RN Cathy Hammond North/Sat_Nurses_1630... · RN Cathy Hammond Specialist Wound Management Service...
Transcript of RN Cathy Hammond North/Sat_Nurses_1630... · RN Cathy Hammond Specialist Wound Management Service...
RN Cathy HammondSpecialist Wound Management Service at Nurse
Maude
Christchurch
16:30 - 17:00 How to Prevent an Acute Wound Becoming Chronic
How to Prevent Chronic Wound Becoming Chronic
Catherine Hammond CNS/CNE2016
Acute wound Healing
Underlying
problem
Inflammatory
cytokines
↑MMPs
↓ TIMPs
Tissue
degradation
Inflammation
History of the wound
• How did it occur
• Duration
• Initial and on-going treatment
• Previous wounds and healing
• Pain
• Movement
• Other wounds or injuries
Manage factors affecting healing
Assess the wound using time
T – tissue
Assess the wound using TIME
• I – Inflammation and infection
Biofilm development
Assess the wound using TIME
M – Moisture
Assess the wound using TIME
E – Epithelializing edge
Assess the surrounding tissue
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
Prioritization
•Diabetic foot ulcers
• Ischaemia
•Gross leg oedema
• Immunosuppression
• Infection
Treat the cause
Manage factors affecting healing
Cleansing the wound and surrounding tissue
Treatment of a biofilm
Broad spectrum antimicrobial
• Iodine
• Silver
• Honey
• PHMB
• Super oxidised solution
• Chlorhexidine
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
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
Prevention is better than cure
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