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Obstacles to Wound Care: It may take more than just a Band-Aid

Obstacles to Wound Care: It may take more than just a Band-Aid. Debra Clair, PhD, RN, CNS, WOCN dclair@neo.rr.com. Recognize and Remove Obstacles for Optimal Healing Exercise Caution With Treatment Until Cause of Wound is Known.

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Obstacles to Wound Care: It may take more than just a Band-Aid

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  1. Obstacles to Wound Care: It may take more than just a Band-Aid Debra Clair, PhD, RN, CNS, WOCN dclair@neo.rr.com

  2. Recognize and Remove Obstacles for Optimal Healing Exercise Caution With Treatment Until Cause of Wound is Known

  3. Subjective Evaluation for Obstacles What the Patient has to Say

  4. Patient’s Knowledge • “I’ve had the wound for 4 years” • “I just saw the wound there” • “My Grandma always said leave the wound open to air” • “I’ve been cleaning the wound with peroxide regularly”

  5. Patient’s History • “I’ve smoked for 40 years” • “I’m on my feet all day” • “I am (or am not) a Diabetic” • “Every time this heals, it re-opens after a couple months” • “My legs were swollen and then this area opened up”

  6. Objective Evaluation for Obstacles • Extrinsic External Assessment

  7. Patient’s Willingness to Change Patient’s Ability to Do Treatment

  8. Assessment of Extrinsic Obstacles • The patient shows signs indicative to being a smoker • The wound has signs and symptoms of infection • Bone or other structures are visible in the wound • Patient appears to have lymph edema

  9. Assessment of Extrinsic Obstacles • Appearance of old dressing • Does the patient appear well nourished • What is the appearance of the wound • Does patient appear to have vascular insufficiency • Patient is in a nursing facility: appears to be unresponsive

  10. Objective Evaluation for Obstacles • Intrinsic Testing

  11. As Appropriate Test for…. • Low blood oxygen content • Infection • Lack of perfusion • Malnutrition • Diabetes • Treatments - immunosuppressants Pulse Volume Recording

  12. Extrinsic Obstacles Patient’s History Intrinsic Obstacles Healing

  13. What about a Biofilm?

  14. A Biofilm is a community of bacteria bound together by sugary molecular strands called “extracellular polymeric substance”

  15. Over 500 species of bacteria have been identified in typical dental plaque biofilm Cunningham, A. B., Lennox, J. E., and Rockford J. R. Biofilms: The Hypertextbook. Retrieved from http://www.cbe.montana.edu/biofilmbook.

  16. How do we remove the biofilm? ? ? ?

  17. Identifying obstacles are the first steps towards healing the wound.

  18. References Boranoski, S. & Ayello, E. (2008). Wound Care Essentials: Practice Principles (2nd edition). Lippincott, Williams, & Wilkins. Cunningham, A. B., Lennox, J. E., and Rockford J. R. Biofilms: The Hypertextbook. Retrieved from http://www.cbe.montana.edu/biofilmbook. Eloquent Learning Health: Promoting Wound Care Excellence.(2008).Retrieved September 20, 2008 from http://www.eloquent.co.za/index_files/Course_details.htm.

  19. Debra Clair, PhD, RN, CNS, WOCN dclair@neo.rr.com

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