Pressure Ulcers

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

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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Karen Zulkowski's picture

By Karen Zulkowski DNS, RN, CWS

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

I have used the Pieper Pressure Ulcer Knowledge Test for many years to examine nurse's knowledge. It actually started as a "bet" between my friend Elizabeth Ayello and me. Elizabeth thought her urban New York City nurses would have more CEU opportunity and would score better than my rural Montana nurses. So she gave the test to nurses employed in a New York hospital and I sent it to rural Montana facilities. We were both surprised when my nurses won by two points. The bad news was everyone scored at a "C" level. We found this very interesting but rather distressing.

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Michael Miller's picture

By Michael Miller DO, FACOS, FAPWCA, WCC

As we enter this New Year, I have several resolutions which I hope will act as a sextant for my upcoming wound care voyages. I promise to be less critical of my colleagues who do horrendous, insipid, unprofessional, unethical, unintelligent, profit-motivated things to patients in the name of good care…OK, maybe not. I have promised to continue my Sinbad-like voyage to find my much sought after ball-laden juggler for whom to send my much needed debridements and IV port placements. I understand that surgeons prefer to evaluate patients before elective procedures to assure that they have no potential problems and that they are low risk candidates for the requested procedure. But asking a 300 lb. paraplegic to come in to a poorly accessible office to vet them and then schedule them days later rarely identifies a reason to defer on the procedure but moreover, places the patient, their family and others at high risk and considerable inconvenience. Can you not arrange to see them early and help them later the same day?

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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