tippett MD's picture

By Aletha Tippett MD

Once the individual has been thoroughly assessed for palliative care and his or her objectives and needs have been discussed, the wound care provider must determine the wound management strategy to follow. This strategy will depend upon the type of wound being treated for palliation. A summary of each type of wound and an appropriate palliative strategy are listed below, including factors such as removal of the wound cause, pain and drainage management, and odor control:

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Michael Miller's picture

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 18

By Michael Miller DO, FACOS, FAPWCA, WCC

One of the problems with writing a blog is not the lack of material on which to vent, vex or vociferate. Rather, I deal with the much desired situation in which there are simply so many aberrancies that appear before my now trifocaled vista, that I have to decide which of many potential entities to offend.

Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Frequently I am asked to review medical records to determine if an individual’s pressure ulcers failed to heal because of inadequate or inappropriate nutritional care. The majority of the cases involve long-term care facilities and the patients are older adults who had unintended weight loss (UWL) and pressure ulcers. After devoting 35 years as a consultant dietitian to nursing homes, I am well aware of the challenges faced by providers as they strive to provide care for our frail elderly.

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Glenda Motta's picture

By Glenda Motta RN, MPH

The Center for Medicare & Medicaid Services (CMS) reports that nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—is readmitted within 30 days, at a cost of over $26 billion every year.

Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

Since we are fast approaching the deadline for the national elections, I decided to join the fray and campaign for accurate completion of the Braden Scale nutrition sub-score. The Centers for Medicare and Medicaid Services (CMS), Minimum Data Set (MDS) 3.0 Section M, Skin Conditions requires pressure ulcer risk assessment. Nursing facilities may use a formal assessment instrument such as the Braden or Norton tool to determine pressure ulcer risk. The most commonly used pressure ulcer assessment tool is the Braden Scale and one of the sub-scales is nutrition. Studies completed by Bergstrom and Braden in skilled nursing facilities found that 80% of pressure ulcers developed in two weeks after admission and 90% within three weeks of admission.

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Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA, WCC

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 16

As I write my blog, I wonder whether anyone really reads it. I know that my wife and daughters do, because they have no choice. For all the foibles my 24 year old is quick to point out --Dad, you’re not really going to wear that; Dad, you have a stain on your shirt; Dad, you need to empty the cat litter (to which I reply, “why, they didn't eat what I poured them yet!”)--, she has commented on an occasion or two, “That was funny” or, “Yeah, it’s pretty good this time.”

Paula Erwin-Toth's picture

By Paula Erwin-Toth MSN, RN, CWOCN, CNS

Part 4 in a series discussing the challenges and opportunities in patient/family education
For Part 1, Click Here
For Part 2, Click Here
For Part 3, Click Here

Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

Taking a positive approach when a pressure ulcer develops at your health care facility usually isn’t the first thing that comes to mind. However, it should be. When a patient develops a pressure ulcer the first thing that usually happens is the blame game: It wasn’t our fault—it must have happened at the (take your pick) nursing home, hospital, OR, ER, etc. In reality, the pressure may have happened prior to the patient’s arrival at the facility.

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