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.

Pyoderma Gangrenosum

Pyoderma Gangrenosum is a serious condition of the skin commonly denoted by cellulitis, ulcerous lesions, or wounds. Daily or weekly dressings are required as well as frequent I.V. infusions to combat secondary infections.
Pyoderma Gangrenosum is an exclusive diagnosis. This is unfortunate, as it leads many temporary and urgent care physicians to bypass the seriousness of the damage by referring to the lesions as ulcers, skin tears, and other superficial tissue damage events to the dermis and subdermis. Pyoderma Gangrenosum lesions are characterized by erosion of healthy via an enlarging or group of lesions. As the skin and nerves deteriorate the intense and the copious drainage make the patient’s life difficult.
Pyoderma Gangrenosum treatment plans require an extraordinary commitment of resources, supplies, nursing hours, consult dates, I.V. PICC line insertion, and even hospital stays or Emergency Room visits. The consult visits can become highly technical and a patient with Pyoderma Gangrenosum is well served to obtain a client advocate to meet their needs.
While Pyoderma Gangrenosum does present a flat-edged, wide-lesion wound area similar to some kinds of bed sores, they are much more infectious and extremely susceptible to Sepsis, C. differens infections and contagious MRSA infections. Pyoderma Gangrenosum patients should observe the best possible hygiene and infection control standards possible. Powdered, sterile, and/or Latex-free gloves must be worn by physicians and consultants present at an examination of the wounds or during any wrapping or re-wrapping of the wounds.
General advice given to patients with Pyoderma Gangrenosum is to diet, lose weight, exercise, and elevate the legs if the affected area is in bilateral lower extremities. Daily or twice daily dressing changes may be ordered as the drainage demands. Because the drainage causes the periwound to succumb to ongoing maceration, when the patient feels the bandages fill with liquid, they must report this to the nurse for a wound care session. Nurses must grow accustomed to checking in with the patient about how the wounds are draining and when another dressing is due. Such patients should be monitored for pain to allow direct contact with the wounds at the scheduled wound care time.

Gloves should be worn by all nursing staff during dressing changes, and even by the patient. Washing and shaving of the skin in the periwound may be necessary. Bathing should only take place immediately before a scheduled dressing change to preserve best standards of infection control.
During the wound care dressing change session, light bathing of the periwound skin can be conducted before placement of sterile topical gels and creams. For the heated skin symptom that often accompanies Pyoderma Gangrenosum, Silvadene silver cream has been shown effective to soothe the extreme pain present at the wound sites.
Because of the erosion of skin and nerve tissue during infection, a regimen of nerve pain medication is advised. Baclofen or Neurontin may be part of a 24 hour cycle of pain medication. NSAID therapy can also be used to lessen potential dependence on PRN opiate painkillers. As the Pyoderma improves or the skin infection conditions worsen, this regimen may need to be adjusted.
Pre-medication may be required for dressing changes when nerve and tissue damage has been severe. The pre-medication order should be arranged by the debridement doctor, the consulting physician, or the patient’s Primary Care Provider. Perspiration through hair follicles draws bacteria into the skin. Shaving and bathing of patients should be coordinated with nursing aides or personal residence staff accordingly.
Any situation where total cleanliness of the wound dressing area and sterility of medications is not present should be reported to the wound care team or the charge nurse immediately.
Although the Pyoderma lesions may present as what some nurses might consider mere “Pressure ulcers” that is not what they are.

Pyoderma Gangrenosum is not “gangrene”, as more ignorant members of the medical field are slow to grasp. Instead the Latin term refers to the spread of the immune disease through the tissues. Pyoderma can often be co-existent with systemic infections such as respiratory tract infections, colitis, cystic acne, and sepsis.
Treatment of Pyoderma Gangrenosum is a multipartite, multilayer effort best done with cooperation of the primary care provider, dermatologist, infectious disease specialist, vascular surgeon, and wound care team. The more sophisticated physicians in metropolitan and urban areas will have the experience treating pyoderma.
The systemic approach to ridding the body of pyoderma gangrenosum is to introduce as many cycles of antibiotic therapy as possible. Identifying the treatment method and material to be used is best done using blood tests and wound culture analyses from the affected lesions.The concurrent treatment for extreme site pain, nerve pain, and control of blood sugars must keep time with the infectious disease treatment.
A typical treatment therapy might be Vancomycin and Doripanem via intravenuous infusion, Bactrim
daily as oral antibiotic, and topical treatment of the skin lesions using the complementary spectrum of hydrogels as appropriate.Other nedications may be assigned as they register in sensitivity to the bacteria from the lab culture.
Sometimes Doxycycline or Cyclosporine is used to treat the Pyoderma condition. A key part of any treatment plan for a systemic condition of Pyoderma Gangrenosum is Prednisone. This use of a steroidal supplement can functiom to arrest the immune system disorder that causes the Pyodermic lesions to erupt. While an initial dose of Prednisone therapy can effectively battle back the worst of new lesions forming, the ongoing struggle to keep blood sugar low continues. Without controlled blood sugar, infection treatments will have
The would culture lab result will point the wound care team in the right direction concerning the effective treatment plan and schedule for wound care changes. One new and trending treatment is Tacrolimus to temper swelling and infection control. New studies have shown that Tacrolimus mixed with the Hydrogel Mupirocin retain highly effective resistance to pseudomonas, a common secondary infection.
Because Pyoderma starts as a lesion with no origin, many physicians and nurses speculate about the patient having contracted Pyoderma Gangrensum through contact
with pets or other animals. Dogs, for example, have been diagnosed with Pyoderma Gangrenosum. Due to the very high probability of bacteria contagion, victims of Pyoderma Gangrenosum cannot live with pets and expect any certain degree of recovery.
It requires a well-educated and proactive physician set to envision and implement a care plan for this disrase. The therapeutic relief of Pyoderma Gangrenosum. needs a patient and consistent evaluator of the effectiveness of current therapies. The patient may not always be ready to hear that a certain medication, device, or treatment is no longer working. In some cases a patient suffering from Pyoderma Gangrenosum will be referred to an amputation and limb preservation clinic for evaluation.

What 4 Medical Skills Make You a Better Nursing Hire?

Occupational employees such as nurses should always keep an eye on the basic skills that make up the daily round of nursing tasks. The quality of how well a nurse or nursing student performs these skills can make their grades or wages rise. In nursing school, many is the time a student nurse can excel in all the academic book work, but the practical shortcomings of real-time nursing performance matter much more. Because patient-centric nursing must be perfect the first time around.
Here are four nursing skills that will make you a more marketable nurse. By rehearsing these skills while in nursing school and using peer guidance and skills review while on-the-job, any nurse can shore up the gaps in his or her work skills. Immediately after improving these nursing skills and demonstrating competence, any job candidate or nursing student becomes the best prospect for a new hire or promotion. For working nurses, this means additional hours on staff or a better rate of pay. Progressive improvement of these skills will allow any nurse to be considered as a medical skills trainer, or as a nursing supervisor or senior charge nurse.
1. Needle Skills
Every nurse gets a basic training in practical skills using needles. Are you good with a needle? Nurses have been improving technical skills with needles over the course of their careers, but the best nursing students will concentrate on administering medications with needles and leaving the patient with the least amount of distress, bruising, and needle point skin tears. A hospital or facility trusts every nurse, RN or LVN, with needles. Medical and nursing facilities must be assured any nurse can work with a needle efficiently on patients, without supervision. Protocols for sharps accidents and blood-born disease control are very severely controlled.
Patients everywhere need nurses who can perform needle injections with a minimum of pain, fuss, and after-puncture bruising. Needle skills and sharps handling is important for hospital wards, log term care floors, and clinic rooms. Many systems of portable pharmaceuticals depend on steady hands and precision administration of individual dosages. Sharps treatment include disposal and sterile storage, as well as delivering medication without unnecessary skin breakage, administration site pain, and resulting needle marks or bruises.
2. Wound Care Skills
Many patients with chronic and acute conditions involve wound care and skin based dressing treatments. Administering wound care means following physician orders, working with the patient, and completing the application of medication and bandages and wrapping in a time-sensitive manner. Some wounds such a pressure sores and ulcers are chronic. Some wounds are acute, and center around conditions that involve infection, surgical recovery, and/or peritoneal dialysis tube insertion sites.
Wound care generally involves preventing infection and utilizing medications and medical supplies to prevent spread of material, decaying skin cells, bacteria, and debridement matter from contact with open wounds, skin tears, or other breaks in the skin. The skin is the body’s largest organ, and often overlooked with respect to its ability to affect overall patient well-being and health. Patients need skilled nurses adept in good wound care. Managing wound care, in sum, means nurses reducing the infection risk and optimizing a patient’s overall chance of recovery.
3. Dialysis Skills
Inserting procedure tubes near the peritoneum and administering dialysis treatments is a marketable skill. Nearly two thirds of all long-term care patients are elderly and dependent on dialysis treatment on a weekly or daily basis. Ambulance fees and transportation logistics make this a nightmare for nursing desks and facilities, not to mention home health patients.
Independence from doctor’s appointments is the dream of every patient. A nurse that can reduce a patient’s schedule y two or three visits a week is a smart hire. The nurse that can administer the dialysis wire, tubes and machinery, as well as funnel a pleasant bedside manner with patients, can be a breadwinner for any medical nursing company or healthcare organization.
4. Admission Skills
Every nurse needs to periodically review their patient charts and submit shift changes in condition, as well as the ritual licensed nurse progress notes for each patient. but progressive experience at any desk means facing the responsibilities of an admission. Whether a patient is returning to the hospital ward, facility, or a new admission, the nurse involves need to be on point for every detail of patient admission processing
The admission nurse must advise the staff that a new bed is being filled; the placement managers will advise the ward or floor that a patient is being admitted and where they are going. It is the nurse’s responsibility to immediately advise the housekeeping staff about the bed, linens, and bed rails and/or bedside equipment required. The admission nurse must take the endorsement from the discharging facility and record and advise the incoming staff concerning all variances in treatment and nursing care the new patient requires.
The admission nurse must review the documents and make sure everything is in order for the next shift’s nursing medicine nurses to follow up and distribute medications. A chart for the patient must be made and the sections and document blanks put in. The nursing assistants must be briefed about that new patient’s special needs. The medications of the new patient must be conveyed to the facility or hospital pharmacy. Any contraindications or conflicts in treatment orders or medications with the patient’s stated condition list and MDS report must be resolved before time of admission.
These admission tasks must be done while ringing phones, audio speak announcements, patient vocalizations, and other distractions are occurring. Coordination with ambulance staff, as well as directing the paramedics to which room and section of the facility to place the patient in, is necessary. Lastly, the admitting nurse must assign a nurse or staff member to orient the patient and/or the family. Communication of Resident’s Rights and facility policy is then performed. Only then can the nurse report to the Director of Nursing, detail the notes in the patient’s chart, and tell the supervisor that admission has been efficiently finished.