Wound Care

Wound Care
Opening statment
1. Hello everyone, Im JJ. Today I'll be talking to you guys a little bit
about wound care, focusing on bed sores. What it means to be a

wound care nurse, skills and qualities you should possess, who's at
risk, the different stages of wounds, treatment.
What is a wound care nurse/ requirements?

2. A certified wound care nurse is specialist who assess, treat, and
monitor patient's wounds and promote health management practices

that prevent recurrence.
3. These nurses work in hospitals, wound care centers, home health care
services, nursing homes, long-term care facilities, hospices and public

health agencies. Because their services are rarely needed on an
emergency basis, they generaly work daytime hours with evenings,
weekends, and holidays free.
4. To be eligible for certification there's certain qualifications you must
meet including holding a bachelor's degree as well as one of the

additional requirements that I'm going to list:
Complete a wound care education program accredited by
the wound ostomy and continence nurses society.
1.
2. Complete a graduate level nursing program with documented

graduate clinical course work of two semester hours
3. Complete 50 continuing education contact hours in wound care
over the most recent five years and 1500 clinical experience hours over the
past five years (with at least 375 hours within the year prior to applying for
certification).
4. Once you've completed that, in order to receive your credential
nurses must pass a certification exam administered by the wound ostomy
and continence certification
Necessary skills and qualities a wound care nurse should possess?

5. Excellent assessment skills. What stage is it? Is the wound getting
better or worse?
6. Excellent documentation skills. You have to complete meticulous
paper work on the progress of wounds to avoid liability. You might

have to take daily or weekly pictures of the wound, and chart clearly.
1.
Importance of ED physical assessment
2. Nurses
also have to be on the look out
Excellent communication skills. You will be communicating with

doctors regarding wound care orders. You also have to educate patients and
families on possible care of wounds at home.
III.
IV. Excellent
interpersonal skills. You'll be collaborating with case

management, the lab, suppliers of wound care products, pharmacy, physical
therapy, dietary, Doctors, home health agencies, and others.
Tolerance?
You also need to tolerate seeing different types of wounds at varying stages.
Skin
7. Largest organ in the body
8. Protection
9. Imune function, temperature regulation, and vitamin production
10. The skin is a dynamic organ in a constant state of change; cells of the
outer layers continuously shed and replaced by inner cells moving to

the surface
What are bed sores?

11. Also called pressure sores or pressure ulcers- are injuries to the skin
and underlying tissue resulting from prolonged pressure on the skin.

Bed sores most often develop on skin that covers bony areas of the
body, such as heels, ankles, hips and tailbone
Causes?
12. Bedsores are caused by pressure against the skin that limits blood
flow to the skin and nearby tissues.

13. Sustained pressure. ex: Wheelchair or bed where you are in the same
position for long periods of time

14. Friction. Friction is the resistance to motion. It may occur when the
skin is dragged across a surface, such as when you change position or

a care provider moves you.
15. Shear. Occurs when two surfaces move in opposite direction.
Elevating head of bed, sliding down. As the tailbone moves down, the
skin over the bone may stay in place, moving in opposite direction.
There are risk factors associated with pressure sores

People are at risk if they have difficulty moving and are unable to easily
change position while seated or in bed. Immobility may be due to
Generally poor health or weakness
Paralysis
Injury or illness that requires bed rest or wheelchair use
Recovery after surgery
Sedation
Coma
Other factors include:
Age: The skin of older adults tends to be more fragile, thinner, less
elastic and drier than the skin of younger adults. Also older adults
usually produce new skin cells more slowly
Lack of sensory perception: Maybe the patient has a spinal cord

injury or a condition where they may not be able to feel pain or
discomfort, so they wouldn't know if they were developing a sore
Weight loss: When some patients are sick, they may not have an
appetite. Muscle atrophy and wasting are common in people with
paralysis, so the loss of fat and muscle provides less cushion between
your bone and the surface of a bed or wheelchair.
Poor nutrition is also a concern: You need fluids, calories, protein,

vitamins and minerals in your diet to maintain a healthy skin and
prevent the breakdown of tissues.
Excess moisture or dryness: Skin that is moist from sweat or lack of

bladder control is more likely to be injured. Dry skin can increase
friction.
Bowel incontinence: Bacteria from fecal matter can cause serious

local infections and lead to life-threatning infections affecting the
whole body
Medical conditions affecting blood flow: Diabetic patients are at

risk because it takes longer for their wounds to heal
Smoking: It reduces blood flow and limits the amount of oxygen in

the blood. Smokers tend to develop more-severe wounds, and their
wounds heal more slowly
Now what are wound care nurses looking for when they are evaluating a
bed bedsore?
Size and depth
Check for bleeding, fluids or debris in the wound can indicate severe
infection
Odors can indicate an infection or dead tissue
Check for other pressure sores. If you have one you prolly have
another
Stages of wound healing
Stage I: The skin is not broken. Skin is red on people with lighter
skin color. The site is tender, painful, soft, warm or cool compared
with the surrounding skin.
Stage II: The outer layer of the skin (epidermis) and part of the
underlying layer of skin (dermis) is damaged or lost. The wound may
be shallow and pinkish or red. The wound may look like a fluid filled
blister or a ruptured blister.
Stage III: The ulcer is a deep wound. The loss of skin usually exposes
some fat. The ulcer looks crater-like. The bottom of the wound may
have some yellowish dead tissue. The damage may extend beyond the
primary wound below layers of healthy skin.
Stage IV: Usually shows a large-scale loss of tissue. The wound may
expose muscle, bone or tendons. The bottom of the wound likely
contains dead tissue tha'ts yellowish or dark and crusty. The damage
often extends beyond the primary wound below layers of health skin.
Unstageable: The wound is considered unstageable if its surface is

covered with yellow, brown, black or dead tissue. And its not possible
to see how deep the wound is
Treatments
Repositioning: you wanna relieve the pressure that caused the sore in
the first place. Bed bound patients need to be repositioned every two
hours >supine, right side, left side. If you're in a wheel chair it's
recommended to shift weight every 15 minutes
Cleaning: Very important. you don't want infection. If its a stage I

where the skin isn't broken, you can wash with water and mild soap
and pat dry. If it's a open sore you need to use sterile saline solution
each time the dressing is changed.
Applying dressings: films, gauzes, gels, foams. It depends on the size

and severity of the wound, amount of discharge, and the ease of
placing and removing the dressing.
Remove damaged tissue: To heal properly wounds need to be free of

damaged, dead, or infected tissue. Removing the tissue is called
debridement
Antibiotics: Infected wounds that are not responding to other

interventions may be treated with topical or oral antibiotics.
A healthy diet: An increase in calories and fluids, a high-protein diet,

and an increase in foods rich in vitamins and minerals
TYPES OF SUPPORT SURFACES

Replacement mattresses: Mattresses with pressure-reducing features placed
on an existing bed frame in place of a standard mattress

Overlays: A support surface placed on top of a standard mattress; made of
foam, water, gel, air, or a combination
Foam: A thick slab of foam with a textured surface placed on top of a
standard mattress to reduce pressure by surrounding the body; should be at
least 34 inches thick to be effective at reducing pressure (2 inches is for
comfort only)
Water: A vinyl mattress or overlay with sections filled with water to
distribute pressure more evenly and create a flotation effect
Gel: Made of a thick fluid that conforms to the contours of the body
Air: A vinyl mattress or overlay inflated with a blower to reduce pressure;
powered or dynamic mattresses have a pump that inflates the mattress
sections in an alternating cycle
Lowair loss: A mattress or overlay with controlled air-flow sections
Air-fluidized: Uses a high rate of blown air to fluidize fine particulate
material (such as silicone beads) to float the patient on the surface

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Wound Care

about wound care, focusing on bed sores. What it means to be a

What is a wound care nurse/ requirements?

monitor patient's wounds and promote health management practices

services, nursing homes, long-term care facilities, hospices and public

meet including holding a bachelor's degree as well as one of the

2. Complete a graduate level nursing program with documented

and continence certification

Necessary skills and qualities a wound care nurse should possess?

paper work on the progress of wounds to avoid liability. You might

Importance of ED physical assessment

also have to be on the look out

Excellent communication skills. You will be communicating with

interpersonal skills. You'll be collaborating with case

outer layers continuously shed and replaced by inner cells moving to

What are bed sores?

and underlying tissue resulting from prolonged pressure on the skin.

flow to the skin and nearby tissues.

position for long periods of time

skin is dragged across a surface, such as when you change position or

There are risk factors associated with pressure sores

Generally poor health or weakness

Injury or illness that requires bed rest or wheelchair use

Recovery after surgery

Other factors include:

Lack of sensory perception: Maybe the patient has a spinal cord

Poor nutrition is also a concern: You need fluids, calories, protein,

Excess moisture or dryness: Skin that is moist from sweat or lack of

Bowel incontinence: Bacteria from fecal matter can cause serious

Medical conditions affecting blood flow: Diabetic patients are at

Smoking: It reduces blood flow and limits the amount of oxygen in

Size and depth

Odors can indicate an infection or dead tissue

Stages of wound healing

Unstageable: The wound is considered unstageable if its surface is

Cleaning: Very important. you don't want infection. If its a stage I

Applying dressings: films, gauzes, gels, foams. It depends on the size

Remove damaged tissue: To heal properly wounds need to be free of

Antibiotics: Infected wounds that are not responding to other

A healthy diet: An increase in calories and fluids, a high-protein diet,

TYPES OF SUPPORT SURFACES

on an existing bed frame in place of a standard mattress

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