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General Principles of Wound Management

Schaffner, Amy

Journal of Wound, Ostomy and Continence Nursing: July/August 2010 - Volume 37 - Issue 4 - p 418–420
doi: 10.1097/WON.0b013e3181e3a0f6
GETTING READY FOR CERTIFICATION
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Amy Schaffner, ARNP, FNP-BC, CWOCN, Board Liaison, WOCNCB Examination Committee, Spokane WA and Family Home Care and Hospice, Liberty Lake, Washington.

Correspondence: Amy Schaffner, ARNP, FNP-BC, CWOCN, WOCNCB Examination Committee, Spokane WA and Family Home Care and Hospice, Liberty Lake, WA 99224 (farbenblinde@hotmail.com).

Everyone wants to be successful in the certification process. The Wound, Ostomy, Continence Nursing Certification Board (WOCNCB) encourages every exam candidate to take the initial steps toward success by thoroughly preparing for their exams. An initial step in the right direction is to review all that is offered on the WOCNCB Web site. To begin the process, log on to the home page at www.wocncb.org and enter “Test-taking” into the Search box. You will be rewarded with a wide variety of helpful tools.

The most important tool is the Content Outline, which is also in the “centerfold” of each WOCNCB Examination Handbook. The content outline identifies the areas that will be covered in the exam, delineates how many questions will be in each section, and specifies the level of complexity that the questions will have.

Other helpful tools and confidence boosters on the WOCNCB Web site are the self-assessment exams. These exams are available for a nominal fee but offer the candidate an opportunity to take a practice test. Each test mirrors the types of questions, format, and complexity levels of the actual exams.

One unique tool is a presentation entitled “To Test or Not to Test: That is the Question: How to Prepare for the WOCNCB Certification Exams.” This PowerPoint presentation was part of the WOCN Society 2009 annual conference. In it, Donna Thompson, MSN, CRNP, FNP-BC, CCCN, combines her clinical expertise and her skills as an educator to lead the reader through test-taking strategies and how to choose the answer for the question being asked. Careful review of this presentation will be a definite plus in setting a framework for success.

In this article, we turn our attention to back to wounds and look at “General Principles of Management” (Content Outline Location 1B). Of the 80 questions asked on the Wound Care exam, 23 come from this section. Questions are categorized as recall, application, or analysis. Here are some practice examples.

  1. When using Dakin's solution (0.025%), what length of time is recommended for treatment?
    • 24 hours
    • 48 hours
    • 15 days
    • 10 days
  2. An elderly woman is admitted to the critical care unit with pneumonia. She has an unstageable pressure ulcer on her coccyx. The periwound has red-hot erythema and the drainage has a foul odor. The best recommendation for debriding this wound is
    • chemical debridement
    • wet to dry debridement
    • surgical sharp debridement
    • whirlpool debridement
  3. A WOC nurse is providing teaching to a diabetic patient. Which is the most important aspect to emphasize?
    • Insulin administration
    • Foot care
    • Blood sugar regulation
    • Skin care
  4. Interventions helpful in reducing pain for the patient by using a negative-pressure wound therapy wound unit include
    • the use of polyurethane instead of polyvinyl foam
    • discontinuation of the unit 30 minutes prior to removal
    • avoiding packing tunnels and undermining
    • the use of intermittent pressure throughout treatment
  5. A trauma patient is admitted to critical care with suspected air embolism. Additionally, the patient has profound blood loss, a diabetic foot ulcer, and an acute myocardial infarction. Which condition is the primary indication for hyperbaric oxygen therapy?
    • Air embolism
    • Blood loss
    • Diabetic foot ulcer
    • Myocardial infarct
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▪ Answers/Discussion

  1. d. This is a recall question'a question that tests the recognition or recall or specific information. Use of an antimicrobial or bactericidal cleansing agent is generally discouraged due to concern for nonselective cytotoxicity. However, when Dakin's solution is used, the current recommendation is a short-term treatment'no more than 10 days.
  2. Content Outline Location: 1B2a
    • Ramundo J. Wound debridement. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:176.
  3. c. In this analysis question, you must select the most appropriate recommendation for debridement for a critically ill patient. When large amounts of tissue need to be removed in a life-threatening situation, surgical debridement is the best choice. The other types of debriders are not appropriate for this situation. Note that the question has a clue in the stem, “best.” Let this clue help guide you in answer selection. Be sure to answer what the question is asking! This is a basic rule of test taking.
  4. Content Outline Location: 1B7 and 1B18
    • Ramundo J. Wound debridement. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:187.
  5. b. This application question requires the exam candidate to be familiar with teaching patients/caregivers about care and prevention strategies in the diabetic. Foot care is crucial, as limb preservation is a primary concern of the WOC nurse. Note that an application question asks a little higher level of knowledge than a simple “recall” question.
  6. Content Outline Location: 1B13
    • Beuscher T. Foot and nail care. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:356.
  7. b. This application question requires that the candidate understand interventions considered in reducing pain related to negative-pressure wound therapy. Correct interventions would include using polyvinyl instead of polyurethane foam, using continuous (not intermittent) pressure, and decreasing the pressure setting prior to dressing changes. When applying a negative-pressure wound dressing, the WOC nurse should always pack tunnels and undermining with the appropriate foam.
  8. Content Outline Location: 1B12
    • Frantz R, Broussard C, Mendez-Eastman S, Cordrey R. Devices and technology in wound care. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:440.
  9. a. This is a straightforward application question with a clue in the stem! The clue is “primary.” Again, always be sure to answer what the question is asking. All of the diagnoses mentioned in the question may be treated with hyperbaric oxygen; however, it is a primary therapy for air/gas embolism. This is a basic rule of thumb in test taking! Although all the answers may be appropriate, primary indications for hyperbaric therapy include air/gas embolism, carbon monoxide poisoning, and decompression sickness.
  10. Content Outline Location: 1B15a
    • Frantz R, Broussard C, Mendez-Eastman S, Cordrey R. Devices and technology in wound care. In: Bryant R, Nix R, eds. Acute and Chronic Wounds. St Louis, MO: Mosby; 2007:428–432.

Are you precepting or working with a WOC exam candidate? Perhaps, you know about someone who is preparing for the exam. If so, would you encourage them to read the Journal of Wound, Ostomy and Continence Nursing (J WOCN) and especially this feature series? In each issue, the WOCNCB offers information that will help “demystify” and “unravel” the exam. Having a thoughtful study plan and appropriate references is the key.

Also, remind them that studying to the Content Outline is an important aspect of WOCNCB test preparation. Finally, refer them to the WOCNCB Web site to seek additional important information regarding the exam. In the next issue, we will look at Ostomy questions.

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▪ Helpful WOCNCB Resources

The WOCNCB offers a variety of resources to help. WOC nurses successfully certify, recertify, and promote the specialty and themselves. Learn more at www.wocncb.org/resources

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Resources for Preparing for the WOC Certification Exam

Free sample test: Try a user-friendly online test at http://www.lxr.com/webtest/login.aspx

Self-assessment exam: Order a computer-based test from the testing company that produces our exam. Go to www.goamp.com and click “e-store.” Then select “HealthCare” and then “Wound, Ostomy, Continence Nurses.” Each individual practice exam costs $30, which gives you 90-day access.

WOCN Society review courses: Each year the WOCN Society offers CD-ROMs of a certification review course presented at its national conference. You can buy these online at www.prolibraries.com/wocns/.

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Become a Certified Foot Care Nurse

The WOCNCB offers foot care certification to RNs. No bachelor's degree is required. Learn more at www.wocncb.org/WhyCFCN

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Not Recertifying Due to Economic Issues?

The WOCNCB created a Benevolence Fund in 2007 to cover exam fees in times like these.

Do not let your certification lapse.

Contact info@wocncb.org. All inquiries are treated with the utmost confidentiality.

Collins Patricia Patricia Collins, MSN, RN, ACNS-BC, CWOCN, Correspondence: pat.collins@stvin.org

One year ago, the WOCNCB published its first Evidence Based Practice (EBP) supplement in the J WOCN: “Review of the Evidence for WOCN Nursing Practice 2007–2008.” The publication was well received by the J WOCN subscribers and the WOCNCB certificants. As one certificant commented, “I can't tell you how often I access this information for use in my practice.”

The first EBP supplement was widely distributed. The WOCNCB sponsored access to the publication on the J WOCN Web site, allowing free access to all nurses. The Web site received more than 1,200 hits for this document in the 9 months it has been posted. Last year, the WOCNCB also distributed to nurse executives at the 2009 annual meeting of the American Organization of Nurse Executives, and mailed more than 1,000 copies to state boards of nursing, nurse executives, state departments of health, and state affiliates of the American Health Care Association and the American Hospital Association. This year, the WOCNCB placed 2,500 copies in the registration bags at the 2010 Joint Conference of the WOCN Society and World Council of Enterostomal Therapists in Phoenix. Additional copies will be made available to participants in the WOCN Society'accredited educational programs.

What is EBP? There are a variety of definitions with different perspectives. The physician community and some national government agencies generally use the definition published in the British Medial Journal (BMJ) article “Evidenced-Based Medicine: What it is and what it isn't”. That definition is “conscientious, explicit and judicious use of current best evidence for care in making decisions about the care of individual patients.” The National Guidelines Clearinghouse publishes best practice guidelines based on the BMJ definition. I personally find the most comprehensive definition from Sigma Theta Tau, which defines EBP as the “integration of the best evidence available, nursing expertise and the values and preferences of the individual, families and the communities who are served.” To me, the latter definition has the more holistic approach; all clinicians must know the evidence in order to discuss the benefits and risks with the patient and the family when recommending a particular treatment plan.

With this issue of the J WOCN, you have received the WOCNCB's second supplement “Review of the Evidence for WOCN Nursing Practice 2009.” To produce it, the WOCNCB's editorial board members carefully read many professional journals, reviewing current research and information relevant to the practice of the WOC nurse. The most important question the editorial board members asked during the process was, “How is this article relevant to everyday practice?”

The editorial board members found a wide variety of exciting and fascinating research. Some of it was “bench practice” research done in the laboratory; other focused on patient quality-of-life issues such as pain perception and management and impact on activities of daily living. As interesting as many of these studies are, they have not yet reached the point of clinical application or they are not robustly supported by data. The editorial board members will continue on this sometimes arduous, often interesting, quest to bring you the latest “Review of the Evidence” next year.

The WOCNCB is again sponsoring free access to the second supplement on the J WOCN Web site and has an aggressive distribution plan to put the supplement in the hands of nurses, WOC nursing students, administrators, regulators, and legislators.

This publication will be useful only if we know what you want and need. Therefore, the WOCNCB will begin contacting certificants with a survey that will ask for your perception of the publication and for any additions or changes you would like to see.

Copyright © 2010 by the Wound, Ostomy and Continence Nurses Society