Wound Assessment

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Holly Hovan MSN, APRN, RN-BC, CWOCN-AP

Identifying wound etiology before initiating topical treatment is important. Additionally, correctly documenting wound etiology is significant in health care settings for many reasons. Accurate documentation and appropriate topical treatment are two critical components of a strong wound treatment plan and program. Bedside staff members should be comfortable with describing wounds, tissue types, and differentiating wound etiologies. Training should be provided by the certified wound care clinician, along with follow-up (chart reviews and documentation checks, one-on-one education as needed, and routine competency or education days). Additionally, the wound care clinician should be able to develop an appropriate treatment plan based on wound etiology, by involving additional disciplines as needed to best treat the whole patient.

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By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWCN-AP, CWS, RNFA

Should pain management interventions be put in place before debriding a venous ulcer?

Without question, yes. Any comprehensive wound treatment plan must include a thorough pain assessment, accounting for cyclical and non-cyclical pain sources. This will best guide interventions based on patient’s unique history, which can potentially include complicating factors such as complex personal pain management secondary to chronic pain, inability to tolerate specific interventions because of existing comorbid conditions, limited financial or social resources, etc. Multimodal pain management is standard of care, using the least invasive options and beginning pharmacologic therapy with the lowest necessary dosage possible.

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By the WoundSource Editors

Before the mid-1990s, venous disorders and disease were classified almost solely on clinical appearance, which failed to achieve diagnostic precision or reproducible treatment results. In response to this, the American Venous Forum developed a classification system in 1994, which was revised in 2004. This classification system has gained widespread acceptance across the clinical and medical research communities, and most published papers now use all or part of the CEAP system (defined in the next section). This system was once again updated in 2020.

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Calciphylaxis

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.

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Fistulas

By the WoundSource Editors

Fistulas are abnormal connections or passageways between two organs or vessels that do not usually connect. Although they typically develop as a result of an injury or surgery, they can also be caused by infection or inflammation. The World Health Organization estimates that there are between 50,000 and 100,000 new cases of obstetric fistula annually, and the number of all types of fistulas is substantially higher.

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Telehealth

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

Wound care has evolved into a massive specialty service in the past few decades, with new treatment modalities, advances in care, and thousands of wound care products. On the forefront of advancements in technology and wound care is a new way to provide care to the patient: telehealth.

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Temple University School of Podiatric Medicine Journal Club

By Temple University School of Podiatric Medicine Journal Review Club

The advancement of technology and the introduction of the World Wide Web have allowed information to be a click of a button away for health care providers as well as patients. This advancement led to the demand and production of portal devices such as smartphones, which transformed many aspects of society today, including health care. Today, smartphone applications may aid health care providers in drug reference, diagnosis, treatment, literature search, and even medical training. In 2009, an estimated 6.5 million patients had chronic wounds and spent more than $25 billion dollars on wound care. In addition, rising costs of wound management have suggested the need for the use of mobile applications in treatment of wound care patients.

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Professional Development

By Holly M. Hovan, MSN, RN-BC, APRN-CNS, CWOCN-AP

As wound, ostomy, and continence (WOC) nurses, and nurses in general, we are often so busy taking care of others that sometimes we forget to take care of ourselves. A wise instructor in nursing school once told me, "If you don't take care of yourself first, you won't be able to take care of anyone else." I am often reminded of this when I travel and the flight attendant says "Please secure your own mask first!" Hearing that simple reminder will always and forever remind me to take care of myself first to best take care of others.

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Classification Systems for Diabetic Foot Ulcers

By the WoundSource Editors

In patients with diabetes, the lifetime risk of diabetic foot ulcers (DFUs) is approximately 25%, and these wounds are frequently a source of pain and discomfort. Severe cases can even result in amputation of a portion of or the entire affected extremity. Proper classification of DFUs is essential for selecting the appropriate treatment course and coordinating care for the patient. Several systems are frequently used in classifying DFUs, although there is no universally agreed-on standard.

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Wound Infection

By the WoundSource Editors

Although complex wounds typically present with clinical challenges in treatment, there are certain types of wounds that clinicians are used to facing: pressure wounds , arterial wounds, venous wounds, diabetic wounds, moisture-related wounds, end-of-life wounds, dehisced or complicated surgical wounds, and wounds of mixed etiology. However, the uncommon complex wounds are the ones often misdiagnosed or misidentified because of a lack of understanding or even ability to have them diagnosed properly. Often the rare or unusual skin lesions or ulcers require advanced diagnostic capabilities, such as the ability to perform a biopsy, tissue culture, radiological study, or other examination. So how do you know that what you’re treating is what you think you’re treating?