Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Wound Care Seminar - 2015

No description
by

Wanda Newton

on 29 January 2015

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Wound Care Seminar - 2015

Wound Care Seminar - Nov 7th / 2013
Introduction
Dr. Scott Newton , PT, DPT, OCS, CWS

Physical Therapist- 20 plus years

Board Certified Wound Care Specialist

American Academy of Wound Care

Association for the Advancement of Wound Care

Over 25 Seminars/Conferences

Guest Lecturer PT/PTA programs

MIRE Research
Wound Assessment and Documentation
Assessing the Patient's Wound
The Role of Debridement
Goals:
Welcome
Dr. Scott Newton, PT, DPT, OCS, CWS
History of Wound Care
1962 Winter’s study the "dressing revolution”

Protect

Barrier

Handle exudate

Occlusive dressings :
moist, warm environment (3-5x faster healing rates)

Early criticism:
infection rates

7.1%
infection rate conventional versus
2.6%
with occlusive

Hemostasis -
occurs within minutes

Inflammation Phase -
Day 1-4

Proliferation (Granulation) Phase -
Day 4-21

Remodeling or Maturation Phase –
Day 21-2 years
Neutrophil
When does a wound become chronic?
Acute wounds
-healed within 3 weeks

Remodeled over the year

Chronic
- becomes stuck in one of the phases

Definition of Chronic Wound
Lazarus G, Cooper D, Knighton D, Margolis D, Pecoraro R, Rodeheaver G, Robson.
Definitions and guidelines for assessment of wounds and evaluation of healing. Archives of Dermatology 1994;130:489-493
”failed to proceed through an orderly and timely process to produce anatomic and functional integrity, or proceeded through the repair process without establishing a sustained anatomic and functional result.”
65 Hairs
100 Sebaceous Glands
78 Yards of Nerves
78 Sensory Apparatuses for Heat
160 Pressure Apparatuses for the perception of tactile stimuli
13 Sensory Apparatuses for cold
650 Sweat Glands
19 Yards of blood vessels
9,500,000 Cells
1,300 Nerve endings
20,000 Sensory Cells
32,000,000 Bacteria!!!

One Square Inch of Skin Contains:
Phases of Wound Healing:
How do Wounds Heal?
CAWC Best Practice Recommendations. www.cawc.net

Identify and control the underlying causes

Support patient centered concerns

Optimize local wound care

Basic Principles of Wound Care
Chronic Wound Pain: A Conceptual Model
Woo, Kevin Y.; Sibbald, R. Gary
Advances in Skin & Wound Care. 21(4):175-188, April 2008.
doi: 10.1097/01.ASW.0000305430.01413.2e


Figure 1. WOUND BED PREPARATION PARADIGM
Copyright © 2009 Advances in Skin & Wound Care. Published by Lippincott Williams & Wilkins.

4:00-4:15
Welcome/Introduction
4:15-5:10
Wound Assessment/
Documentation: Strategies for Success in
Wound Care Litigation
5:10-5:25
The Role of Debridement
5:25-5:55
Is it infected? Colonized?
5:55-6:25
Dress for Success: What do I put on the
Wound?
6:25-6:35 Break
6:35-6:55
Wound Procedures (Negative
Pressure) and Devices
6:55-7:40
Venous Ulcers: The Right Plan makes
a Difference
7:40-8:10
Diabetic Ulcers: Take a Load Off
8:10-8:30
Q & A

Schedule
Wound Types
Acute Wounds
Chronic Wounds
Surgical wound

Penetrating wound (e.g. knife or bullet wound)

Avulsion Injury (e.g. finger tip amputation)

Crushing or shearing Injury

Burn Injury

Laceration

Bite wound (Dog bite, cat bite, human bite)
Arterial Ulcer (Peripheral Vascular Disease)
Venous Ulcer (Venous Insufficiency)
Lymphedema
Pressure Ulcer (Decubitus Ulcer)
Neuropathic ulcer (Diabetes Mellitus)

Further Classification
Classification
Superficial
Partial Thickness
Full Thickness
Wound Assessment
Location
Surrounding Skin
– color, moisture, suppleness
Size/Depth
- length, width, or trace and depth
Wound edges
- undermining and condition of margins
Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor
Odor
Exudate
-Quality & Quantity

Surrounding Skin
Color

Edema-
pitting/non-pitting

Induration –
abnormal firmness. Inability to pinch the tissue

Temperature

Size
Common methods of Measurement:

Tape Measure
(length and width)

Tracing
(disposable Acetate sheet or planometer)

Photographic
(with measurement guide or stereophotogrammetry)


Wound Edges

Indistinct, diffuse =
unable to clearly distinguish

Attached =
even or flush with wound base

Rolled under

Hyperkeratosis =
callous-like tissue

Fibrotic, scarred =
hard, rigid to touch

Not attached =
floor or base of wound is deeper than edge

Undermining

Tunneling

Wound Bed

- Necrotic Tissue amount
(%) and type
Black Eschar
Yellow Slough
White/grey
Define as loose or adhered

- Granular Tissue amount
(%)
- Epithelialization
(%)

Exudate Type & Amount
Serosanguineous
= thin, watery, pale red/pink

Serous
= thin, watery, clear

Purulent
= thin or thick, opaque, tan/yellow

Foul Purulent
= thick, opaque, yellow/green with odor.

Exudate amount
None
Scant
Small
Moderate
Large
- Description may help clarify.
- The exudate filled 75% of a large combiderm in 48 hours.


Local Wound Care
The Role of Debridement
Clinical Significance
Local infection causes tissue destruction, increasing the severity of the wound.
Ischemic tissue impedes healing and encourages infection, which may lead to further ischemia.
Premature wound closure leads to dead space and potential abscess formation.
Eschar impairs the host response and tissue formation.
Foreign matter in the wound encourages growth of anaerobic bacteria.
Bacterial Balance &
Inflamation/ Infection
All chronic wounds contain bacterial flora.

Wound contamination
- the presence of non-replicating microorganisms

Wound colonization
- the presence of replicating microorganisms within a wound in the absence of host injury
Moisture Balance
1940’s Bloom’s work with occlusive wound care in WWII burn victims.
1960’s George Winter’s work.
Why has it taken so long for the word to spread??
Types of debridement
Autolytic

Enzymatic =
Collagenase Santyl

Mechanical
= Wet-dry dressing, Hydrotherapy, pulsed lavage, pressured irrigation. Simple and cost effective but may damage healthy tissue


Surgical
= Most effective? Fast and selective.

Sharp
= Scalpel, scissors, or a curette. Less invasive, can be performed at bedside/outpatient

Debridement -Conclusions
Debridement is an essential step in wound management.
Means to suit the various clinical needs.
Different approaches may be used interchangeable based on clinical progress.
An individual approach is required when selecting the proper debridement method.
Bacterial Balance cont.
Wound infection
-the presence of replicating microorganisms within a wound with subsequent host injury.

Wound infection is far less common than wound colonization and contamination.

Wound infections can be covert
—little evidence of host injury on superficial inspection

Advantages of Moist Wound Healing
Decreased dehydration and cell death

Increased angiogenesis

Enhanced autolytic debridement

Increased re-epithelialization
Bacterial barrier and decreased infection rates

Decreased Pain

Decreased Costs

Quiz
Private Litigation: Personal Injury Lawsuits
Webb v. University Place Care and Rehabilitation Center (FL, 2012): NH facility resident x 10 years, awarded $ 900M.
- Multiple Pressure Ulcer, LE Amputation, Infection, Unexplained Weight Loss.
Olsen dba Gentiva v. Cody (FL, 2008): pareplegic with stage 2 PrU that dereriorated during course of home health care awarded $ 3.05M.

- On admission to home health: 5cm X 0.4cm x 0.2cm, 100% pink and no odor;
- Day 5: 90% pink with "fetid" odor;
- Day 14: 80% necrotic tissue, increased in drainage, fetid odor; 9cm x 8cm x 1cm, undermining;
- Day 15: 40% necrotic tissue, admitted to hospital with stage 4 coccyx PrU
*After 3 weeks of treatment in the hospital, measured 20cm x 30cm;
*Never fully healed, underwent multiple failed flap procedures.
Wound Care Documentation Consistent with Legally Defensible Care
General Principles:
Write legible! Use appropriate grammar and correct spelling;
Objective, factual, comprehensive but concise;
Chronological: document at the same time as assessment or treatment performed;
Avoid gaps in documentation: complete treatment records and wound care flow sheets;
Follow facility documentation policies: frequency, corrections, late entries;
Regular Wound Documentation
Documentation should be concise: location, stage, size, odor, quality and quantity of exudate, pain, color and type of tissue in wound bed, presence of tunneling or undermining, condition of wound edges and surrounding tissues;

Use appropriate anatomical terminology;

Offloading interventions and pressure redistribution surfaces;

Turning/ repositioning schedule.
Pic 1: TPTA Executive Committee member
Pic 2 /3 - Haiti 2010
Strategies for Success in Wound Care Litigation
The Role of
Debridement
Bacterial Balance
, Is it Infected?
Moisture Balance
. Dress for Success
Goals of Wound Care
The Skin is the largest Organ
in the Body
Depth
Sterile Q-tip. Document distance and position according to the clock for undermining or tunneling (patient’s head is 12 o’clock)
Location

Surrounding Skin
– color, moisture, suppleness

Size/Depth
- length, width, or trace and depth

Wound edges
- undermining and condition of margins

Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor

Odor

Exudate
-Quality & Quantity


Location

Surrounding Skin
– color, moisture, suppleness

Size/Depth
- length, width, or trace and depth

Wound edges
- undermining and condition of margins

Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor

Odor

Exudate
-Quality & Quantity
Location

Surrounding Skin
– color, moisture, suppleness

Size/Depth
- length, width, or trace and depth

Wound edges
- undermining and condition of margins

Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor

Odor

Exudate
-Quality & Quantity
Location

Surrounding Skin
– color, moisture, suppleness

Size/Depth
- length, width, or trace and depth

Wound edges
- undermining and condition of margins

Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor

Odor

Exudate
-Quality & Quantity
Location

Surrounding Skin
– color, moisture, suppleness

Size/Depth
- length, width, or trace and depth

Wound edges
- undermining and condition of margins

Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor

Odor

Exudate
-Quality & Quantity
Location

Surrounding Skin
– color, moisture, suppleness

Size/Depth
- length, width, or trace and depth

Wound edges
- undermining and condition of margins

Wound bed
- necrotic, granulation tissue, fibrin slough, epithelium, exudate , odor

Odor

Exudate
-Quality & Quantity
more discussion to come
more discussion to come
1 -Phases of wound
healing include:
a) hemostasis
b) Inflammation
c) Proliferation
d) Remodeling
e) all of the above
2 -Wound Assessment includes all of the following, except:
a) wound bed
b) size
c) wound edges
d) exudate
e) debridement technique
3 -Local wound
care includes:
a) Debridement, moisture balance and bacterial balance
b) Culture, ABI
c) Moisture and bacterial balance only
4 - T or F ?
Location of the wound helps identify the type of wound.
Document adverse events properly: progress notes vs incident report, record sequence of events and follow up;
Consistent: e.g., wound measurement- same clinician if possible;
Document implementation of prescriber orders for wound-related interventions;
Use patient's/ family's own words if significant;
Use approved abbreviations;
Sign, date and time entry;
Poor documentation practices undermine clinician credibility: lack of consistency in documentation raises questions about consistency of the care given.
Cont.
- Cancer is the uncontrolled growth of abnormal cells in the body.

- Cancer develops when the body's normal mechanism stops working.. Old cells do not die and cells grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor. Some cancers, such leukemia, do not form tumors.
Cancer
Full transcript