wound care education powerpoint

Summarization is a technique providers can use to wrap up the conversation or transition to a new topic by reviewing important points and confirming patients understanding and agreement with the recommendations.14, Frameworks to assist providers in implementing MI include the 5 As and 5 Rs.1 During initial conversations with patients, providers can apply the 5 As:1, If patients are not yet ready to engage in recommended health behaviors, providers can use the 5 Rs:1, When using MI, providers should respect patient autonomy. Metronidazole Gel will typically reduce odour in a few days. Dressings that seal the area off can sometimes create more moisture and heat, making the tissue more vulnerable to further damage. 10. In evaluating the effectiveness of a treatment regime, the healthcare professional should be able to clearly state the wound type and what the treatment aims were. With continued best-practice interventions, these signs indicate that the wound will most likely go on to heal. wound care specific to the type of wound. Krist A, Tong S, Aycock R, Longo D. Engaging patients in decision-making and behavior change to promote prevention. Bonham P, Flemister B, Droste L, et al. 2003. Building a foundation for brief motivational interviewing: communication to promote health literacy and behavior change. Due to the negative pressure, the wound edges are drawn in, helping to promptly reduce wound surface. Generally, the rule is: if the tissue is dry and ischaemic, then keep it dry. If this is not possible, then a skilled clinician may be able to conservatively sharp-debride the tissue to just above the viable base. Kivela K, Elo S, Kaariainen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. This wound and dressings guide will identify some of the most common wound types and guide you in setting your aim of care and selecting the best dressing or product to achieve that aim. Iodosorb powder or ointment. Bandura A. A collaborative approach to wound prevention and management also optimizes treatment outcomes. The classic signs and symptoms of each of these ulcer types can be found in the Mrs H.: [makes a face and shakes her head] I think I would rather stick with my clogs. Mesalt and 2. 2023 Ausmed Education Pty Ltd (ABN: 33 107 354 441), 4. Communication throughout the course of treatment allows providers to continue to reinforce patients motivations. Even after maintenance, relapse can occur despite temporary success.2 Providers can promote adherence by tailoring education interventions to match patients readiness to change (Figure 3). DPT: Thank you for telling me. Mepitel, Commence with one layer, if tolerated, then add another second layer but extending to only 2/3 of the lower leg and finally, if tolerance is maintained, then add another 1/3. Ann Fam Med 2016;14(2):14854. Wound care for nurses. Tubigrip) if the wound is on a limb. (4) How do patients think their wounds should be treated? Therefore, patient education should be directed toward strategies that promote venous return and reduce edema. DPT: Good point; one leg is essentially longer than the other because of the height difference between your clog and the walking boot. Aquacel Foam non adhesive, Every time you bend your finger, it puts strain on that cut and stops it from healing. Most clinicians take a watch-and-wait approach. They keep the area warm and provide a certain amount of cushioning from further damage. For women greater than 51 years of age, and all healthy adult men, the intake is recommended to be 8 mg per day. The words 'cleansing' and 'debridement' are often used interchangeably, however, they are two distinct terms to describe different management processes: The application of a fluid that is then wiped across the wound area with gentle strokes to aid in the removal of any loose, unwanted product or agent. Their complimentary wound care webinars include Diabetic Ulcers Identification & Treatment and Bariatrics & Skin Fold Management. Get new journal Tables of Contents sent right to your email inbox, www.who.int/chp/knowledge/publications/adherence_full_report.pdf, Patient-Centered Education in Wound Management: Improving Outcomes and Adherence, Articles in PubMed by Lynelle F. Callender, DNP, RN, Articles in Google Scholar by Lynelle F. Callender, DNP, RN, Other articles in this journal by Lynelle F. Callender, DNP, RN, Putting the 2019 Nutrition Recommendations for Pressure Injury Prevention and Treatment into Practice. wound healing phase. 28. Exercise caution when debriding infected necrotic tissue as bleeding may occur; generally a few days of antibiotic therapy prior to debriding is ideal when performing in a community setting. Stay on course with complimentary wound care education courses from McKesson Academy, featuring topics for CNAs and licensed nursing professionals. Should the body decide to separate the eschar from the tissue below it, the eschar then usually provides a well-demarcated edge from which to work. The term used to describe pale, grey/white tissue found at the edges of a wound. Some restrictions may apply. Personalized education enhances adherence, patient satisfaction, and wound healing.3, Providers should also consider patient perceptions that pose potential challenges to adherence. Some clinicians believe the use of silver nitrate (burning the tissue back) is the best option. With the above information, it is now time to undertake When your assessment reveals that the wound is heavily soiled, necrotic tissue is present, and/or there is the potential of bacterial colonisation, then more regular dressings will be required. (3) What is the perceived severity of the wound? Betadine lotion is used to achieve this and keep the eschar dry. The authors, faculty, staff, and planners in any position to control the content of this CME/NCPD activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies relevant to this educational activity. Products chosen at this time can remain in situ for four to five days, or even as long as seven days, depending on the absorbent capacity and nature of the wound interface material. Full thickness tissue loss, subcutaneous fat may be visible, slough may be present. Being too thin or obese, will delay healing. By expressing empathy toward patient challenges and inviting opposing viewpoints, providers can promote patient ownership and control of their own health.10. There is a misconception regarding the use of antiseptics in wound care, and healthcare professionals need to be educated on best-practice policies in relation to chemical management of infected wounds. Patient Educ Couns 2014;97(2):14757. Int J Environ Res Public Health 2018;15(9):1810. There are a number of well-identified risk factors that can lead to We can definitely talk about some other ideas besides the scooter. [produces walking boot]. Both of these processes will affect new cellular growth and hence must be addressed. This wound care vacuum cleaner will remove excess exudate and contain it in a canister, away from the wound surface. Mrs H.: Oh man, that thing looks bulky and heavy. Treatment outcomes for neuropathic ulcers are also heavily dependent on patients adherence to nutrition recommendations, blood glucose monitoring, physical activity, and weight management.27 Patient education that includes explicit steps for diet and exercise is more likely to achieve success than generic recommendations.27, Self-management is influenced by patients cognitive understanding, motivation level, and ability to troubleshoot problems and barriers.27 In patients with diabetes, low perceived severity of illness and its consequences may be influenced by family history and assumptions that diabetes is a natural part of genetics and/or aging.27 These assumptions can reduce outcome expectations and self-efficacy by creating the impression that diabetes and its consequences are unavoidable.27 Patients and providers should discuss these perceptions and promote skills that enhance self-care, including the ability to troubleshoot unanticipated problems and barriers.27 Other barriers to adherence may include the lack of measurable results for patients who are adherent yet still experience disease progression.27 These barriers can be mitigated by social-environmental support from family, friends, and community resources.28, From a cognitive perspective, the ability to record and interpret glucose measurements, calculate medication doses, and read nutrition labels requires a certain level of literacy and mathematical skill.27 Providers should also assist patients in understanding the difference between test results that show immediate glycemic control (plasma glucose level) versus long-range control (hemoglobin A1c; Table 1).27. Mefix. . 11. 'Separation of the layers of a surgical wound, it may be partial or only superficial, or complete with separation of all layers and total disruption. Granulation tissue (firm, beefy red tissue) requires some exudate management and protection. (6) What fears do patients have regarding wound treatment? Advances in Skin & Wound Care34(8):403-410, August 2021. Whilst there are some being used overseas, none of these have yet been approved for use in Australia. Hydrotul. 1: https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html, In-Office Lab Testing for Respiratory Illnesses, Cleaning, Decontamination & Sterilization, Antibacterial Foam Dressing McKesson 4 X 4 Inch Square Adhesive with Border Sterile, Silicone Foam Dressing Mepilex Border 4 X 4 Inch Square Silicone Adhesive with Border Sterile, Thin Silicone Foam Dressing Allevyn Gentle Border Lite 4 X 4 Inch Square Silicone Gel Adhesive with Border Sterile, Transparent Film Dressing 3M Tegaderm Rectangle 4 X 4-3/4 Inch Frame Style Delivery With Label Sterile, Silicone Foam Dressing McKesson 4 X 4 Inch Square Silicone Adhesive with Border Sterile, Gauze Sponge McKesson Cotton 12-Ply 4 X 4 Inch Square NonSterile, Cohesive Bandage 3M Coban LF 2 Inch X 5 Yard Standard Compression Self-adherent Closure Bright Green / Bright Orange / Bright Pink / Purple / Blue / Black NonSterile, Adhesive Strip McKesson 1 X 3 Inch Fabric Rectangle Tan Sterile, Skin Protectant Thera Calazinc Body Shield 4 oz. 18. Keyword Highlighting Effective patient education involves three essential components: self-care skills, how to recognize and respond to problems, and preventive management. Patients with venous insufficiency often need advice about strategies to protect against inadvertent lower extremity trauma, dermatitis, and ulceration.26 Effective prevention includes the use of appropriate footwear,18 skin cleansers, and topical agents.26 Additional steps that patients can take to prevent or reduce venous insufficiency and risk of ulceration include tobacco cessation.26, In patients with peripheral neuropathy, the loss of protective sensation is a primary risk factor for wounds and delayed healing. Steri-Strips and either a waterproof, light, absorbent dressing or a non-waterproof, light, absorbent, adhesive dressing, using the principles mentioned earlier about the risk of infection. However, as with protein and vitamin C, this increases to an RDI of 15-25 mg per day in individuals with a complex, slow-healing wound. Other essential self-care skills include proper handwashing, wound cleansing, and dressing changes. Flaminal Hydro or The guiding principles of wound care have always been focused around defining the wound, identifying any associated factors that may influence the healing process, then All wounds should be treated as though they have been contaminated with microorganisms 16 Immediate Care Step 1 To minimize infection, clean wound with copious amounts of soap, water, and sterile solution Avoid hydrogen peroxide and bacterial solutions initially 17 Immediate Care Step 2 Control bleeding Universal precautions must be taken to reduce Mrs H. (fictional patient) is a 60-year-old catering chef referred for outpatient wound management secondary to a nonhealing ulcer on the plantar aspect of her left foot. Iodosorb ointment/powder. Uses: fixing primary dressings, catheters and tubes. The wound has been present for more than 19 weeks and has increased in depth since onset. Acknowledging patients right to self-determination reduces the likelihood of resistance and defensiveness. Is there anything else we can do to help this stupid foot heal faster? Samples cannot be sent to PO boxes. Promoted the Vagus Nerve Stimulator for Epilepsy and Depression (VNS). It is also important that patients can distinguish good versus bad tissue. Resources include 88 Relias courses and 50+ McKesson Clinical Connection webinars. Obesity may raise concerns about skin fold infections and repeated colonisation. Wound, Ostomy and Continence Nurses SocietyWound Guidelines Task Force. 3. Whats happening now with your foot is that every time you stand or walk, it puts the same type of strain on the wound and makes it harder for the body to repair it. Wound Care Assessment 2. Once the patient and provider select this goal, the provider can use MI techniques to guide the conversation toward specific steps designed to achieve the desired outcomes. Please enable scripts and reload this page. Kelechi T, Johnson J; WOCN Society. If the wound is locally infected, the clinician may choose to manage the infective tissue with debridement and topical antimicrobials (not topical antibiotics) (Lipsky & Hoey 2009). Guideline for the management of wounds in patients with lower-extremity venous disease: an executive summary. Dressing Pressure Injuries and Ulcerations 5. DPT: I am sure that must be very frustrating for you. 2. Patient-centered education for effective self-management decreases episodes of care and reduces health expenditures while promoting independence. Scand J Caring Sci 2014;28(4):64856. Removal of necrotic tissue and management of infection is paramount to move on to the This also reduces oedema, an important aspect to consider in all instances of wound care. There are other nutrients required that also play an important role, but these four are often considered vital. Iron intake is also necessary for wound healing. Important factors include:18, Education concerning specialized nutrition requirements is particularly important for patients with underlying comorbidities, such as diabetes, renal disease, anemia, or difficulty eating.19 Dietary advice and information concerning the use of supplements can enhance patients sense of control over the wound healing process. Time constraints are one of the greatest barriers to applying MI within clinical settings.15 The pressures of a busy schedule can restrict provider ability to engage in detailed conversations with patients. If the wound is infected, then cleansing with an antiseptic solution and rinsing this off after 2 minutes will assist in reducing bacterial load. Instead of having you stay out of work, this walking boot would help redistribute the pressure on the bottom of your foot while the wound is healing. Green L, Ratcliffe D, Masters K, Story L. Educational intervention for nutrition, 20. Patient Educ Couns 2012;87(3):39894. London F. Teaching patients about wound care. Cellular growth is dependent on adequate intake of protein, vitamin C, zinc and iron. How do you think this wound should be treated? If there are any signs of infection, or if the wound was . Even if patients are reliant on caregivers to examine their skin, the ability to recognize problems and seek appropriate treatment fosters independence.23 In addition, patients and caregivers often require instruction regarding proper hygiene and skin care.23 As with other types of chronic wounds, patients with PIs benefit from education regarding behavioral risks, such as tobacco use, nutrition, hydration, exercise, and medication adherence.23, Patients with peripheral arterial disease often underestimate their risk of serious complications.24 This may stem from lack of knowledge or denial about the impact of nonadherence.24 Providers can address these issues by reviewing factors that mitigate risks, such as tobacco cessation, exercise, and proper diet.25 Further, providers should encourage patients to engage in proper self-management of common comorbidities, such as hypertension and type 2 diabetes.25 Adherence and self-care can be enhanced by teaching patients how to interpret their own test results (eg, total cholesterol and total triglycerides).25, Depending on the severity of circulatory insufficiency, it may be best to keep arterial wounds dry pending revascularization. You may be trying to access this site from a secured browser on the server. I make sure I dry it really well, and then we put a new piece of gauze on it. Metronidazole Gel. Conservative sharp wound debridement is the next best option, and is usually carried out by a skilled clinician such as a wound consultant or podiatrist. All tests are now online only; take the test at http://cme.lww.com for physicians and http://www.NursingCenter.com/CE/ASWC for nurses. European Wound Management Association 2019. There are a few enzyme products available around the world but the only one currently available in Australia is The secondary dressing on this mesh is generally a light absorbent adhesive pad, such as Opsite Post-Op, Shiny or dry. If an offloading device is used, it must be donned whenever the patient is weight-bearing, even if the patient is only going from the bed to the bathroom in the middle of the night. An additional complication could be underlying involvement of the bone (known as osteomyelitis) in deep pressure injuries. Select management options for healable, nonhealable, and maintenance wounds. Because most neuropathic ulcers occur on the plantar aspect of the foot, treatment for existing wounds often includes the use of offloading devices to redistribute pressure. I just want you to have all the necessary information to make good choices. Are you having trouble with it? Examples of adhesive foam include At the next dressing change, if there are no signs of infection, then a waterproof dressing can be used as the secondary dressing, provided all environmental considerations have been made. Issues can arise in older adults who fail to fulfil the RDIs for the required nutrients, and this is when wounds in older adults may fail to heal due to lack of appropriate nutrients. Wound Dressing 4. To earn CME credit, you must read the CME article and complete the quiz online, answering at least 7 of the 10 questions correctly. Conversations should focus on the following aspects: what actions patients should perform and what is an acceptable degree of adherence (eg, how often or how much adherence is required). As part of the plan, providers should encourage patients to discuss feasibility and usefulness of the treatment recommendations.15 The plan should also include scheduled follow-ups in person, by phone, and/or electronic communication.16, Finally, providers must remember that nonadherence can be intentional or unintentional.17 Reasons for intentional nonadherence include pain and patients perceptions regarding the feasibility and effectiveness of treatment recommendations, as well as insufficient explanations from clinicians regarding the rationale supporting recommendations.17. DPT: Would it be all right if I explained a little more about why I think the walking boot will be so helpful? The principles of effective wound care Caring for a person with a wound must be based on a complete assessment of the resident and the wound, considering both intrinsic and extrinsic factors. Wound care providers can also promote adherence by tracking goals and acknowledging patients accomplishments.2 Setting small, incremental goals promotes gradual increases in patient self-efficacy.13 These goals should be SMART (specific, measurable, achievable, relevant, and timely); otherwise, lack of attainment can discourage adherence.2 In addition, it is important for patients and providers to discuss potential challenges and collaboratively identify strategies to prevent behavioral lapses.2 Scheduled follow-ups help affirm positive results and provide an opportunity to review any unexpected barriers to adherence.13 Discussing barriers helps patients maintain positive health behaviors, strengthen commitment, and identify new strategies when necessary.13, There are two basic phases in MI: (1) eliciting change talk, that is, desire, reasons, and ability to change; and (2) promoting commitment to new behaviors.10 The mnemonic OARS (open-ended questions, affirmations, reflective listening, and summarization) describes communication techniques commonly used in MI. Wound Healing 6. Mrs H.: Well, my husband helps me take the bandage off so that I can soak my foot every night. Partial-thickness loss of dermis presenting as a shallow, open wound with a red/pink wound bed, without slough or bruising. Because you are coming back in 2 days, lets see how the walking boot works for you first. Once these parameters have been considered, an aim can be set. These wounds are generally acute and, in most circumstances, go on to heal almost regardless of what is done. Some clinicians believe maceration is overhydrated keratin and not to be worried about, however, take note that when appearing on weight-bearing areas of the body the soft, soggy edges of a wound will collapse under pressure and will become larger. activities that promote health which in turn leads to poor wound healing. Nutritional impediments to healing include inadequate protein and carbohydrate intake.19 Supplements, such as vitamins A, C, D, and E, and minerals, such as zinc, copper, selenium, and folic acid, may also be prescribed.19, Patients with mobility and/or sensory impairments have an elevated risk of pressure injuries (PIs). Wound care Management Mahesh Sivaji 970 views15 slides Current concept in Wound care national hosp abuja 1.6K views55 slides Wound management by saumya agarwal Central Institute of Orthopaedics, Safdarjang Hospital and VMMC, New Delhi 8.4K views108 slides Wound management Imran Javed 26.2K views45 slides Slideshows for you (20) Providers can help patients reframe failed attempts as opportunities to learn about ineffective approaches to adherence while identifying suitable alternatives. All surgical wounds do require support and this is an important factor both for reducing oedema and ensuring patient comfort. Student Nurse Knowledge of and Attitudes Toward Pressure Injury Prevention: How Sufficient Is Undergraduate Education? Mepitel, McDermott M, Mandapat A, Moates A, et al. Although traditional MI requires 30 to 60 minutes, brief MI can take as little as 5 to 10 minutes.10 Brief MI focuses on a single goal. Allevyn Life. Our wound care certification courses offer: Up to 60 CE/CME hours The most up-to-date wound management content created by wound-certified professionals 100% online study with unique and interactive learning tools The ability to proceed at your own pace 24/7 course access "Until-You-Pass" risk-free guarantee Miller W, Rollnick S. Motivational Interviewing: Helping People Change. Proliferation (Granulation) 4. DPT: Great! Medical professionals, medical facility employees 855.571.2100, Need help with SupplyManager?800.422.0280, Everything you need to help provide the best care for your wound & skin care patients. Active or passive exposure to cigarettes will inhibit or delay wound healing. Another consideration if colonisation is of concern, is to use generalised body skin-antiseptic cleansers to reduce the possibility of bacteria colonising from one area to another. Opsite Post-Op and Minimize time that wounds are open to air. This wound keeps getting bigger no matter what I do. Features: reduces the risk of infection, kills bacteria. After completing the WTA Program, the wound treatment associate will: Receive a certificate of completion. This tissue responds poorly to too much moisture and in most cases a dressing that protects this tissue from the effects of moisture is used. Foreign bodies and penetrating, deep lacerations may involve tendons and nerves, which will require specific specialised care. This continuing educational activity will expire for physicians on July 31, 2023, and for nurses June 7, 2024. The recommended dietary intake (RDI) of vitamin C for a normal healthy adult is 45 mg per day, however, in an individual with a chronic wound, this increases to approximately 100-200 mg per day (NHMRC 2014). Often, past failures and challenges can decrease patient confidence and ability to engage in appropriate self-care. It's a costly lesson. You have the power to prevent infections. Wound Healing and Management Node Group 2013, 'Wound Management: Debridement - Autolytic'. Pignataro R, Huddleston J. Managing odour becomes the priority. Diabetes Care 2010;33(4):7513. DPT: I understand that would be very difficult. The conversation exemplifies the use of MI techniques and theoretical frameworks. It has been my experience that an approach to bacterial load, direct pressure and dressings that will manage moisture are more acceptable. Shear, friction and pressure will all affect the wound tissue and periwound condition. Wound Tissue Types 3. Fisher L, Polonsky W, Hessler D, Potter M. A practical framework for encouraging and supporting positive behavior change in diabetes. Important questions to ask include: What caused this wound? The first thing to do before addressing any wound is to perform an overall assessment of the patient. This is exacerbated by sensory deficits that result in low or absent pain signals despite the presence of significant integumentary damage. Can we try one on to see what you think? Inammation 3. Therefore having a knowledge of the characteristics of venous and arterial ulcers is imperative to ensure appropriate decision-making regarding management of these wounds. Assessing the impact of a patient. Diabet Med 2017;34(12):165866. Hemostasis 2. Patients with chronic wounds make daily decisions that affect healing and treatment outcomes. 26. If you still dont agree, I will respect your decision. May develop thin blister or eschar over dark wound bed. Be prepared to function as an integral and valuable member of your wound care . Just like everything else we talk about, please let me know if you feel like I am crossing the line, and I will back off. The Theory of Planned Behavior: reactions and reflections. If you think this may be a concern for one of your patients, it is best to ask the pharmacist to check medications for any that could impact healing and have these discussed with the attending physician when able. Using forceps to gently scrape the tissue may also help lift debris off the wound. Iodosorb Powder or Effective education and enhanced adherence decrease episodes of care, reduce health expenditures, and prevent serious complications.3,6 Impediments to adherence encompass provider characteristics as well as patient characteristics. An antimicrobial dressing that is also absorbent and protective would be ideal. selecting the appropriate wound dressing or treatment device to meet the aim and aid the Some may lapse into earlier stages when met with challenges. Prontosan Gel, Like the HBM and TPB, Social Cognitive Theory (SCT) stresses the importance of self-efficacy. J Wound Ostomy Continence Nurs 2017;44(3):2416. How long do patients think it will take for their wound to heal? wound assessment can now be conducted. There are many things that can be done to help prevent pressure injuries, including: Regular risk, skin and tissue assessments Proactive skin hygiene Effective continence management Use of low friction equipment and devices Use of prophylactic dressings Pressure injury treatment strategies Leaper, DJ, Schultz, G, Carville, K, Fletcher, J, Swanson, T & Drake, R 2012, 'Extending the TIME concept: what have we learned in the past 10 years?'. Atrauman Ag, Price P. How can we improve adherence?Diabetes Metab Res Rev 2016;32(Suppl 1):2015.

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