Skin tears are injuries to the skin that happen when you bump into, hit or fall onto something. This can cause the skin to rip or tear. They can also occur from a caregiver grabbing a person by the arm to help them reposition in bed or even to stand up. Simply holding onto the persons arm can cause the skin layers to separate and tear causing an open wound. Your skin is made of collagen and elastin. These help your skin stay strong and flexible. As you get older, your body makes less collagen and elastin. Your skin becomes thinner and dryer. Your body also makes less oil to lubricate your skin. It also takes your skin two times as long to repair itself when you are older. All of these things will make you more likely to get a skin tear if you bump into something. If you get a skin tear, it is important to treat it quickly. Some skin tears will pull a flap of skin up. If this happens, clean the area and try to put the flap of skin back in place to. Wash the wound with a wound cleanser or saline, pat dry, apply an antibiotic ointment and cover with a clean non-adherent bandage. If you are able to place the skin back in place, the skin will provide protection to the open wound in order to prevent infection.
If you have had venous disease for a long time, you are at risk of getting ulcers (wounds) on your legs. A venous ulcer is the most common type of leg wound.
When blood “pools” in your lower legs and ankles, your veins and smaller blood vessels swell. You may have swelling in your legs that gets worse later in the day. The best management of edema in the lower legs is to keep them elevated as much as possible. This can be difficult for someone who is active. It is recommended that both legs be elevated at least thirty minutes three or four times daily. Minimizing the swelling is critical to help prevent wounds or to aid in the healing process of an open wound. You may also have varicose veins. When this happens, they may leak blood cells and fluid into the nearby tissue. Over time, this tissue breaks down and a wound forms.
Venous ulcers are most often found on the inside of your leg, just above your ankle. As part of your daily foot care, look for signs of a wound. If you have a venous ulcer, it will most likely:
• be moist to the touch
• be shaped with irregular (jagged) edges
• be dark red or yellow in color
• drain a lot
• be large
• pain is relieved by elevating the legs
The goals of treatment are to reduce edema, improve ulcer healing, and prevent recurrence. The treatment regime may include compression therapy which is the standard of care. Compression can be accomplished with use of a 2-layer, 3-layer or 4-layer dressing. This will be determined by the treating physician. Intermittent pneumatic therapy is also utilized in some circumstances; however, the benefit is still unclear.
Reducing edema in the lower extremities can also be accomplished by elevating them. It is recommended that the patient elevate the legs at least 30 minutes three to four times daily.
The treatment of any open wounds is not specific for venous ulcers. The dressing is determined by the appearance of the wound bed and the amount of drainage. Often times the wound bed is covered with slough; therefore, it is necessary to debride the wound. Debridement can be achieved through several different methods.
Autolysis uses the body’s own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved usin an occlusive or semi-occlusive dressings which will maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films.
Enzymatic debridement is another method of debridement.Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective, while some are not. This method works best on any wound with a large amount of necrotic debris, or with eschar formation.
Mechanical debridement is a technique that allows a dressing to proceed from moist to dry, then manually removing the dressing causes a form of non-selective debridement. This method works best on wounds with moderate amounts of necrotic debris.
Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement. They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind. Surgical debridement can be performed in the operating room or at bedside, depending on the extent of the necrotic material. This method works best on wounds with a large amount of necrotic tissue in conjunction with infected tissue in the wound.
We are all a team. The patient, family members and other caregivers are all part of the team. Our goal is to provide timely, efficient and cost effective wound treatment that promotes the best healing environment for the individualized wound patient. We provide wound assessment and treatment recommendations for accute and chronic wounds. Please visit http://www.mywoundconsultant.com for more information on elderly care and wound care options. We also provide products that will aid in the care of the elderly and all home bound patients.
A diabetic ulcer is a wound on the foot. This includes the toes, heel, and the top or bottom of the foot. Tiny blood vessels carry oxygen and nutrients to the skin and tissue. When the blood is cut off and the tissue does not get oxygen and other nutrients, the skin and tissue begin to die. Then a wound forms.
When you have diabetes, neuropathy occurs. Neuropathy is nerve damage and loss of feeling which most often occurs in your feet and legs and may change the way you walk and stand. You may injure yourself and cause a wound, but not feel it because of the loss of feeling.
Diabetic ulcers are most often caused by the following:
• Trauma—an injury or tear in your skin that you may not have pain with due to loss of feeling
• Pressure—bones in your feet change due to neuropathy and you may lose fatty tissue in your feet. This can put more pressure on the tissue in your feet and can cause a wound. Calluses may form on your feet that also cause pressure.
• Vascular disease—poor circulation and decreased oxygen supply to the tissues causes your feet and legs to be dry and the skin to crack. The combination of bacteria and moisture accumulating in the cracks of the skin may lead to infection and wounds begin.
As nurses it is very important to educate our patients on proper foot care:
- Inspect feet daily
- Report any foot problems to podiatrist or MD.
- Wash feet daily with warm water and soap, rinse well and pat dry especially between the toes.
- File nails straight across. Have podiatrist clip nails to decrease risk of injury or infection.
- Wear well fitted socks and shoes, wear shoes that support.
- Avoid going barefooted.
- Avoid exposing feet to extreme temperatures.
- Avoid tobacco.
Wound Consult available:
I have the opportunity to observe in a Houston area wound care center once a week. I always enjoy this time because it provides me with the chance to learn more about wound care. There are two different physicians that I follow and they each seem to have a favorite product they love to use. Santyl ointment is one of those products. Although I have used this product for a long time, I have learned a few facts about it recently.
Collagenase Santyl® Ointment is a sterile enzymatic debriding ointment which contains 250 collagenase units per gram of white petrolatum USP. This is something we do know.
But, do you know the answers to these two simple questions?
Please answer the above questions and stay tuned for the answers later this week. Santyl is an expensive ointment and can be difficult for most patients to afford. The next post will give handy tips to help you learn how to best use this product to provide the best results in the least amount of time. You may be surprised by this simple solution.
How do feel about Santyl ointment? If you have used this product on wounds, have you had good results? Did you know that the wound cleanser you are using may affect the benefits of Santyl ointment?
Several years ago I felt that Santyl was just another expensive product that most patients could not afford and did not even work. Little did I know that products I may have used was actually interfering with the results I was getting and delayed the healing process. If you need information on which cleanser to use and how to make this product work for you, please share your questions or concerns.
I have a new patient I saw this past week for the first time. I will call him Bob. He has a stage 3 pressure ulcer on the sacrum which was much smaller until he was hospitalized. After coming home the wound now measures 12.5 x 6 x 2.5, it has 90% thick, yellow-brown slough with pick tissue visible at 12 o’clock and 6 o’clock. Undermining is present at 12 o’clock measuring 3.0 cm using a 6″ Q-tip and when inserted bone is felt. Tunneling is noted at 6 o’clock, when using a 6″ Q-tip I am able to insert approximately 3.0 cm until the cotton-tip protrudes through a 0.5 cm opening superior to the anus.
What would you do for this patient?
If you would like to see the photo taken, please message me individually and I will be happy to share it with you on that basis.
I am very interested in your nursing judgement for this patient. I will post in 2-3 days to let you know what treatment regime I initiated and how it is going. At that point, I may consider options nurses share on this post. Thanks.
It is difficult to explain how Judith was such a nice, sweet lady, but at the same time most nurses seemed to dread having to see her. She was in her late sixties, was diabetic, weighed over 350 pounds and used oxygen to assist her breathing. She suffered from incontinence of urine and therefore; she required an indwelling catheter which had to be changed on a monthly basis. Judith was actually on nursing service for the treatment of a chronic wound on her sacral area. She had this wound for years. At one time she had it surgically closed, but since that time it had returned due to the constant pressure from sitting in her wheelchair. Because of her weight, Judith had a hard time getting around and spent most of her time in bed or sitting in the wheelchair. As a result it was difficult to treat her wound.
I saw Judith three times a week. I decided to see her first thing in the morning in order to get her visit done and move on to the next patient. Her visits would normally take at least an hour regardless of what needed to be done. Judith looked forward to the nurse coming. She didn’t get many visitors and once I arrived, she literally talked the entire time. She would ask about each of my family members, tell many about her family, share pictures, brag about her grandchildren and on and on. She never ran out of things to talk about.
Since Judith had such a difficult time getting around, she had to rely on others to help her with simple tasks. Therefore, when I arrived she took advantage of that time to have me do little odds and ends for her. It could be as simple as emptying the trash, moving stuff around or getting her a drink to keep by her bedside. I would quickly do the little tasks for her, pick up my books and actually walk backwards towards the door as we came to a stopping point in the conversation.
What was it about Judith that bothered me? Why did I dread going to see her? She was such a nice lady and just needed someone to talk to. I started to pray for Judith each day when I traveled to her home. I asked God to help me to find joy in seeing her and to give me a love for her.
ღ HEART ACTION
Matthew 5:41 And whoever, compels you to go one mile, go with him two.
I had to make the decision to go the extra mile for Judith. Instead of dreading all the little things she was going to ask me to do. I decided to surprise her. Instead of waiting for her to ask me, I started asking her what I could help her with before I would leave. Sometimes I would just start emptying the trash or picking up items from the floor. The one thing Judith like the most was have a large drink beside her bed and it was not just any drink. She liked a large cup, filled with as much ice as possible before filling it with kool-aid and making sure the straw was all the way to the bottom. Her drink was almost like a snow cone. I even practiced getting it perfect each time. I found ways of making it easier like putting the straw in first before packing it with ice so the straw would always be all the way to the bottom, yet the ice would stay packed the way she liked it. I made her visit like a game. It was a challenge but once I concentrated on how much I could get done for her I found a joy of helping her instead of the dread I once had when I felt like I was being taken advantage of. Judith was a mission field I faced one mile at a time.