Chronic Wound Care 4th Edition Excerpts
Chapter 54
The Role of the Healthcare Team in the Prevention and Management of Diabetic Foot Ulcers
Anne B. Kenshole, MB, BS, FRCPC, FACP; Jeanette Macdonald, MA, RSW, CDE
Diabetes educators establish a vital link with the client by providing diabetes education services to the wound clinic and liaising with home care and community-based health professionals. This connection can continue after treatment is completed, when the person with diabetes may be better able, psychologically and physically, to benefit from a diabetes program that provides comprehensive education and support, with the emphasis on long-term diabetes self-management techniques to prevent the recurrence of ulceration.
Chapter 55
Assessment of the Diabetic Foot
Lee C. Rogers, DPM; Vickie R. Driver, DPM, MS; David G. Armstrong, DPM, PhD
Foot ulceration is the most common cause of hospitalization in people with diabetes. Diabetic foot ulcers and amputations will affect up to 25% of people with diabetes during their lifetimes. If the number of amputations is to be reduced, the underlying causes and pathogenesis of diabetic foot ulceration, as well as its predisposing factors, must be understood. This chapter is divided into sections concentrating on causes and risk factors for diabetic foot ulcers and causes and risk factors for lower-extremity amputation. The necessary evidence-based information is presented to allow the reader to rapidly classify patients into risk categories.
Chapter 56
Offloading Foot Wounds in People with Diabetes
David G. Armstrong, DPM, PhD; Nicholas J. Bevilacqua, DPM; Stephanie C. Wu, DPM, MS
In general, foot ulcers in people with diabetes result from repetitive moderate stress applied to the plantar aspect of the foot while walking. This mechanism of injury commonly occurs because neuropathy provides a permissive environment for these wounds to occur. Without the ability to adequately respond to noxious stimuli, patients without protective sensation may sustain a breach of the skin, the way sensate persons wear holes in their stockings. As there are no current means available to completely ameliorate the effects of diabetic neuropathy, the present tenet for treating and preventing wounds focuses on the redistribution of pressure. Although many offloading modalities are currently utilized, only a small number of case series exist describing the frequency and rate of wound healing associated with these modalities. This review describes the most commonly used modalities and the evidence that supports their employment.
Chapter 57
The Team Approach to Treating Ulcers in People with Diabetes
Heather L. Orsted, RN, BN, ET, MSc; Shane Inlow, MD
This chapter looks at the needs of those with diabetes and examines ideal services required as well as the reality of maximizing existing available services. How can you make the most of what you have?
Section 8: Pressure Ulcers
Chapter 58
Pressure Ulcers: Assessment, Classification, and Management
Dot Weir, RN, CWON, CWS
The use of a systematic approach in the assessment of pressure ulcers and the documentation of that assessment unquestionably leads to better decision making and optimum outcomes. Using tools that enable the tracking of healing over time as well as healing outcomes ensures that interventions developed are sound and that healing is being achieved, which is obviously the goal for most of the patients under our care. Realistic goals must be well thought out and appropriate to the specific patient. Patients cross healthcare lines and settings with great frequency. Speaking a common language and communication across these lines is paramount to success in wound healing and patient care in general.
Chapter 59
Assessment of Wound Appearance of Chronic Pressure Ulcers
Pamela E. Houghton, BScPT, PhD; M. Gail Woodbury, BSc, BSCPT, MSc, PhD
The decision to use a particular wound status tool for clinical and/or research purposes depends on the purpose for its development, how it was developed, the extent to which it has been validated, and the practicality of its use. To aid the clinician in the understanding of the advantages and disadvantages of using the available tools, a critical appraisal of the literature about the PSST/BWAT, PUSH Tool, SWHT, Sessing Scale, and the PWAT has been included in this chapter. To this end, we have summarized the methods for the development of each instrument, the extent to which they have been validated to date, and the practicality of their use. Our appraisal is affected, therefore, by the amount of detail provided about the procedures in the published reports. This chapter highlights new information published in the literature up to September 2006.
Chapter 60
Risk Assessment in Pressure Ulcer Prevention
Barbara J. Braden, PhD, RN, FAAN; Shirley Blanchard, PhD, OTR/L
In recent years, a consensus has developed that the incidence of pressure ulcers in a facility or agency is an important indicator of quality of care. Unfortunately, as nurses and other healthcare professionals adjust to the increasing acuity of patients being cared for in every setting, they are suffering a sort of sensory overload. As more problems compete for their attention and less time is available to analyze the implications of all the data they collect, certain basic assessments and interventions are sometimes overlooked. Pressure ulcer risk assessment and prevention seems to have been among these overlooked problems. One way to assure optimal risk assessment and effective prevention is through collaboration with multiple disciplines. The 2 disciplines most often involved in risk assessment and prevention are nursing and occupational therapy, but this collaboration has been minimally addressed in the literature. This chapter will pay significant attention to the contributions of both nursing and occupational therapy to effective prevention.
Chapter 61
Moisture Control, Urinary and Fecal Incontinence, and Perineal Skin Management
Diane K. Newman, RNC, MSN, CRNP, FAAN; Ave Maria Preston, RN, MSN, CWOCN; Sylvia Salazar, MD
Healthcare providers have long understood the relationship between the presence of urinary and/or fecal incontinence, excessive skin moisture, subsequent skin injury, and the development of pressure ulcers. It is thought that urine, perspiration moisture, and fecal enzymes reduce the resistance of the skin to ulceration and infection and thus increase the risk of injury and pressure ulcer formation. The evidence of such a cause-and-effect relationship is mounting but is not yet clearly established. This chapter will discuss the known relationships between these conditions and provide information that leads to a therapeutic approach for these conditions.
Chapter 62
Support Surfaces: Tissue Integrity, Terms, Principles, and Choice
Cynthia A. Fleck, MBA, BSN, RN, ET/WOCN, CWS, DNC, DAPWCA, FCCWS; Stephen Springle, PhD, PT
In the pursuit of prevention and management of skin and tissue breakdown, support surface selection remains an important decision for the clinician. Pressure ulcers are caused by a myriad of intrinsic and extrinsic factors. Support surfaces can have significant influence over extrinsic factors, such as pressure, shear, friction, moisture, and temperature. These factors directly impact deformation of the soft tissue, blood flow, tissue ischemia and necrosis, and pressure ulcer development, especially in the immobile patient. The manner by which support surfaces manage these extrinsic factors can be used by clinicians as they select support surfaces for their patients.
Chapter 63
The Role of Technology in Pressure Ulcer Prevention
Susan L. Garber, MA, OTR, FAOTA; Narender P. Reddy, PhD; Kathleen M. McLane, MSN, RN, CPNP, ET; Thomas A. Krouskop, PhD, PE
Over the past several decades, myriad technologies were developed that found their way into the pressure ulcer prevention marketplace. Most of the products can be classified as either alarm systems, evaluation tools, or support surfaces. Unfortunately, many of the products have had little effect on pressure ulcer incidence, because they are not effectively used. In order for a technological aid to fulfill its role, it must be reliable; it must be easy to use; it must interface easily with other pieces of technology that a patient requires; it must fill a perceived need; and it must perform its expected function.
Chapter 64
Surgical Management of Pressure Ulcers
David L. Brown, MD; Steven J. Kasten, MD; David J. Smith, Jr, MD
Wounds associated with paraplegia or other states of prolonged immobility have been frequently called decubitus ulcers. The word decubitus is a derivation of the Latin decumbere, meaning “to lie down.” Pressure ulcer is a more accurate term than decubitus ulcer, as it more correctly describes the etiology of the wound. The pathophysiology of pressure ulcers involves pressure-induced ischemia, edema formation, and often infection. The cost to society as a whole for this problem is significant.