Ostomy/wound management
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Ostomy/wound management · Sep 2011
Hair braids as a risk factor for occipital pressure ulcer development: a case study.
The development of pressure ulcers in acute care settings remains an important concern, especially in high-risk populations such as patients who are critically ill and admitted to an ICU setting. In addition to immobility and other risk factors associated with critical illness, occipital pressure ulcer development has been associated with young age (neonates, infants, and young children) and patient care devices (cervical collars, bed lateral rotation). ⋯ All wounds eventually healed, but scarring alopecia at the site of the largest wound was visible. This is the first case study describing hair braids as a potential risk factor for occipital pressure-related skin dam- age and suggests that if a patient is immobile and admitted with braids, patient/family and nursing staff education should include discussing the importance of releasing the hair to decrease the risk of occipital ulcers.
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Ostomy/wound management · Mar 2011
Impact of hypernatremia on burn wound healing: results of an exploratory, retrospective study.
Severely burned patients need extensive initial fluid resuscitation. Formulas to calculate fluid needs during burn shock are well established. However, protocols for normalizing circulating fluid volume after cellular integrity has recovered do not exist. ⋯ Patients in this group underwent an average of 1.3 (± 0.8) re-grafting procedures compared to 0.35 (± 0.5) for patients without hypernatremia (P = 0.001). There was good correlation (r = 0.525) between daily infusion-diuresis ratios (IDR) and serum sodium levels, as well as between serum sodium levels and re-skin grafting occurrences (r = 0.62). The results indicate that research to confirm that hypernatremia is an indicator of dehydration and affects skin graft take is warranted and that protocols to optimize fluid volume following burn shock treatment are needed.
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Ostomy/wound management · Dec 2010
Case ReportsSevere indwelling urinary catheter-associated urethral erosion in four elderly men.
Medical devices often are overlooked as a potential cause of pressure ulcers. Indwelling urinary catheters have been described as a cause of urethral erosion. In men, the resultant partial-thickness or full-thickness wound can involve a small area of the glans penis or cleave the glans or penile shaft, requiring reconstructive surgery or urinary diversion. ⋯ As part of creating a latex-free environment, the facility had recently replaced the (softer) latex-containing catheters with new silicone catheters. In addition to providing meticulous catheter care and comfort measures for the patients, all securement procedures were reviewed and different silicone catheters were evaluated for their potential to cause pressure ulcers. This case series highlights the importance of careful evaluation of catheter materials and securement devices before selecting them for widespread patient use and emphasizes the need for research focused on catheter composition and pressure injury risk.
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Ostomy/wound management · Nov 2010
Disaster management, triage-based wound care, and patient safety: reflections on practice following an earthquake.
Triage is the process of prioritizing patient care based on need and available resources. Clinicians in wound clinics triage daily because time and resources never seem to be sufficient. The triage concept is taken to an extreme when a disaster strikes--the clinical goal of patient care transforms from the individual patient to providing the greatest good for the greatest number of patients. ⋯ The rate of under- and over-triage in wound clinics can be reduced by utilizing commonly collected outcomes and operational data. Patient safety improves when the hierarchy is flattened, communication is open, checklists are used, debriefings are held, and teamwork is encouraged. Reflecting on the working conditions in Haiti, it is clear that patients and clinicians benefit when success is measured by patient outcomes instead of individual accomplishments.
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Since Sackett et al established the defining principles almost 20 years ago, the concept evidence-based medicine (EBM) has grown and is reflected in the current US healthcare reform debate. To determine the relevancy of EBM elements to wound care, a review of the literature was conducted using several electronic databases. English-language literature was searched for articles published between 1985 and 2009 with regard to EBM principles, study design, systematic reviews, meta-analysis, safety, and clinical practice guidelines to find insightful and balanced studies and commentary. ⋯ Research also suggests that clinical practice guideline implementation studies are needed if their content is to be fully appreciated by practicing clinicians. Thus, while EBM has advanced considerably in the last 20 years, tradition-based care is still evident in wound care. The challenge is to ensure EBM continues to integrate individual clinical expertise with the best available external clinical evidence from high quality research.