Advances in Skin & Wound Care:
Departments: Practice Points
Cathy Thomas Hess, BSN, RN, CWOCN, is Vice President and Chief Clinical Officer, Net Health Systems, Inc. Please address correspondence to: Cathy Thomas Hess, BSN, RN, CWOCN, via e-mail: firstname.lastname@example.org.
The key to treating any chronic wound is to address the underlying problem. A pressure ulcer (PrU) is a localized site of cell death that occurs most commonly in areas of compromised circulation secondary to pressure. These ulcers may be superficial, caused by local skin irritation with subsequent surface maceration, or deep, originating in underlying tissue. Deep ulcers may go undetected until they penetrate the skin.
Pressure ulcers are most likely to develop in patients who experience sustained pressure over bony prominences. Patients who spend most or all of their time in a bed or alternative seating device such as a wheelchair without shifting their body weight properly are at great risk. Risks increase with various cofactors, such as partial or total paralysis and malnutrition. All stages of PrUs require topical wound care, and surgical intervention may be required for Stages III and IV. Topical wound care varies with the management modalities used and the ulcer’s stage. Interventions to reduce pressure over bony prominences, such as the use of support surfaces, are vital to the success of the care plan.1
When assessing a pressure ulcer at week 4, take time to look at the wound to determine progress, stagnation, or decline. Review the prior documentation and interventions. Introducing new approaches into the plan of care may be appropriate at this time. Figure 1 provides clinicians and physicians with evidence-based recommendations for the care of pressurerelated wounds. Key decision points are provided based on research that combines healing rates at 4 weeks with expected outcomes. If the patient does not meet a given healing rate, closure objective research suggests that he/she will experience delayed healing in theweeks to come. The providermay, at this point, act on further evidence-based adjunctive therapy recommendations to improve the patient’s “expected” negative outcome.
1. Hess CT. Clinical Guide: Skin and Wound Care. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.
2. Van Rijswijk L. Full-thickness pressure ulcers: patient and wound healing characteristics. Decubitus 1993; 6 (1): 16–21.
3. Whitney J, Phillips L, Aslam R, et al. Guidelines for the treatment of pressure ulcers. Wound Repair Regen 2006; 14: 663–79.