Wound Care Challenges: Physical Therapy Strategies to Support Healing
Four questions may guide you in assigning etiology of areas of the trunk where moisture may be a contributing factor:
- Where is the wound located on the body?
- What is the appearance of skin/wound?
- What is the clinical history?
- What are the best treatment options?
Incontinence-Associated Dermatitis
- Location
- Perineal, buttocks, thighs
- Appearance
- Superficial
- With or without fungal component
- History
- Persistent or recurrent incontinence
- Fecal and/or urinary
- Treatment Options
- Resolve incontinence when possible through toileting, thickening stool, eliminating aggravating factors
- Contain incontinence through super absorbent polymer (SAP) briefs/pads
- Protect/treat skin through emollients (lanolin, mineral oil, petroleum types) or crusting applications (copolymer powders & skin barrier wipes/sprays)
Intertriginous Dermatitis
- Location
- Base of body fold
- Opposing surfaces of body fold
- Appearance
- Linear opening/break in the skin
- Shallow kissing lesions
- No ischemia
- History
- Diaphoresis
- Trapped moisture
- Treatment Options
- Separate wet skin folds
- Use wicking products for weeping skin folds
- Drying powders or skin barrier wipes
Friction
- Location
- Fleshy skin areas in contact with linens, bed, or chair
- Heel or area that rubs against linen, etc.
- Appearance
- Skin moist or fragile
- Serous blister over heel
- No ischemia
- History
- Patient restless
- Fragile skin
- Frequent perineal cleansing
- Treatment Options
- Manage moisture
- Protect skin in agitated patients
- Emollients or skin protectants for prevention/treatment
- Early recognition
Pressure Ulcer
- Location
- Over bony prominence
- Under medical device
- Appearance
- Defined edges
- Tissue ischemia
- History
- Periods of immobility
- Compression by device
- Treatment Options
- Redistribute pressure and envelopment within a surface
- Moisture management via surface & wicking products
- Debridement
- Infection prevention/treatment
- Nutrition
This blog was brought to life by PESI speaker and author Kim Saunders, MSN/ED, RN, CWON®, CFN. Kim Saunders has 18 years as a wound, ostomy, and continence expert in home health, acute care, hospice, and outpatient settings. Kim consults for patients related to wounds, ostomy, and incontinence-associated dermatitis. Her experience includes healthcare system-projects related to bed, stretcher, and wheelchair surfaces as well as system processes for skin and wound issues. She also is a co-owner of WOC Consulting, LLC.
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David Schnarch, PhD, director of the Crucible Institute, is the author of Intimacy & Desire,Passionate Marriage, and Constructing the Sexual Crucible.
Kim Saunders, MSN/ED, RN, CWON®, CFCN, has extensive experiences as a wound, ostomy, and continence nurse across a variety of settings, including acute care, hospice, home health and skilled nursing facilities. As a respected expert in her field, Kim evolved her practice to be able to more fully share her insights as co-owner of WOC Consulting, LLC. In this role, she consults with healthcare systems on a variety of challenges that develop related to wound, ostomy, and incontinence-associated dermatitis. Some of the special projects her knowledge has been sought for include: guiding standardization of wound care formularies and pressure-relieving device selections, as well as a myriad of other processes to standardize and improve upon existing skin and wound care delivery. Her wound care experience goes beyond trouble-shooting the most challenging of patient wounds. It also includes expertise regarding the increasingly important ability to incorporate cost-effective care and reimbursement considerations at the bedside.
Kim is an active member of the Wound, Ostomy and Continence Nurses Society™ and the Advanced Wound Care Society. She has traveled the country extensively to deliver practice-changing wound care trainings to experienced healthcare professionals. Kim is also the author of the Wound Care Pocket Guide: Clinical Reference, Second Edition (PESI, 2017).
Speaker Disclosures:
Financial: Kim Saunders is the owner of WOC Consulting. She receives a speaking honorarium from PESI, Inc. She has no relevant financial relationships with ineligible organizations.
Non-financial: Kim Saunders is a member of the Wound, Ostomy, Continence Nurse Society.
