A Community to Advance Excellence in Long Term Care Nursing

Question: What solution is used for specific bacteria eg. psedomonas

Answer: Dakins solution and acetic acid are both bactericidal to Pseudomonas aeruginosa, however studies show that acetic acid is more effective against Pseudomas aeruginosa.  http://tr.im/HeAK
Acetic acid is frequently used in wounds as a 0.25-percent or 0.5-percent solution.  Here is a link to research article that discusses the use of acetic acid in wounds.  http://tr.im/Heyk

Q: We have an incontinent patient that is continually experiencing skin breakdown in the gluteal folds and buttocks area, would this be considered a pressure ulcer?

A:  If the skin breakdown is related to exposure from urinary and fecal incontinence this is referred to as: incontinence associated dermatitis (IAD). Incontinence Dermatitis is characterized by irritation and inflammation of the skin from prolonged exposure to urine or stool. It can also be caused by the regular use of an absorptive containment device such as an incontinence brief or pad, which raises the pH of the underlying skin and increases production of perspiration. The clinical characteristics of incontinence dermatitis will appear as redness, blistering, erosion; lesions remain partial-thickness and free from necrosis (slough or eschar). The areas of redness may be patchy or consolidated. IAD associated with urinary incontinence tends to occur in the folds of the labia majora in women or the scrotum in men, whereas IAD associated with fecal incontinence tends to originate in the perianal area. A full-thickness wound (tissue destruction into the subcutaneous tissue or deeper), with or without necrosis (slough or eschar), reflects ischemic tissue damage and would be classified as a pressure ulcer not as incontinence dermatitis. Incontinence dermatitis is often referred to by other names including perineal dermatitis, irritant dermatitis, intertrigo, heat rash and diaper rash when noted in children. Another common description for IAD used by many nurses is “excoriated”, however this is incorrect. The definition of excoriation is a linear erosion; destruction of the skin by mechanical means. Loss of epidermis, caused by exposure to urine, feces, body fluids, wound drainage, or friction should be described as “denuded”.

Q:  What cause some wounds to stink?
A:  Research has shown that wounds most commonly associated with odor include draining wounds, chronic pressure ulcers, venous leg ulcers, diabetic/neuropathic ulcers, cancerous or malignant lesions and wounds with necrotic tissue. It is believed that most all wound odors are due to tissue degradation (decomposition) or anaerobic bacteria that have colonized within the wound tissues. Another culprit of wound odor is saturated wet dressings and bandages that contain necrotic exudate from the wound. Certain dressings, such as hydrocolloids tend to also produce odor due to their occlusive nature and the chemical reaction that takes place between the dressing and wound exudate.

Q : How many Pressure Ulcers are in the USA?
A:  Over 1 million people with pressure ulcers in the USA.  We need more clinicians out there that know about wound care.

Q: I have a saggy wound - How do you re: positioning a patient for wound measurement when the wound edges sag over the wound bed?
A:  Sagging of the wound edges generally occurs with wounds that have undermining. This is due to a lack of subcutaneous support around the wound and when combined with the pull of gravity the edges look droopy and sag making it hard to obtain accurate measurements. Position the resident comfortably with the wound as far from the sleep surface as possible; example: for a right trochanter wound, position resident on left trochanter for measurement. While measuring have an assistant apply uniform tension to both edges to keep sagging to a minimum. Do not apply too much tension that the wound looks over-stretched, just enough that the edges look consistent and the wound bed can be visualized. Upon completion include how the resident was positioned in your documentation so they can be placed in the same anatomical position each time wound measurements are taken. The purpose of measuring wounds is to track and measure the progression of healing from week to week. For the measurements to be useful consistency is the key.

Q:  Our facility was recently cited a deficiency for inappropriate treatment due to application of zinc oxide to a stage 2 pressure ulcer on the buttocks. Why is this not an appropriate treatment?

A:  Zinc oxide ointment can be used on stage 2 pressure ulcers. Appropriate use could include: superficial wound free from infection or wound with frequent exposure to moisture. Inappropriate use could include: allergy to zinc oxide, continued use of zinc oxide beyond 7 days with no improvement in wound noted, not following facility protocol - e.g. No policy or procedure in place for using zinc oxide on pressure ulcers.

Q: Should I debride stable heel ulcers?

A:  AHRQ Clinical Practice Guidelines for Pressure Ulcer Treatment: Heel ulcers with dry eschar need not be debrided if they do not have edema, erythema, fluctuance, or drainage. Assess these wounds daily to monitor for pressure ulcer complications that would require debridement (e.g., edema, erythema, fluctuance, drainage).

Q.  How can you tell the difference between slough and eschar?

A:  This is a picture of Eschar
- Slough is usually lighter in color, thinner and stringy in consistency; Color – Can be yellow, gray, white, green, brown, - Eschar – usually darker in color, thicker and hard consistency black or brown in color.