rn cathy hammond north/sat_nurses_1630... · rn cathy hammond specialist wound management service...
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RN Cathy HammondSpecialist Wound Management Service at Nurse
Maude
Christchurch
16:30 - 17:00 How to Prevent an Acute Wound Becoming Chronic
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How to Prevent Chronic Wound Becoming Chronic
Catherine Hammond CNS/CNE2016
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Acute wound Healing
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Underlying
problem
Inflammatory
cytokines
↑MMPs
↓ TIMPs
Tissue
degradation
Inflammation
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History of the wound
• How did it occur
• Duration
• Initial and on-going treatment
• Previous wounds and healing
• Pain
• Movement
• Other wounds or injuries
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Manage factors affecting healing
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Assess the wound using time
T – tissue
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Assess the wound using TIME
• I – Inflammation and infection
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Biofilm development
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Assess the wound using TIME
M – Moisture
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Assess the wound using TIME
E – Epithelializing edge
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Assess the surrounding tissue
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Interpretation of assessment findings
Determine the goals of care and outcome measures
What are the aims of wound treatment
• Debridement
• Control of infection
• Absorb exudate
• Donate moisture
• Protection
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Prioritization
•Diabetic foot ulcers
• Ischaemia
•Gross leg oedema
• Immunosuppression
• Infection
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Treat the cause
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Manage factors affecting healing
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Cleansing the wound and surrounding tissue
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Treatment of a biofilm
Broad spectrum antimicrobial
• Iodine
• Silver
• Honey
• PHMB
• Super oxidised solution
• Chlorhexidine
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Choose appropriate wound dressing
• Moist, warm environment
• Comfortable
• Free from toxic substances
• Dose not lint into wound
• Cost effective
• Does not cause trauma
• Allows gaseous exchange
• Control bacterial load
• Wick away moisture as needed
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Products Made Simple
Antimicrobials
Silver dressings PHMB
Cadexomer iodine SOS
Iodine
Honey
Donate Moisture
Hydrogels
Hydrocolloids
Absorb Moisture
Alginates
Hydrofibre
Foams
Absorbent pads
Protection
Films
Foams
Silicone
Fine woven tulle
TIME
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Prevention is better than cure
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References
Gottrup, F. Apelquist, J. Bjanshott, T et al (2013). Antimicrobials and non-healing wounds. Evidence, controversies and suggestions. Journal of Wound Care, 22(5), S1
Hubner, N & Kramer, A. (2010). Review on the efficacy, safety and clinical applications of polihexanide, a modern wound antiseptic. Skin Pharmacol Physiol 23, suppl 1, 17-27
European Wound Management Association (EWMA). (2008). Position document. Hard to heal wounds: a holistic approach. MEPLtd.
Pieper, B. (2009). Honey-based dressing and and wound care. Journal of wound ostomy and continence nursing. 36(10), 45-51
Principals of Best Practice: Wound Infection in Clinical Practice. An International Consensus. London: MEP Ltd. 2008.
Wilson, J. & Clarke, J. (2003). Obesity: Impediment to wound healing. Critical Care Nursing 26(2), 119-132