Nursing and the Wound Care Dilemma

Wound Care in recent years has become big business. As a medical specialty group wound care has grown into a competitive market of the larger medical services provider industry. Wound care has also made a name for itself by providing mobile services. For many at-home patients and institutional clients without in-house debridement doctors, this is a winning solution.

But many patients receiving wound care by such onsite providers have to wrestle with a whole new set of problems. Because of the frequency and the proximity of the new surgeon’s provider visits, this brand-new physician now rules over the patient’s care plan. This random new doctor now is the most influential surgeon in the patient’s orbit.
In the medical world, certain conventions of eminence and integrity are assumed. A physician is generally esteemed by the level of education attained, the prestige of their academic credentials and their source, and the work history performed after graduation. The prestige of the places a physician works after graduation and the relative importance of their work experience determines the opportunities in the medical industry. This also predicates their authority in future patient care giving advice.
The occupational issues the physicians will come up against in the medical community will be a reflection of their formal training. But a position in wound care is due to years spent practicing in the field of wound care medicine. This standing
comes after years, sometimes decades working in professional medical care. Patients receiving wound care services almost never choose the doctor or know anything about them, unlike other types of doctors.
Mobile wound care surgeons analyze the condition of the skin. They measure and record the size depth and breadth of wounds and infected areas. The debridement surgeon can advise new courses of treatment. The wound care surgeon can also discontinue applications if treatments he or she finds detrimental or causeless. They may dismiss effective regimens without a second thought.
Soon the orders for the wound care may bear no similarity at all to the most successful and most impactful wound care regimens the patient has known. No other services can be authorized anymore. The patient is cornered. Then in addition to the discomfort and trauma of heavy infections, the wound care patient is twice over a victim. He or she will be left scratching their head, wondering ‘How did I get here?’

Medical provider services are part of an industry that makes money not doing its job. The more disorders, wounds, lesions, and infection that occur, the more money the hospitals, clinics, and services providers make. Of the gargantuan corporate behemoths that run modern medicine, all of them run on a modern theme: Sickness is an income opportunity.

Wound Care is a segment of an industry that nevertheless subscribes to business drivers that try to curry relationships with their business-to-business clients. In this particular, the patron is the long term care facility or Home Health corporation the patient belongs to. This means that a side contract is attached to the agreement between the physician and the patient. In the B2B world, this means that the interests of the facility and their case management prerogatives come before the wishes of the patient. While the patient may be under the impression that they are in partnership trying to improve their wound care ailments, the real boss of the situation is the facility or Home Health provider management.

This is a dilatory arrangement, as the patient will take consideration of other providers’ advice, including that of the PCP, assuming ongoing wound care success. They may discuss and develop the care plan with a projection of straightforward cooperation from the wound care service. But this assumption may be unwarranted. After making communications with other physicians regarding treatment, medication, and new therapies, the patient may find that the care plan is the victim of a hostile takeover.
Now the patient has heard so many different opinions about her case she feels seasick. After years of listening to persuasive opinions about treatments, the pendulum never rests. There is an endless cycle of wound care referral, the provider’s care initiation, the physician’s kindly bedside manner and befriendment. Then comes the sales pitch, the heavy sell, the isolation from other treatment doctors, and then the coup de gras. The wound care physician announces “It’s my way or the highway”, and the patient wonders how they got into this mess.
Now, all the documentation sets up the wound care provider as the decision-maker of the care plan. Nurses would do well to assist patients in coping and dealing with their doctors double-crossing them. Nurses and counselors should update case managers and family members if the observe patients feeling upset and confused by unsuccessful efforts to make their wishes understood. The concept of respecting resident rights is one that nurses should apply very seriously to all their charges.

The wound care physician now holds the upper hand and if the patient does not obey orders, the doctor can fault the patient for not being compliant. This can discredit the patient with the medical insurer. Documentation like this can risk the patient losing their medical coverage.
All of the assurances and advice that the patients received when other physicians were following the along the case somehow now gets lost. And it is surely a sheer coincidence that the recommendations of the most recent wound care visits dovetail with the least cost scenario for wound care treatment.
Nurses should recognize when patients feel distressed about any treatment they are receiving. But the impetus of hospitals and long term care facilities is to allow the business drivers of any medical care instituion have the last word.
Nurses today must decide whether to honor patient wishes or put the fiscal gains of their employer first.
This is the wound care dilemma for nurses. To step forward, and help, or do nothing, and hinder the situation. Nurses must acknowledge when the transparency and quality of patient care is compromised by the absence of patient consideration. Nurses must also operate with loyalty toward their employer. For nurses experiencing the above referenced type of scenario, serious reflection should ensue. These issues should make nurses everywhere advocate for patients who are getting manipulated by the ‘system.’
And professional nurses will serve their ethics best by obeying traditional standards of nursing handed down by generations. Namely, to put patient health, welfare, and recovery above all other considerations. Monetary and otherwise.

Chronic Pain Syndrome

A severely challenging condition threatening patients today is chronic pain syndrome. This occurs when various parts of the body and mind come together is a constantly recurring cycle of pain throughout the body. When it occurs, chronic pain syndrome can also affect certain areas of the body after they have been injured, wounded, or operated upon. The pain can be general or it may be concentrated, such as in the temples, legs, hands, or chest and back. A skilled physician experienced in observing chronic pain syndrome can assign this diagnosis and track the symptoms in their quality, severity, and consistency.
The hard part about treating chronic pain syndrome is that to many people it sounds like the typical complaining any patient might do. But the persistence of this kind of pain, its general presence, and the way it avoids being treated by drugstore or over-the-counter painkillers is one clue that chronic pain syndrome is present. Another trait of chronic pain syndrome is that it can subsume after a burst of general health, but then after a period the overall condition can suffer. The patient’s health will weaken and then the chronic pain syndrome can re-emerge when the patient’s overall sense of well-being or general health correspondingly weakens.
For reasons such as these, people in the main confuse chronic pain syndrome with “getting run down”. People in good health maintain regular cycles of endorphins and a balance of hormone. But depression and chronic pain sufferers actually alter the chemicals in their body and brain over a period of time when their behavior alters. Self-injury and accidents can occur as patients become more clumsy and careless dealing with another day in pain. Their impulses to deal with their stress and pain do not take healthy roads and the results can be seen in the way people stop taking care of themselves.
But with chronic pain syndrome, damaged nerves can keep up live pain enactions upon the central nervous system and mind long after the flesh and other damaged or diseased areas have been repaired. The axons of neurons keep firing and “informing” the brain of pain that in fact is no longer being inflicted. The patient feels pressure and the slightest sensation with a magnification that few nurses initially can credit. Just getting dressed, driving, and/or working activities can be physically and mentally impossible for some patients with chronic pain syndrome.
This can affect patients recovering from a long disease, suffering from other conditions at the same time, or suffering from chronic pain as a complication of other conditions, wounds, or diseases of the body. The physical treatment of the chronic pain syndrome also involves attention paid to the creative fulfillment, intellectual stimulation, connection to nature and energetic physical endeavors of the patient to put balance back into their routine. But many patients suffering from chronic pain syndrome are not ready for these interventions yet.
Not by medication alone can chronic pain syndrome be treated. And in some cases, patients will report as few as a two to three hours a day or even in one week when they can handle activities such as writing, reading, reviewing accounts, discussing business affairs, or even concentrating on complex ideas or complicated matters. The patient recognizes this loss even as they battle it being lost. The mental attitude of a chronic pain syndrome patient cannot convert chronic pain into nothingness, but a sharpened perspective and a better-motivated alertness to the positive side of things can assist in keeping the chronic pain from controlling and ruining one’s life.
Nurses taking care of patients with chronic pain syndrome will have some difficulty moving them out of a mode of lethargy and into a spirit of motivated exercise. Movement is a key way to change the ingrained tendencies toward “moping” and dwelling on the pain that chronic pain syndrome involves. Patients such as this need to be urged to get out once in a while, make lists of things they like to do and schedule them. Sufferers of chronic pain syndrome must take an active role in combating the wear and tear of the disease. The behavioral aspect of their choices can overtake their neurobiological symptoms.
Chronic pain patients, especially the elderly, develop patterns of coping with their pain that may not seem helpful to outsiders. But survivors of wounds, attacks, diseases, and other complicated life events will nurse problematic chronic pain conditions for the rest of their lives. This is in contrast to the acute care approach to many painful issues in the otherwise straightforward assistance that urgent care patients receive. But long-term care and elderly patients will usually have an onset of chronic pain syndrome with the severely worsening of arthritis, osteoarthritis, sciatica, and back pain.
Unfortunately, not a lot of physicians train or prepare their patients on how to deal with chronic pain syndrome psychologically. Pharmaceutically the plan of care can treat the pain as it occurs or worsens. But the ongoing struggle with the challenges of chronic pain syndrome, complex and long standing, are unique to the individual patient in many cases. Because many chronic pain sufferers avoid public places, noise, chaotic events like concerts or music clubs, and unpredictable and physically demanding environments, they develop a coping system of this avoidance and they become viewed as “shut-ins”. The outsider observes the behavior of avoidance and misses the fact that there is reason and a pattern of behavior behind it. The patient is just trying to avoiding trigger situations where their chronic pain can be set off.
Nurses can keep an eye on their chronic pain syndrome patients and counsel them about their health. Nurses and case managers can provide helpful advice about how to spend their free time as well as enhance the attention paid to details other than their vital statistics and medication schedules. Such patients may be suffering from depression because of their inability to deal with their chronic pain syndrome. Nurses spend a good deal of time talking with patients. They hear how the patients speak of themselves. These patients may need to learn to interrupt negative belief systems, they may need encouragement and praise, and they may need to find ways to reward themselves and learn new ways of spending their time.
Sufferers of chronic pain may give out signals that friends and relatives do not understand. And chronic pain sufferers do not like to advertise how much pain they are in. They can mask their problems with overeating, Internet surfing, “quick-hit fixes” like smoking, video games, light movies or soft drinks. These activities can hijack feelings of serious ongoing pain in extremities, the temples , in the lower back or neck, et cetera. Sufferers of chronic pain may not understand that they have a serious problem, and may simply put their issues down to emotional problems or being unsuccessful at functioning to a higher standard.
Patients dealing with chronic pain syndrome will plot ways to avoid dealings with their pain by avoiding exercise or going out, to compare themselves unfavorably with others. They know their health is in decline, they just may not understand why. Chronic pain victims will isolate themselves and often appear erratic and eccentric. Chronic pain sufferers can cope with sudden and uncontrollable pain by stomping their feet,(to displace nerve pain) drinking, (to numb the nerve pain) watching TV, (for distraction), playing music (to give the pain white noise to play against) , and/or driving too fast, (because they can’t control the pain in their limbs and leg nerves). Or, when suffering from unpredictable intensities of chronic pain patients may cancel appointments and social engagements because they can’t anticipate when the pain will peak.
The solution to a problem with chronic pain is to concoct a care plan with many moving parts . This plan then becomes the patient’s responsibility to keep those moving parts improving and going, growing and becoming better. These are significant goals that can alter the quality of life for sufferers of chronic pain syndrome. The many motifs in a successful care plan for chronic pain syndrome are simply a roadmap to access all the information involved and plot a best case scenario. A nurse can assist any patient in the parts of the care plan they feel most comfortable with. Sometimes just visualizing a better frame of mind or achieving small goals can be helpful to the health of the patient. Nurses should refer their patients showing symptoms to chronic nerve pain specialists, or care plan managers.

Spinal Cord Nursing Notes-Treatment

The contusion condition of the spinal cord requires careful nursing and treatment advice. Nursing of this type of patient and providing health care must allow for direct spinal cord adjustment within the spinal cord nerve housings as well as delicate avoidance of the nerves controlling respiratory action and organ failure.

The spine is one of the most challenging nursing assignments on record. The unconscious nervous system is only treated in cases of shock and failure by contact with technological machines which preserve their action. However, the physician will estimate in what cases this will bring about total recovery or dependence ultimately on machines for any wellness caliber at all.

The variety of symptoms will surprise nonmedical personnel, but to trained nurses they will signify a serious underlying condition or set of underlying spinal injuries. Lack of voluntary muscle control, and appearance of having no spinal reflexes, perception of light and perspiration as well as obvious bladder failure and bowel dysfunction will make nurses remind the physician to assess the patient using the neurological scale. The basis of total paralysis to active movement should be universally objective.

Nurses should practice making observations to test their independent ability to rate active movement  and the continuum to total paralysis. These assessments will not be purely physical symptoms.  Bowel dysfunction is indicative of central nerve failure the ability to control motor actions should indicate a lapse in spinal activity control overall. If the physician is so informed of any lack of active ovement, a new appraoc to patient care that involves the patient’s immobility should be udnertaken. Cervical collars, stretchers, and backboards must be used as soon as any of th attending staff observe lack of motor senrry volition.

If the EMT staff, the nurses, the physicians, and the participants in a surgery do not observe the signs of spinal cord injury, then the symptoms may be occluded by injuries and traumatic accident recoveryside effects. When the field officer makes the necessary report, a protocol spinal cord recovery program should be observed. in this way, every patient admitted to critical care for any medical trauma will be checked for lack of motor control and other spinal cord related functions.

When the SCI paralysis test is failed, this does not mean there will never be any spinal cord injury. It means that the patient as it stands currently does not show signs of spinal cord injury. However any damage suffered from lacerations, contusions, concussions, dislocations, compressions, and transections may show up later. The consequent discovery of the symptoms of central spinal cord, anterior cord, Brown-sequard, and conus medullus as well as causa equina should be immediately communicated to the physician.

Nurses for this reason must examine their patients after traumatic injury admission and not allow them to go to sleep. Nurses must check the medications for drowsiness or effect on motor neuron areas. Testing for asymmetric pain and radicular pain, however severe, should be noted on the chart. Loss of bladder control and bowel control may be common in shock and bedridden patients. Examination of natural sensory and motor reflex activity will better indicate the presence of paralysis than mere incontinence.

Nurses and attendants must review all patient symptoms for each motor deficit, sensory loss, (e.g. Pain, texture, taste, sound) or pressure or vibration that fails to register. Assessment must recur with every repositioning and 48 hour check. The spinal cord injury, or SCI, is a life changing experience for any patient and often will change a patient’s personality and challenge the patient’s family and support network.

An SCI injury will present as a sensory “deafness” that observant nurses will notice. Keep an entire rotation of CNA and mobiilty support persons on notice for these characteristics is a valid endorsement. Herniated discs and a cut cord (laterally) will evince itself in Brown-Sequard index responses such as a flinch that only includes the right maxillofacial muscles and right shoulders. Possibly there will be an attempt to stand that will display balance using muscles on the left side, left legs and left arms only.

SCI patients will orient toward close contact with the physical therapy nursing staff. Sleeping patients cannot be tested for involuntary motor control action lapses and/or paralysis. And the ability to measure the extent to which a patient has changed their SC injury status and the direction in which the change has occurred is not detectable when the patient is asleep.

Furthermore, is the patient does not awaken naturally the conditions of blood pressure, spinal cord injury, and cardiopulmonary arrest may overtake treatment of spinal cord shock episodes. Careful charting must accompany every station’s monitoring of this patient.

The spinal cord conditions must be addressed in concert with other more dramatic organ failures, skin wounds and possible bone breakage. An evaluation by the therapist must occur every so often.

The respiratory system may survey the initial incident but they may become during the recovery phase. The nursing attendants must take careful notes about the extent of the patients recovery if any during the rest stages. Patients will also exhibit great stress and reactions to great pain when they awaken or recover from surgical intervention. Nurses should calm the patient and only allow them to be informed of as much information as the physician believes is feasible.

The nature of what information to tell patients in dramatic situations of spinal cord injury is debatable. Some schools of thought hold that nurses are bound by patient wishes and should be told of the extent to brain and spine and recovery processes at once. But some physicians believe this information can cause a stress episode to the patient that can irreversibly negate a positive outcome.

 

Nurses should indicate the family or spouse the seriousness of the condition and ask them how they think the patient will want to deal with the decisions regarding mechanical stabilization beyond spinal cord natural involuntary muscle and nerve control. Some patients will have a living will prepared in which they treat their plans for these situations.

 

However, many patients do not realize the full extent of the damage and what partial or total spinal cord injury can mean. The nerve system within the spinal cord may never fully recover from shock. Furthermore, any additional trauma to the spinal cord nerves may trigger recurrences of nerve damage or activate old contusions, lacerations, hyperinflexions, and other conditions of the SC index.

If the nurse feels that the patient does not have enough information to make an informed decision and no living will is present the physician must dictate what information they are told to get the necessary qualifying advice for further treatment. Some individual health plans will stipulate the decision to not activate artificial recovery if the patient lapses voluntary respiratory control or nervous control governing neural systems, cardiac nerves and other functions. Some patients will want every last measure taken to prevent loss of life and loss of nerve activity.

 

Nurse Treatment of Back Pain

The nurse with a patient complaining of back pain should screen the individual or treatment and therapeutic approach. Back pain, especially in the elderly or the very young, can be a red flag for more extreme disorders or more involved and complicated medical problems. Nurses studying the symptoms of back pain disorders and related conditions should review the list of symptoms and therapies. There is a tendency to medicate back pain, which can shield the patient from being diagnosed with more complex attention to the patient’s more overall health. Smoking and depression, for example, have been linked with diagnosis of back pain.

A nurse’s advice is the first line of defense when back pain strikes or rears up. A nurse should be fiercely protective of any patient complaining of unusual amounts of back pain, especially when they seem to have no basis in normal causes. Backaches after pregnancy and fibromyalgia, for example, would be considered expected. But a nurse will be able to single out over time that a patient has experienced serve back pain during some phases of their condition, and less or none in other stages of their admission. Nurses should be careful to fit the bed positioning to suit the best rest position for that particular patient‘s size and height.

A patient will rely (consciously or unconsciously) on the nurse’s ability to relate this occurrence of symptoms with the physician or other nurses. The nursing staff can plot from the chart when and under what stress the patient reports the most pain. The nurse can review notes from other nurses concerning the most serious incidents of back pain in a patient and analyze the cause. Does the pain result from exercise or inaction? Too much bed rest or not enough in the right position? Too many hours straining over a hot laptop, and not enough restful sleep in a bed meant for the purpose?

A change in bathing habits or a change in the weather could activate arthritis nerves, escalating back pain for a patient who previously only generally complained of it. Turning a mattress or finding a different sort of pillow may be ease the neck tension that cause the surprise of back pain for a patient. The patient may be so used to their particular daily habits in sitting or standing, sleeping and resting, that they have not noticed that these may have damaged best posture or their sleep rhythm. Even temporary daily adjustment to a poorly formed car seat could cause problems over time.

The usual amounts of back pain every adult processes can be due to stress, weight gain in the abdomen, rare syndromes, and poor sitting postures. But unusual pain experienced when the patient is sitting down or lying down can be cause for concern. The spinal cord and related nerves, and the pelvic bones and the sternum area, all come into play. Neck tension and postural neck pain can become the cause of tensed nerve in the lower back, often related to motion in the bed during sleep hours. Nurses should survey the patient upon waking about how their neck and back feels.

Patients with back pain should embrace alternate technologies as well as a consult with e specialty physician. Some habits can be cured, such as reading in bed and poor posture. Homeopathic alternatives for pain treatment have enjoyed a resurgence lately. Such patients should be monitored and the intervention be written for nursing prompts for better posture or “lights out” for less reading in bed, for example. Movement and grooming should be evaluated for best posture and less strain on lower back positioning for long periods of time. Nurses should be particularly attentive to fall/injury risks for back pain sufferers, such as dressing, transitioning from bed to standing without support, and in-bed movement without a rail.

Reflexology, meditation, and acupuncture can give significant relief for back pain sufferers, and many HMOs and insurance types cover these regimens. And massage can often do wonder for back pain victims. Thoracic exercise, lumbar spine exercise, Pilates, and Yoga can contribute to better overall back health. But the conventional medical approach still matters. Surgery and injections may be necessary, depending on the level of the condition. A hybrid approach can work well.

A general physician or custodial doctor may refer the back pain patient for an X-ray, MRI or CT scan. A bone scan or discography may be necessary to evaluate the cause of the back pain. The general physician may refer the patient to a specialty physician. Several physicians may need to be seen before the right one grasps the needs of a specific patient. The pain doctor or chiropractor may direct the patient to multiple modalities, such as stress management, physical therapy, holistic directions, as well as improved posture while sleeping, a better mattress and better neck rest from incorrect arrangement of pillows. And an evaluation of the patient’s coverage can allow for further options.

A nurse should be concerned with an over-reliance on medications to solve these pain problems. Chronic pain can be a condition too often medicated for, and not analyzed enough. Too often, many patients are impressed with commercialized depictions of pain-free lives in pharmaceutical advertisements. A nurse may have to parse these ideals down to simple English for a patient eager to accept the pill path of pain treatment. The dispute over NSAID therapy, more widely advertised drugs, and clinical trial results marches on.

Persons with back pain should be encouraged to try non-pharmaceutical approaches like yoga for strengthening the back, stretching, environment, or focused breathing. The level of attachment a patient has to their back pain can affect their willingness to employ various methods to lessen it or get rid of it entirely. Lifting the tent flap of back pain can reveal unpleasant truths a patient may be unwilling or unable to deal with. Bridging the gap between current pain symptoms and a pattern of anti-pain practices should be the care plan goal of many patient dealing with such issues.

Back pain is also a symptom of tense nerves, chronic stress, and harmful relationships. A watchful nurse can plot a record of just when the patient complains of back pain symptoms and analyze what occurred that might have prompted spasms or a cramped lower back. During times of medical issues and their tendency to create unrelated crises, the relatives and friends of a patient can create havoc with their emotions and concerns “dumped” on the patient. A nurse should observe when a certain phone caller or visitor makes the patient distraught.

Of course, energy vampires suck the energy from an empathic patient who does not have a filter to stop the onslaught of verbal disputes and arguments that occur when medical planning and family conflicts persist. Too often, a nurse will see the patient giving attention to a person who will deflate the and overload them with complaints and problems.

A person suffering from back pain must have a strategy to eliminate harmful inputs that worsen their symptoms. The intervention in the care plan will indicate to a nurse what steps they are authorized to take, such as moving abusive family members on and providing hints for coping.

Student nurses should know that duodenum ulcers, kidney problems, osteoporosis, and inappropriate headrests can cause back pain. Lifestyle choices such as a heavy shoulder bag or handbag, heavy lifting or stooping, or overstuffed pillows can disturb delicate rhythms in spinal function and rest. The causes of back pain and the conditions resulting in untreated back pain should be a regular course of study and a basis for materials review.