Pressure Ulcers

Karen Zulkowski's picture
Skin Conditions

By Karen Zulkowski DNS, RN, CWS

I previously discussed the need for a complete head-to-toe skin assessment. Certainly this can tell you whether or not the person is dehydrated, has open or discolored areas, and many other things about their overall health. Color, for example, can give you clues to additional problems such as vitamin and mineral deficiencies that can show on the skin.

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By Karen Zulkowski DNS, RN, CWS

Looking at a person's skin from head to toe is an important nursing function. Certainly nurses document this on the patient's admission, but not so much thereafter. Often the CNA is the first person to notice a problem. Yet there may not be good communication between disciplines or training of the CNA to understand the significance of what they are observing.

Lindsay Andronaco's picture

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Part 2 in a series on skin failure
For Part 1, Click Here

In March of 1989 the National Pressure Ulcer Advisory Panel (NPUAP) convened, during which Karen Lou Kennedy first described the Kennedy Terminal Ulcer (KTU) phenomenon. A KTU is an unavoidable skin breakdown or skin failure that is thought to be a perfusion problem exacerbated by vascular/profusion insufficiency, organ failure, and/or the dying process. A KTU is a visible sign, an explanation, of what is transpiring within the patient.

Margaret Heale's picture

By Margaret Heale, RN, MSc, CWOCN

So after I last wrote, I was to assist with a dressing change, as the resident is more relaxed with somebody having their focus on her and not also trying to do the procedure. I have done a million or two dressings in my time but had not seen a negative pressure wound therapy (NPWT) vacuum till I started helping out at the nursing home where my granddaughter works. I came across the treatment accidentally, very accidentally.

Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

In last month's blog, I discussed recent research and publication of the consensus statement of the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.): Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition).

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Margaret Heale's picture

By Margaret Heale, RN, MSc, CWOCN

Well it's me again, Matron Marley. I got in through the door no problem today. My granddaughter dropped me off as she is doing some MDS training. I am feeling more comfortable as a volunteer now that I have visited a few times. When talking to the staff about their wanderer last time I was here and being reminded about the first recliner butt I saw, I wanted to drop back to the past again and tell you why I was so concerned.

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Margaret Heale's picture

By Margaret Heale, RN, MSc, CWOCN

Here I am again, Matron Marley, working as a volunteer in the local nursing home on just my second visit. I had a little difficulty getting in and discovered it was because of the door lock alarm on a resident. Such a good idea but a bit irritating. I managed to sneak in while the resident moved away briefly and entered into a bright airy reception area, so welcoming. The first home I ran was really dingy with cold stone steps to the 1st floor where the ‘geri’ ward was. Today I am greeted by a woman about my age with a pocket book asking, “Is the bus here yet, I have to pick up Robbie.” I heard the door click as she neared it, locking out my granddaughter who works here. I coaxed her away from the door with a promise to help her find the bus down a long hallway. It is soon revealed that she is a wanderer and spends much of her time trying to exit the building. Her mention of the bus brought to mind a patient I'd once had named Mable.

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Aletha Tippett MD's picture

By Aletha Tippett MD

The great medical pioneer, Dr. Paul Brand, was right when he said it's not about medicine, it's about mechanics. Think of the ulcers you are asked to see and treat. I hope the first question you ask about any wound is "how did this get here?" If the mechanics of a wound are not addressed, the medicine will not be successful.

Karen Zulkowski's picture
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By Karen Zulkowski DNS, RN, CWS

Part 3 in a series on Pressure Ulcer Knowledge
For Part 1, Click here
For Part 2, Click here

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Mary Ellen Posthauer's picture

By Mary Ellen Posthauer RDN, CD, LD, FAND

The NPUAP/EPUAP Pressure Ulcer Prevention and Treatment Guidelines published in 2009 have been widely circulated around the globe and translated into 17 languages. Successful implementation of any guideline requires a "buy-in" by all the members on the interprofessional team. As a member of the wound care team at a long-term care facility, I participate in weekly wound care rounds. Prior to our meeting, the wound care nurse has measured the wounds and documented them on an information sheet that also includes the type of wound (pressure vs. circulatory etc.) plus support surfaces and nutrition interventions.

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