Volume 52 - Issue 8 - August, 2006
Connecting the Dots to Improve Patient Care
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Nothing in nature is isolated. Nothing is without reference to something else. Nothing achieves meaning apart from that which neighbors it.
— Goethe (1749–1832)
When the goal is better patient care, understanding theories, concepts, and issues such as validity and reliability seems unnecessary— you just want to know what to do. Similarly, when a researcher wants to learn more about, for example, the role of fibroblasts in healing, spending precious time reading the results of a case study or the steps
Management of High-Output Fecal Stomas
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One of the greatest challenges ostomy care clinicians face is the management of high-output fecal stomas. Not only are they frustrating for the clinician, but they also create significant quality-of-life issues for the patient. For example, daily containment of 2,400 mL of fecal output in a traditionally sized ostomy pouch requires constant emptying, odor management, peristomal skin protection, and concern regarding large volumes of nighttime stool while the patient sleeps.
The most common type of high-output fecal stoma is a jejunostomy — an opening into the jejunum, the midporti
A Day in the Life of an ET Nurse
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You would remember meeting Nancy Faller, RN, MSN, PhD, ET Nurse Clinical Specialist. Soft spoken (if emphatic), compassionate (if no-nonsense), her small stature and ponytails belie the wisdom and power inherent to and nurtured by her many years as a nurse. One can easily imagine her not taking any guff from either her superiors or her patients when she served in the US Army, whether during her first year as a staff nurse at the station hospital on Fort Knox, Ky, or her second year in Vietnam, where she received the Bronze Star for Achievement.
While serving at the 67th Evacu
Variations in Assessment Based on Skin Color
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The importance of thorough skin assessment, including patient history and physical examination, cannot be overemphasized. The patient should be made as comfortable as possible for the physical examination; the clinician should provide a warm, comfortable, private environment that has adequate lighting; eliminate distractions and disruptions; have needed equipment readily available (including a transparent ruler, penlight or flashlight, magnifier, and gloves); and warm her/his hands and equipment before touching the patient. The examination should be performed in the following manner:
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Topical Antimicrobials in the Control of Wound Bioburden—Part 1
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Intact skin provides a physical barrier to the ingress of micro-organisms. When skin is wounded, micro-organisms from the surrounding skin, other body sites, or exogenous sources have access to a warm, moist environment. Whether organisms survive and multiply depends on 1) their ability to evade the body’s immune system and 2) whether essential chemical and physical requirements are met.
Wound microbial contaminants may not persist,1 but it has been shown that species that flourish may establish the states described as colonization, critical colonization, or wound infe
Topical Antimicrobials in the Control of Wound Bioburden—Part 2
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Commonly Used Antiseptics
Iodine. Iodine (particularly in the safe, modern, formulations of the iodophor povidone iodine [polyvinylpyrrolidone iodine complex, or PVP-I] and cadexomer iodine) is a useful bacteriostatic and bactericidal agent shown to be effective against MRSA and other pathogens in in vitro and clinical studies.73-75 The slow release from the iodophor and cadexomer versions is intended to optimize activity and reduce toxicity. The use of PVP-I as a pre-surgical skin antiseptic is unquestioned76 although its value
Treatment of Pressure Ulcers: Results of a Study Comparing Evidence and Practice
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Although pressure ulcers are presumed to be preventable, their prevalence remains high. A 2002 survey of 55 German hospitals and nursing homes found that 25% of the hospital patients and 17% of the nursing home residents identified by the Braden Scale as at-risk had pressure ulcers.1 These wounds are costly in terms of financial expense and human suffering.2,3 Their prevention and treatment must be based on the best available evidence. To examine the regimens used to treat pressure ulcers in German hospitals and nursing homes, the treatment regimens used, and whether trea
Wound Management: Using Levine’s Conservation Model to Guide Practice
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Levine’s conservation model,1 initially constructed as a teaching framework for medical-surgical nursing,2 is based on the belief that nursing interventions should be aimed at conserving function.3,4 Roberts and Taylor5 and Fawcett4 state that nurses currently use Levine’s model in practice by acting to preserve client energy and integrity — encouraging bed rest, maintaining pressure area care, and preserving privacy. To clarify the relationship between Levine’s conservation model and wound management, each of the f
The 19th Annual Symposium on Advanced Wound Care & 16th Medical Research Forum on Wound Repair
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The 2006 SAWC traveled to San Antonio, the eighth largest city in the US. The Native Americans who first lived along the San Antonio River called the area “Yanaguana,” which means “refreshing waters” or “clear waters.” Conference attendees followed the cobblestone and flagstone paths along this river enjoying the River Walk, a 2.5-mile welcoming mix of park, European-style sidewalk cafes, nightclubs, restaurants, hotels, and shopping sequestered 20 feet below street level. Of course, the city is best known for the mission where 189 defenders held off som
August 2006
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Expert panel updates guidelines for use of NPWT device on diabetic foot wounds
Kinetic Concepts Inc. (San Antonio, Tex), announces the publication of new clinical guidelines on the use of KCI’s Vacuum Assisted Closure® (V.A.C.® Therapy) in the treatment of the diabetic foot. The new guidelines were compiled by a multidisciplinary panel of experts and are intended to update the findings published in the 2004 guidelines. Specifically, the latest guidelines weigh the most current clinical evidence, refute or confirm current consensus, provide practical clinical gui
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