Chronic Wound Care 4th Edition Excerpts
Section 9: Chronic Wounds in Special Populations
Chapter 65
Geriatric Principles in the Practice of Chronic Wound Care
Madhuri Reddy, MD, MSc, FRCPC; Jayna Holroyd-Leduc, MD, FRCPC; Catherine Cheung, MD, FRCPC; Kevin Woo, RN, MSc, PhD(c), ACNP, GNC(C)
Care of the geriatric individual often involves managing patients who are among the oldest old (persons 85 years and older), who constitute the fastest-growing segment of the older adult population. More than half of the oldest old live in the community but need some personal assistance. They may have several noncurable but treatable chronic diseases, are usually minimally dependent, often take several prescription drugs, and occasionally are hospitalized for exacerbations of their chronic diseases. Most older patients with chronic wounds fall into this category, and this chapter focuses primarily on them.
Chapter 66
Chronic Wounds in Neonates and Children
Mona M. Baharestani, PhD, ANP, CWOCN, CWS, FCCWS, FAPWCA; Elena Pope, MD, MSc, FRCPC
Little pediatric wound-healing research upon which to guide clinical practice exists in the literature. Few wound-care products have been studied in this population. In fact, it is not unusual for skin-care regimes to be based on individual or institutional preference and routine, rather than on evidence. Most articles on wound care in neonates and children are anecdotal or simply discussions of wound-healing principles and clinical practice guidelines for adults. Research data regarding the effects of dressing types, adjunctive treatment, and wound healing in neonates and children are needed.
Chapter 67
Skin and Wound Care for the Bariatric Patient
Karen Lou Kennedy-Evans, RN, CS, FNP; Therese Henn, BSN, CS, G/ANP; Norman Levine, MD
As Americans are getting bigger so are the skin care needs of this population. Bariatric patients may present with a multitude of skin conditions not seen as commonly in the nonobese population. Particular attention should be paid to identifying and managing issues of skin cleansing, skin moisture, infections, and injuries. Lower-extremity problems are frequently encountered and can be difficult to manage. The goals are to manage and treat identified problems and prevent further complications in a dignified, safe, and effective manner.
Chapter 68
Management and Care of Clients with Surgical Wounds in the Community
Heather L. Orsted, RN, BN, ET, MSc; Virginia McNaughton, RN, BA, ET, MPA; Cynthia Whitehead, AB, MD, CCFP, FCFP
Surgical-site surveillance, diagnosis, and treatment are care issues in the community. More must be done to identify presurgical risk factors. For example, pre-operative forms should include factors that relate to surgical wound healing. Family physicians and nurses in surgeon’s offices and pre-operative clinics have the potential to identify clients at risk of wound healing failure prior to surgery. Tools to assist these clinicians to identify such clients and treat the causes before surgery could have a significant impact in reducing the likelihood of wound-healing failure. Once identified, these clients will have closer surveillance by community nurses facilitating better outcomes of care.
Chapter 69
Altered Parastomal Skin and Tissue Integrity: Thought, Treatment, and Teaching
Nancy A. Faller, RN, MSN, PhD
Patients with abdominal stool or urine stomas are at risk for altered parastomal skin and tissue integrity. Stool stomas include colostomies and ileostomies. Colostomies can be created anywhere in the large intestine from the sigmoid colon back to the ascending colon. Ileostomies are usually created at the distal end of the ileum but are sometimes further up. Urostomies can be created anywhere in the urinary tract from the bladder back to the kidneys. In each case, a portion of the excretory tract may be bypassed or removed.
Chapter 70
Malignant Wound Management: A Patient-Centered Approach
Patti Barton, RN, PHN, ET; Nancy Parslow, RN, ET; Pamela Savage, RN, MAEd, CON(C)
There is no universally accepted definition for the term “malignant wound.” Medical terminology defines the invasion of cancer cells into the skin as a primary skin cancer, such as a basal cell, squamous cell, or malignant melanoma. Additionally, a malignant wound may occur as a result of a primary cancer, such as breast, ovary, colon, etc, that has developed as skin metastasis and presents as visible changes of the skin. Metastases may occur at a distant site or infiltrate locally, such as in adjacent incision lines. When a malignant lesion develops as an infiltration in the late phases of disease, extension is often volatile and visibly progressive. The incidence of this unfortunate occurrence has not been well established, but a rate of 10% has been reported among patients with metastatic disease during the terminal phase of illness. Regardless of the etiology of the malignant wound, the interprofessional team, including the patient, must consider the fundamental physical and psychosocial concerns that may be experienced.
Chapter 71
Skin Care for the Oncology Patient
Anne E. Belcher, PhD, RN, CNE, AOCN, FAAN; Joan Selekof, BSN, RN, CWOCN
Patients with cancer may experience disruptions in skin integrity related to the disease or its treatment. In 1994, Shaffer summarized the causes of impaired skin integrity in patients with cancer, including “immobility, malignant skin lesions, infectious skin lesions, nonspecific rashes, irritation from urinary and/or fecal incontinence, abrasions resulting from scratching and shearing forces, invasive therapeutic procedures, radiation skin reactions, recall skin reactions, chemotherapy extravasation, lymphatic and/or vascular obstruction, decubiti, and/or malnutrition.” With the advent of autologous and allogenic bone marrow transplantation (BMT) for patients with leukemias and solid tumors, graft-versus-host disease (GVHD) has become an additional skin-care challenge.
Chapter 72
When a Wound is not a Wound: Tubes, Drains, Fistulae, and Draining Wounds
Nancy A. Faller, RN, MSN, PhD; Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN; Bruce A. Orkin, MD, FACS, FASCRS
Tubes, drains, fistulae, and draining wounds, at first glance, seem to have nothing in common. However, on closer scrutiny, a link becomes apparent—skin and tissue integrity. With each of these conditions, an underlying priority for care is prevention of altered skin and tissue integrity at the stoma, os, or opening. This chapter investigates the demographics and the associated risk factors of these conditions collectively and the management options for these conditions individually.
Chapter 73
Management of Wound Recalcitrance and Deterioration
Bonnie Sue Rolstad, RN, MS, CWOCN; Denise Nix, RN, MS, CWOCN
This chapter represents a synthesis of learning. The science and theoretical basis for managing chronic wounds is presented in other chapters. Here, we discuss the assessment and application of this information when managing a recalcitrant or deteriorating wound. The process for decision making and weighing of treatment alternatives is provided.