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Handout Table of Contents

Wound Care

page #

A word about the skin

................................................................

A word about wounds

....................................................................

Wound stages

13

.................................................................

14

..........................................................................

15

Risk factors for wounds Types of wounds

11-12

..........................................................................

16-17

Wound care treatment plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Pain and wound care

.....................................................................

Infection and wound care

...........................................................

20-21

........................................

22

.................................................................

23

Things you can do to help your wound heal Medicines for infections

19

..........................................................

24

Causes of pressure ulcers

..............................................................

25

Preventing pressure ulcers

.............................................................

26

A word about pressure ulcers

Change positions often

..............................................................

Using pressure relief devices Move as much as you can

29-30

...............................................................

Avoid friction and shearing

.............................................................

31 32

.............................................................

33-34

........................................................................

35-36

Keep clean and stay dry Check your skin

......................................................

27-28

Pressure ulcer prevention plan

....................................................

Tips for preventing pressure ulcers

5

...........................................................

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

Cleaning a pressure ulcer

..............................................

39-40 41-43

.......................................................

44-45

...........................................................

46-47

Wound healing management Dressing a pressure ulcer

37-38

Changing a pressure ulcer dressing

.............................................

48-50

Causes of diabetic ulcers

...............................................................

51

Preventing diabetic ulcers

..............................................................

52

....................................................................

53

Control your diabetes

Take good care of feet and legs

...................................................

Treat a wound as soon as it occurs

54-55

...................................................

56

Continued on next page. Wound Care ✒

Š Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

1


Handout Table of Contents – Wound Care, continued Relieve pressure from wound area

page #

...................................................

58-60

Cleaning a diabetic ulcer

............................................................

Dressing a diabetic ulcer

................................................................

Changing a diabetic wound or ulcer dressing Causes of arterial ulcers

.................................

57 61

62-63

.................................................................

64

...............................................................

65

Preventing arterial ulcers

Treatment of arterial (chronic) ulcers

............................................

66-67

Causes of venous ulcers

................................................................

68

Preventing venous ulcers

...............................................................

69

.........................................................

70-71

................................................................

72-73

Treatment of venous ulcers Compression therapy

About surgical wounds

..............................................................

Changing a dressing (with a shower)

............................................

Staying active

78-79

...................................................................

80-81

..............................................................................

82

............................................................................

83

......................................................................................

84

Handling stress Hygiene

76-77

........................................

Changing a dressing (without a shower) Jackson-Pratt drain

74-75

Eat a healthy diet

85-86

.............................................................................

87

...................................................................................

88

Follow-up care

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

Resources

......................................................................

Wound Care ✒

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.


Diagnosis: Wound Care Education Materials for:

Suggested Initial Visit • • • •

• • • • •

Visit 1— Begin discharge instruction for patient, family and/or caregiver on: outcome goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10 a word about the skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-12 a word about wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 types of wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 A. pressure ulcers B. diabetic ulcers C. arterial ulcers D. venous ulcers E. surgical wounds wound stages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16-17 wound care treatment plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 wound complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-23 A. pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 B. infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20-21 C. infection healing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 D. medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 pressure ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-50 A. causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 B. prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26-40 ■ preventing pressure ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 ■ change positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27-28 ■ pressure relief devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29-30 ■ movement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 ■ avoid friction and shearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

• • •

patient learning assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .introduction, 5-7 pain assessment and control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .see PN*, 3-29 outcome goals assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7 advance directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AD*, 3-22

Continued on next page.

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

Wound Care G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

1 3


Diagnosis: Wound Care

page 2

keep skin clean and dry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33-34 check your skin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35-36, RK*, 45-46 ■ prevention plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37-38 ■ prevention tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39-40 C. treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41-50 ■ cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41-43 ■ wound healing management . . . . . . . . . . . . . . . . . . . . . . .44-45, RK*, 46 ■ dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46-47 ■ changing a dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48-50, RK*, 41-42 diabetic ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51-63 A. causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 B. prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52-56 ■ preventing diabetic wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 ■ control disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 ■ take good care of feet and legs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54-55 ■ treat wounds immediately . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 C. treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57-63 ■ pressure relief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 ■ cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58-60 ■ dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 ■ changing dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62-63 arterial ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64-67 A. causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 B. prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65 C. treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66-67 venous ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68-73 A. causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 B. prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 C. treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70-71 E. compression therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .72-73 surgical wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74-84 A. about surgical wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74-75 B. treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76-84 ■ changing dressing with shower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76-77 ■ changing dressing without shower . . . . . . . . . . . . . . . . . . . . . . . . . . .78-79 ■ Jackson-Pratt drain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80-81 ■ ■

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

Continued on next page.

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

Wound Care G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

2


Diagnosis: Wound Care

page 3

staying active . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 handling stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 ■ hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 eating a healthy diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85-86, RK*, 6-13 home safety measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PM*, 22-45 care team phone numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .RK*, 3 infection control guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .PC*, 3-4 ■ ■

• • • •

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

Visit 2-6—Begin discharge instruction for patient, family and/or caregiver on: • follow-up care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87 • resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

Wound Care G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

3


5 Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92 Š Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.


Medical Record #:

Wound Care

Patient:

Outcome Goals Assessment

Teacher:

Learner(s):

Teacher:

Learner(s):

Teacher: signature(s)

signature(s)

Page #s

Goals

Met

Date

V

Explanation of Variance

initials

code

Patient, family and/or significant other will be able to: 1. Understand the type of wound

11-17

2. Describe the treatment plan and how to prevent problems

18, 44-45, RK*, 44-46

3. Demonstrate the specific wound care steps: • pressure ulcers

41-50

• diabetic ulcers

57-63

• arterial ulcers

66-67

• venous ulcers

70-71

• surgical wounds

76-84, RK*, 44

4. Identify when other types of dressings may be needed:

• diabetic ulcers

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• venous ulcers

46-50, RK* 44-46 61-63, RK* 44 72-73, RK* 44

5

• pressure ulcers

• surgical wounds

5. Identify healthy food choices to help with wound healing 6. Understand how other health issues affect wound healing

76-79, RK* 44 85-86, RK*, 6-13

14, 19-23, 82-84, 85-86

Continued on next page.

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

Wound Care G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

5


Medical Record #: Patient:

Wound Care Outcome Goals Assessment

page 2

Learner(s):

Teacher: Teacher:

Learner(s):

Teacher: signature(s)

signature(s)

Page #s

Goals

Met

Date

V

Explanation of Variance

initials

code

Patient, family and/or significant other will be able to: 7. Identify signs and symptoms of infection

20-21,

8. Identify and demonstrate infection control measures

22-23, PC*, 3-4

9. Identify any pain you may have, understand how to explain it to others and know how to control it

19, PN* 3-29

10. Describe ways to help prevent wound: • pressure ulcers

26-40, RK*, 45-46

• diabetic ulcers

52-56

• arterial ulcers

65 69

• venous ulcers 11. Identify proper safety measures for the home

PM*, 22-45

13-14, 25 13-14, 51

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• pressure ulcers

5

12. Verbalize understanding of risk factors for type of wound:

• diabetic ulcers • arterial ulcers

13-14, 64

• venous ulcers

13-14, 68

• surgical wound

13-14, 74-75, 82-84

Continued on next page.

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

Wound Care G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

6


Medical Record #:

Wound Care Outcome Goals Assessment

Patient:

page 3

Learner(s):

Teacher: Teacher:

Learner(s):

Teacher: signature(s)

signature(s)

Page #s

Goals

Met

Date

V

Explanation of Variance

initials

code

Patient, family and/or significant other will be able to: 87

14. Describe available resources and support systems

88

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

13. Keep follow-up appointments as instructed

*KEY CODE for referenced pages in Volume 1: AD = Advance Directives AS = Caregiver Assisting Skills HO = Hospice

Wound Care G

IV = IV Therapy PC = Personal Care PM = Positioning & Movement

PN = Pain Management RK = Patient Record Keeping DP = Depression

Š Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

7


5 Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92 Wound Care 6

Š Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.


Wound Care

Outcome Goals DATE BEGUN

DATE COMPLETED

You will be able to:

1. Know the type of wound you have 2. Discuss your treatment plan and how to prevent problems

3. Show that you know how to take care of your wound as instructed

4. Know when you may need another type of dressing 5. Take in enough food and fluids so your body has enough moisture and nutrition

6. Discuss how other health issues may affect how your wound heals

7. Identify the signs and symptoms of infection in your wound

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

your wound area

5

8. Show that you know how to control infection in

9. Identify any pain you may have, understand how to explain it to others and know how to control it

10. List ways to help prevent wounds/pressure ulcers 11. Identify safety measures for your home

Continued on next page. Wound Care ✒

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

9


outcome goals DATE BEGUN

page 2

DATE COMPLETED

12. Show that you know the risk factors for the type of wound you have

13. Understand why it is important to see your doctor for follow-up care

14. Know about available resources

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

and support systems

Wound Care 6

Š Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

10


A word about the skin Your body is covered with skin. It is the largest organ in your body. Its main job is to protect you from: 1. infection 2. loss of fluids 3. the sun’s rays 4. injury 5. stress from outside forces Your skin has 2 major layers: • epidermis

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

• dermis

Continued on next page. Wound Care ✴

© Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

11


a word about the skin

page 2

Epidermis layer The epidermis is the outside layer of skin. It is the most important layer of your skin. It grows and sheds all the time. About every month, it grows a whole new layer. This layer of skin varies in thickness depending on where it is on your body. For example, the skin on the bottom of your feet is thicker than that on your stomach.

Dermis layer The dermis is the layer of skin just below the epidermis. It supports the outside layer. The dermis lets your skin stretch and contract when your body moves. This layer of skin is made up of thick connective tissue. It contains fine elastic fibers that help keep your skin smooth. As you age, this tissue becomes thin and less elastic, and you begin to wrinkle.

5

Subcutaneous tissue

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

Under the epidermis and dermis layers is a layer of fat called the subcutaneous tissue. This layer of fatty tissue provides a cushion for the body. epidermis layer dermis layer

subcutaneous tissue

muscle

bone

Wound Care ✒

Š Pritchett & Hull Associates, Inc., Atlanta, GA From The Teaching Book. Use restricted by license agreement.

12


A word about wounds A wound is an injury to your body’s tissue. It causes the skin to tear or break and damages the tissue under it. A wound can be caused by: red swollen skin

• a disease process • a trauma (injury) • pressure • too much moisture • surgery wound

There are two main types of wounds: 1. Acute wound—heals in a short time. (Example– a wound caused by surgery or trauma)

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

5

2. Chronic wound—takes longer to heal because of other problems, like diabetes and poor circulation, and it could be caused by pressure or too much moisture. Ask your nurse about your wound.

You want to prevent wounds, but sometimes they happen. When you have a wound, it needs to be treated. If not treated, it may become infected. Wound infections can cause more skin damage and even make you sick.

Wound Care ✒

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13


Risk factors for wounds A wound is more likely to happen if you: • do not eat a healthy diet • become dehydrated (don’t have enough fluids in your body) • have poor circulation or hardening of the arteries • have diabetes • cannot control your bladder or bowel • are not able to move or are immobile • are unable to feel pain or pressure • have used steroids (like prednisone) for some time • have an immune system problem

5

• are in a bed or wheelchair most of the time

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• are older

• have an IV line or port

• are anemic (low red blood cell count)

• have areas of your body that are exposed to moisture all the time

Wound Care ✒

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Types of wounds A wound (sometimes called an ulcer) causes the skin to tear or break and damages the tissue under it. There are different types of wounds, including: • Pressure Ulcers • Diabetic Ulcers • Arterial Ulcers • Venous Ulcers • Surgical Wounds

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5

The type of wound I have is a/an: __________________________

Wound Care ✒

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Wound stages Wounds are put into stages based on the amount of tissue involved. The stage number shows the degree of skin damage. The stages go from 1 to 4, with 1 having the least damage and 4 the most damage. Damage can range from unbroken skin with a change in color (stage 1) all the way down to severe, deep wounds that go down into the muscle and bone (stage 4). If the wound has dead tissue in it, it is unstageable. A stage cannot be known until the dead skin and debris is removed and the bottom of the wound can be seen. The cleaning away of the dead skin and debris is called debridement.

Wound stages Stage 1

wound skin (epidermis layer) skin (dermis layer)

5

fat (subcutaneous tissue)

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muscle

bone

Stage 2

Stage 3

Stage 4

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wound stages

page 2

Wound stages are identified this way: Stage 1: A reddened area that does not fade after 30 minutes of taking away pressure. If you have light skin, the skin color may change to a dark purple or red area that does not become pale under finger pressure. If you have dark skin, the area may be darker than normal. The area may be warm, hard, tender to touch and swollen. The area is often over bony areas, such as: the shoulder blades, tailbone, buttocks, heels or ankle bones. With proper care, these wounds heal easily. Stage 2: In this stage there is a partial loss of some thickness of skin. It may be an abrasion, a blister or a little crater. It is most often pink in color and painful.

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Stage 4: This wound extends deep into the tissue and often affects the muscle, joint, tendons and bone. It looks like a deep crater and may be black or infected or both. There is a large amount of nerve damage so pain is not felt.

5

Stage 3: In this stage the wound is deeper and may have gone into the subcutaneous (fatty) tissue. It can look like a deep crater or it may have a thick scab over it. The tissue may become black or infected or both. Because there is some nerve damage, a stage 3 wound is not as painful.

Wound Care ✒

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Wound care treatment plan patient’s name_______________________________________________

Treatment

Special Instructions

1. Assess healing As your wound heals, it will slowly get smaller and drain less. Look for new tissue at the bottom of the sore that is light red or pink and looks lumpy and shiny. Do not try to get rid of this tissue.

2. Tell your nurse if: a. the wound seems to be getting bigger b. the amount of drainage has increased c. you see any signs of infection in the wound d. it does not appear to be healing after 2 to 4 weeks of care

3. Change your dressing each day as instructed 4. Maintain a moist wound

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6. Tell your nurse if the wound is too dry (dressing sticks to wound when changing dressing) or wound and dressings are too moist (the dressing is not able to absorb normal drainage)

5

5. Absorb excess drainage

7. Protect the wound from infection and further injury 8. Assess wound healing each week

Other instructions:

Wound Care ✒

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Pain and wound care As you treat your wound, problems may come up. This is true, even if you do everything you should. Pain is one of these problems. Pain can make it hard to move or to care for your wound. You may feel pain in or near the wound. If you do, tell your nurse about this. Covering the wound with a dressing may help lessen some of the pain. Changing your body position may also help. If you have pain as you are cleaning the wound or when you are changing your dressing, you may need to take pain medicine. An over-the-counter pain medicine may be enough for you. Or, you may need to get a prescription pain medicine. Talk with your nurse about this.

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5

Take your pain medicine about 30 minutes to 1 hour before you clean your wound or change your dressing. This will give the medicine time to work before you have to do these tasks. If your pain medicine does not work to relieve your pain, tell your nurse. You may need another type of pain medicine.

Wound Care 6

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Infection and wound care Even if you do all you are told to do to care for your wound, it can still become infected. Infection can cause the wound not to heal as it should. Your wound may heal more slowly if it becomes infected. An infected wound can also spread to other tissue around it. And, if left untreated, it can spread into your body and even into a bone. An infection needs to be treated at once. Look for any signs of infection in and around your wound each day. If you note any, call your nurse right away. These are signs of infection: • thick, green or yellow drainage

Normal, healing wound a normal wound looks bumpy and red with a moist base

• bad smelling odor from wound after cleaning

skin looks normal, not red or swollen

• redness or warmth around the wound

5

Infected Wound (not healing normally)

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• tenderness of area around the wound • swelling

• fever or chills

an infected wound looks yellow and soupy

• weakness

• confusion or having a hard time concentrating

skin is red, warm, tender

• rapid heart beat

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infection and wound care

page 2

If any of these signs of infection are there, your treatment plan may need to be changed. Also tell your nurse if: • the wound is larger or deeper than before • the wound does not get smaller and begin to heal in 2 to 4 weeks • more fluid is draining from the wound than before • the fluid is a different color or smells bad • you cannot eat a healthy diet • you have any problem following your treatment plan

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5

• you are sick

Wound Care ✒

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Things you can do to help your wound heal • Rest so your body has energy to heal. • Keep the wound area free from germs. • Avoid putting direct pressure on the area. Use pillows to keep the wound from touching the bed or chair. Change positions often to keep from putting pressure on the wound. Use a special mattress or cushion if you can. (Ask your nurse where you can get this.) • If possible, raise the area to reduce swelling and pain. This will improve blood flow and help you heal. • If the wound is on your calf or foot, do not cross your legs. Do not walk on your foot. Use special shoes to reduce pressure in the wounded area. • Eat a healthy diet rich in protein, carbohydrates and vitamins (A, B complex, C and D). Ask your doctor or nurse what foods you should eat.

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• Try to avoid stress.

5

• Drink lots of fluids.

• To promote healing, follow a regular exercise program and stay active (if your doctor says it’s OK).

Wound Care ✴

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Medicines for infections CAUTION There are 4 types of medicines that your doctor may give you for infections:

Do not quit taking your medicine until it is all gone— even if you feel better.

• antibiotics • antifungal agents • antiviral drugs • anti-inflammatory agents For your medicines to work best, you must take them exactly as prescribed. Talk with your nurse or the pharmacist to learn these things about your medicine:▲ • the name(s) of your medicine(s) • how to prepare them • how and when to take (with food?) • side effects to watch for and what to do if they occur • what to do if you miss a dose

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5

• how one medicine interacts with any others you are taking (do not take over-the-counter medicines without talking to your doctor first) • how certain foods affect your medicine(s) Some foods may have a bad effect on your medicines. Talk with your doctor or nurse about your medicines and which foods or drinks you should avoid. Write them here: Medicine

Wound Care ✒

▲ RK, 51-52

Foods/drinks to avoid

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a

A word about pressure ulcers

A pressure ulcer is a wound to the skin and the tissue below it. Pressure ulcers are also called: • pressure sores • bed sores

• decubitus (dee-cube-it-us) ulcers

Tiny blood vessels carry oxygen and nutrients to the tissue. If the tissue does not get these, it starts to die. It most often happens over bony areas that receive too much pressure or other stress. A pressure ulcer then forms.

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5

a

Damage from pressure ulcers can start after as little as two hours of pressure.

Wound Care ✒

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Causes of pressure ulcers A pressure ulcer may be caused by: • pressure—when you sit or lie in the same position for as little as 2 hours or longer, the pressure can squeeze shut the tiny blood vessels that take blood to the tissue

• shearing—when your body slides against something it can cause the skin to pull away from the tissue under it, stretching and tearing blood vessels

Wound Care ✴

Bed

Elbow

Movement

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• friction—when your skin is rubbed against something, it can cause the top layer of skin to be taken off (like if your heel is rubbed against the sheets on your bed) which reduces the blood flow to the tissue

Moisture

5

• moisture—when urine, stool or sweat stays next to the skin for too long, it causes the skin to become softened and the tissue can break down

Bed

Pressure

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Preventing pressure ulcers The best thing you can do is to prevent a pressure ulcer from forming. Pressure ulcers can start after as little as two hours of pressure. To prevent pressure ulcers: • change positions often (at least every 2 hours) • use pressure relief devices in your bed and in your chair • avoid friction and shearing • keep clean and stay dry • eat a healthy diet

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Use a mirror to check the spots you cannot see.

5

• check your skin around bony areas (back shoulders, hips, tailbone, elbows, heels, etc.) many times a day

Wound Care ✒

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Change positions often In bed: 1. Shift your weight at least every hour. Change positions at least every two hours. Make sure your weight is spread evenly with no pressure on bony areas. Ask your nurse for information on how to align your body while lying on your back, your side or your stomach.▲ 2. Keep track of when you turn. This is even more important if you depend on others to turn you. Set a timer or ask your nurse for a turning clock.■ Or keep a notebook, writing down each time you turn, what position you turn to and if there are any marks on your skin that need to be watched.

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Lying on side

5

3. Work your turning schedule around your activities. For example, schedule lying on your back for mealtimes.

Top leg bent, pillow beneath

Not directly on hip bone Pillow(s) behind back, hip

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▲ PM, 17-21, ■ RK, 46

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change positions often

page 2

In a chair or wheelchair: 1. Maintain good posture. Do not slump. 2. Shift your weight at least every 15 minutes. To do this try one of these: a. Lift your hips as you lean from side to side. b. With your safety belt on, put your feet flat on the floor. Lean forward and lift your weight from the chair. c. Press down on the arms of the chair and lift your weight off the seat. d. Have someone sit behind you and tilt your chair back. (Be sure to lock the wheels.) The wheelchair handles should rest on the person’s lap. Use a pillow for your head.

a

3. Change positions at least every hour.

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5

4. Be careful to avoid scrapes, bumps and bruises when switching from bed to chair and back.

Caution: Always lock your wheelchair before shifting weight.

Wound Care ✒

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Using pressure relief devices Before you buy or use a device, ask your nurse or doctor which is best for you. Ask where you can buy or rent devices and shop around to get the best price. Check with your insurance company to see if it is covered. In bed: • Use a gel, water, air, foam or other special mattress to help spread your weight evenly.

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• Wear foam, thickly quilted or gel heel protectors, or place a pillow under your legs between your ankles and calves to keep your heels off the bed. Never put a pillow under just your knees. This can cut off blood flow.

5

• Place a pillow or wedge between your knees to keep them from touching. Do the same for your ankles. Use other pillows or wedges as needed for propping. But don’t use a back wedge. This shifts weight to the bony part of your back.

• To keep sheets and blankets from resting on your legs and feet, try using a bed cradle. It is like a tent.

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using pressure relief devices

page 2

• Use a padded footboard to keep your feet at 90 degrees. If feeling and blood supply are good, you can wear thick sports socks and loosely tied high top tennis shoes for 2 to 3 hours at a time. • For lifting, a drawsheet can be used by 2 caregivers. A trapeze or mechanical lift may be helpful if there is only 1 caregiver.

One...Two... Three....

• Do not lie on drainage tube devices (like, IVs or catheters) or oxygen tubes. In a chair or wheelchair: • Use a foam, air, gel or other special cushion to relieve pressure.

12"

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5

• Do not use a donut-type cushion. It can reduce blood flow, increasing the chance of pressure ulcers.

• Use a rigid seat insert under cushion, if you sit in any sling-type chair.

Wound Care ✒

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Move as much as you can If in bed, turn and move every 1 to 2 hours. Lift instead of pulling or sliding to reduce friction and shearing. Heels are hard to protect. Keep them off the bed. Socks may help reduce friction. Stay out of bed as much as you are allowed. Blood flow is better when you are up. Good blood flow helps to keep your skin healthy. Change chairs once in a while. Any activity will help you change position and prevent pressure ulcers. If in a wheelchair, shift your weight every 20 minutes to increase blood flow. At first, you may want to wear a watch to remind you.

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5

If you can, walk or do other exercise to keep up a good blood flow. Ask your nurse about range of motion exercises and physical therapy.

Wound Care 6

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Avoid friction and shearing Except for eating, don’t raise the head of the bed higher than 30 degrees. This prevents sliding. If you have problems breathing or are tube feeding, talk to your nurse or doctor about this. The best position is mostly flat or semi-flat (15 degrees). Raising the foot of the bed slightly will also help prevent sliding. Lift and move, don’t slide, when moving in or between the bed and chair. If you need to, have your caregivers use a drawsheet or mechanical lifting device. Avoid tight or rough clothes and clothes with thick seams or folds, like jeans. Use padding or protective dressings on bony areas. No higher than 30° unless eating

30° OK

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5

15° GOOD

0° BEST when flat

Wound Care ✴

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Keep clean and stay dry Follow these tips to keep clean and stay dry to help prevent pressure ulcers: • Bathe or shower regularly. Use warm (not hot) water, a mild soap (like Dove®) and a soft cloth. • Pat, don’t rub, skin dry. Be sure to dry skin folds well. • Use cream or oil to keep your skin from getting too dry. Dry skin is less elastic and easier to damage. Rub in cream or lotion so it does not leave your skin too moist. • Avoid dry or cold air, as this will dry your skin.

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5

• Do not massage over bony areas that are red or purple. This is the first sign of a pressure ulcer. Tell your nurse about it.

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keep clean and stay dry

page 2

When bowel or bladder control is a problem: • Clean skin as soon as it is soiled. • Change wet sheets and clothes at once. • Use an ointment or cream to protect skin from urine or stool. • Use pads or briefs that pull moisture away from the skin. • Use a single layer of padding. A heavier layer wrinkles easier and could cause sweating or pressure areas. • Make sure drainage devices such as tubes are set right.

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5

• Don’t sit on a toilet or bedpan for longer than a few minutes. This cuts off blood flow and can cause pressure ulcers.

Wound Care ✒

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Check your skin Checking may seem like a lot of bother at first, but once you know what, how and where to look, it will become routine. A little time checking now can beat a lot of healing time later. Check your skin often to find any warning signs of a pressure ulcer. Do this at least once a day and more often if you have a higher risk of getting a pressure ulcer. Look for any of these warning signs: • if you have light skin, pink, red or dusky colored areas that do not turn white when touched. If you have dark skin, blue or purple areas • areas that feel hard and/or warm

5

• blisters, scrapes or other broken skin

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• pain over bony areas

• swelling

Keep a record of any warning signs you find. Ask your nurse for a form to do this on.▲ This will help you keep track of an ulcer’s progress, too. It can also help your nurse know what treatment might be needed.

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▲ RK, 45

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check your skin

page 2

How and what to check Look at all the bony and other areas shown below. As you turn and move throughout the day, check all skin areas getting pressure, friction, shearing or moisture. Carefully check areas where you can feel bone near the skin or where the bone sticks up, like near the tailbone, hip, ankles and heels.

5

Check all areas that you can see, then use a mirror to check those you cannot. Touch the areas to see if they feel warm or hard. If you cannot stand, you will need to do this in bed. If you need help, ask someone to help check those areas you cannot.

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If you find a pressure ulcer, try to figure out what caused it. Was it friction, moisture or pressure? Then get rid of the problem. Tell you nurse about the pressure ulcer or warning signs you find.

Wound Care ✒

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Pressure ulcer prevention plan Here is a way for you to keep up with the steps you take to help prevent a pressure ulcer. Ask your nurse to help you fill this in so you will have a plan.

Use pressure relief devices Special Instructions

Device

Move as much as possible How Often

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Avoid shearing and friction

5

Activities

Lifting methods to use

How much to raise head off bed

Other

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pressure ulcer prevention plan

Keep clean, stay dry Bathe how often Soaps, ointments, creams to use Other

Eat a healthy diet Foods

Amount of fluids to drink

a page 2

How Much

How Often

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5

a Wound Care ✒

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Tips for preventing pressure ulcers Here are some tips to help prevent pressure ulcers: • If you cannot control your bladder or bowel, clean the area with a personal cleaner instead of harsh soaps and water. Use a protective moisture barrier cream for added protection. Dry skin gently. • After you turn or move, check to see that there are no wrinkles in sheets or clothes. After eating, check bed, chair and clothes for crumbs. Keep track of small objects such as combs, nail files, drainage caps, etc.

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5

• Be careful with cigarettes, hot drinks and the temperature of tub and shower water. Don’t use hot water bottles or other heating devices on parts of your body that have no feeling or reduced feeling.

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tips for preventing pressure ulcers

page 2

• If swelling is a problem, elevate your hands and feet. Wear support hose, if your doctor or nurse recommends them. Be sure you remove the hose on a regular schedule. Moisturize your skin. • If you will be having anesthesia or taking medicine that will cause you to be less alert, write down instructions about your skin care for others to follow. • Cornstarch can help prevent friction between your skin and dressings with a slippery backing. • Wear cotton clothing next to your skin. It helps absorb the moisture. • Check skin under braces and splints often for sores or red or dark areas, and for moisture. Report any of these to your nurse.

Heel

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5

Back of head

Tailbone and hip

Wound Care ✒

Wrist

Elbow

Shoulder

Back of ears

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Cleaning a pressure ulcer Pressure ulcers heal best when they are clean. They should be free of dead tissue (which may look like a scab), excess fluid and other debris. If not, healing can be slowed and the ulcer can become infected. Follow these steps to clean your pressure ulcer: 1. Get your supplies ready: cleaning solution (Ask your nurse what is best for you to use. Most likely it is saline.), clean plastic gloves (exam gloves or sterile gloves) and disposable plastic bags. 2. Wash your hands well with soap and water, or you may use a waterless alcohol-based hand rub. Dry them and put on the plastic gloves.

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• swelling

5

3. Check the ulcer for signs of infection:

• pus

• drainage • redness

• foul smell • darkness • fever

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cleaning a pressure ulcer

page 2

4. Clean the wound with a clean gauze pad and cleaning solution. Cleaning involves rinsing or irrigating the wound. You may use a syringe with a special tip, and rinse with saline solution. Loose matter may be wiped away. Wipe gently from the top of the ulcer to the bottom. Use a new pad with each wipe. Be careful not to leave fibers behind. It is important to clean the wound the right way. Some pressure is needed, but not too much. If too much force is applied when rinsing, tissue can be damaged. If too little force is used, it may not clean out all the dead tissue. Your nurse will show you how to clean your wound each time. 5. Use only cleaning solutions that your nurse or doctor has advised you to use. As a rule, saline is best for rinsing the pressure ulcer.

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5

Saline can be bought at a drug store with a prescription or made at home. (Tap water is not used for open wounds.)

Your nurse may give you saline and dressing material ordered by your doctor or nurse.

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cleaning a pressure ulcer

page 3

Recipe for making saline at home: 1. Use 4 cups of distilled water or boil 1 gallon of tap water for 5 minutes. Do not use well water or sea water.

Ask your nurse about this.

2. Add 2 tsps of table salt to the distilled or boiled water. 3. Mix well until the salt is all dissolved. Be sure storage container and mixing utensils are clean (boiled). Keep in a tightly sealed container for up to 1 week. 4. Store the saline in the refrigerator. Take it out 30 minutes before using, to allow it to warm to room temperature.

6. Pat the wound dry with a clean gauze pad.

5

TRASH

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7. Put all used gauze pads and gloves in a plastic bag and throw away. 8. Wash and dry your hands, or use a waterless alcohol-based hand rub.

Wound Care ✒

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Wound healing management A wound that heals fast is called acute. A wound that takes a long time to heal is called chronic. A chronic wound appears to get stuck in the healing process. Debridement (removing dead skin and debris) can reverse this chronic state back to an acute state. A picture is worth a thousand words. So a picture of your wound may be taken to note how it is healing. Regular measurements may also be taken to keep up with its size. You will need to visit your doctor or wound care clinic for a check up from time to time. You may have one or more checkups while you are healing. This is called follow-up care. In order for wounds to heal they need a good environment.

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• slow down blood flow

5

Too much pressure on a wound may:

• cause further tissue damage

• cause more swelling around it

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wound healing management

page 2

To help your wound heal best, keep it: • clean—use a mild soap and water or a special wound cleanser, if your doctor or nurse tells you to • moist—use treatment ordered by your doctor • protected—your nurse will tell you ways to protect your skin from wound drainage If your wound drains a lot, it will need to have a dressing put over it to help absorb the drainage. Your doctor and nurse will decide the best dressing to use for your wound. For your wound to heal fast, eat a healthy diet. A healthy diet may also help ward off infection in your wound. Your skin and the tissue around it need oxygen and nutrients to stay healthy and heal. A healthy, well balanced diet includes a lot of: • protein • iron

• Vitamin C

BEANS

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• Vitamin A

5

• zinc

• Vitamin B complex

BEANS

BEANS

Wound Care ✴

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Dressing a pressure ulcer Your doctor or nurse will decide which dressing is the right one to be used on your pressure ulcer. Choosing the right dressing is important. Where and how bad your ulcer is will help in deciding what dressing to use. The most common dressings are: • gauze (moistened with saline) • film (see-through) • hydrocolloid (transparentmoisture and oxygen retaining) • alginates (to absorb excess drainage) You must keep gauze dressings moist with saline. The body naturally releases fluids that speed the healing process. By keeping the gauze moist, you maintain these fluids. This prevents any damage to the healing tissue when the gauze is removed. It keeps the gauze from sticking to the wound. Use saline before changing the dressing, and ask the doctor how often the dressing should be changed.

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5

Unless the ulcer is infected, you can leave film or hydrocolloid dressings on for several days to keep the ulcer’s natural moisture in. Signs of infection are: • swelling

• foul smell from wound

• pus

• dark area around wound

• drainage

• fever

• redness

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dressing a pressure ulcer

page 2

The choice of dressing is based on: • what material will help your ulcer heal best • how often your dressing will need to be changed • whether your ulcer is infected

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The purpose of the dressing is to keep the ulcer moist and the area around it dry. As your ulcer heals, a different type of dressing may be needed.

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Changing a pressure ulcer dressing Change your dressing as often as your doctor says to keep the wound clean and to check for infection. Ask your nurse for your personal wound care procedures form.▲ Use infection control guidelines.● 1. Get your supplies together: dressing, scissors (if needed), cleaning solution, saline water, surgical tape, clean (exam) gloves or sterile gloves, disposable plastic bags, irrigating equipment like a syringe (if needed) and baby oil.

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3. Wash and dry your hands well. Use soap and water. You may use a waterless alcohol-based hand rub instead of soap and water. Put on clean gloves.

5

2. Have the new dressing and strips of surgical tape (if needed) ready.

4. Slowly remove the old dressing tape. If the tape sticks, put a little baby oil on it. Remove all the tape. Pull tape toward the wound to keep from tearing the skin around the wound. Do not get oil on the wound.

Continued on next page. Wound Care ✒

▲ RK, 44

● PC, 3-4

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changing a pressure ulcer dressing

page 2

5. Carefully remove the old dressing. If it sticks to the wound, let your nurse know. Put a little saline water on it to loosen it, if the dressing is dry. Put old dressing into the plastic bag.

TRASH

6. If you are told to measure the amount of drainage, write down how much of the dressing is saturated (example: 50%, 25%, all, etc.). Record the amount on your drainage record chart.▲ 7. Take off gloves, put them into the plastic bag and throw them away. 8. Wash and dry your hands well, or use a waterless alcohol-based hand rub. Put on fresh gloves.

50

45

40

35

30

25

20

15

10

5

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10. If your doctor or nurse has told you to clean and flush the wound with a special solution and a syringe, do this now.

5

9. Check the wound for signs of infection: swelling, pus, drainage, pain, redness, darkness or foul smell.

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▲ RK, 42

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changing a pressure ulcer dressing

page 3

11. Pat the wound dry with a clean gauze pad. 12. If you have been told to put a gel, ointment, powder or absorbent material on the wound, do it now. Don’t let the bottle or tube touch the wound. 13. Put on a new dressing. Don’t touch the area of the dressing that will touch the wound. 14. Remove gloves. Tape down the 4 sides of the dressing, if needed. Put all used gauze pads and gloves in the plastic bag, and throw away.

TRASH

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5

15. Wash and dry your hands well, or use a waterless alcoholbased hand rub. 16. Put away remaining supplies in a closed container or cupboard. Do not store open fluids with dry dressings.

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Causes of diabetic ulcers A diabetic ulcer is a wound to the skin and the tissue below it. Tiny blood vessels carry oxygen and nutrients to the skin and tissue. When the blood is cut off and the tissue does not get oxygen and other nutrients, the skin and tissue begin to die. Then a wound forms. When you have diabetes, neuropathy (nerve damage and loss of feeling) most often occurs in your feet and legs. It may change the way you walk and stand. You may injure yourself and cause a wound, but not feel it because of the loss of feeling. Diabetic ulcers are most often caused by: • trauma—an injury or tear in your skin that you may not have pain with due to loss of feeling • pressure—when you sit or lie in the same position for a long time, the pressure can squeeze shut the tiny blood vessels that take blood to the tissue

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5

• vascular disease—poor circulation and decreased oxygen supply to the tissues causes your feet and legs to be dry and the skin to crack (This lets infection and wounds begin.)

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Preventing diabetic ulcers Two complications of diabetes are neuropathy and vascular disease. These can make you more prone to wounds or ulcers. Preventing wounds is the best thing you can do when you have diabetes. The best way to do this is: • control your disease • take good care of your feet and legs • avoid any injury • take care when trimming nails —use a file

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5

• treat any wound as soon as it occurs

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Control your diabetes When you have diabetes, your goal is to keep your blood glucose in a healthy range. This can prevent or delay health problems caused by your disease. You can do this by: • testing your blood glucose regularly and keeping it within your target range • taking your medicine (insulin and/or oral agents) as prescribed • eating the right amounts and kinds of food at the right times • doing some physical activity each day Over time, diabetes can cause serious, long-term health problems. It can damage your nerves, feet and blood vessels. This can let wounds occur more often.

5

But, this doesn’t have to happen. Taking care of yourself and controlling your blood glucose can help prevent or at least reduce these problems.

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Ask your nurse for a diabetes diary to keep track of this.▲

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Bedtime

Dinner

Blood Glucose

Breakfast

_________ (dose____)

_________ (dose____)

_________ (dose____)

Exercise

Snack 2

Snack 1

Dinner

Breakfast

Lunch

▲ RK, 17-18

My healthy blood glucose range is

name

Medicines*

Meal Plan

Date

for

Lunch

Diabetes Diary

before meals: _____ to _____ 2 hours after meals: _____ to _____ at bedtime: _____ to _____ Notes

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Take good care of feet and legs People with diabetes need to take good care of their feet and legs. Having high blood glucose can cause vascular disease (poor circulation) and neuropathy (loss of feeling due to nerve damage). When you have poor circulation, your legs and feet don’t get a good blood flow. Wounds or ulcers can happen as a result of this. And, you may not be able to fight off infections as well as someone with good circulation. Simple cuts, sores and bruises can become very serious. Left untreated, these can lead to gangrene (blood poisoning) and amputation (removal of a leg or foot). When you have nerve damage, you may have numbness or a loss of feeling in your feet and legs. You may not notice a small cut or sore since you didn’t feel when it happened. Left untreated, these can become serious wounds. The way to know if you have any cuts, sores or bruises is to check your legs and feet before putting shoes on and when taking them off.

5

• look for cuts, scratches, cracks, blisters or redness

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• check between toes and on the bottoms of your feet • use a mirror if you can’t see the bottoms of your feet or ask someone else to help you

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take good care of feet and legs

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To take good care of your feet and legs, follow these tips: • don’t go barefoot—not even inside • wear shoes that fit (leather and canvas are best) • don’t wear sandals or shoes with open toes or heels • make sure the inside of your shoes are smooth, with no torn linings or rough areas to rub against your feet • wear clean cotton socks to absorb moisture • protect your feet from heat and cold • wash your feet every day, but don’t soak them • dry your feet by patting them dry instead of rubbing • dry well between your toes

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• keep your toenails trim and smooth (the best time to trim and file them is right after you wash)—have a podiatrist show you how to do it the right way

5

• don’t put lotion between your toes

• don’t cut corns or calluses

• don’t use corn plasters or liquid corn or callus removers

• don’t use antiseptics or tape on your feet

• don’t use hot water bottles, heating pads, battery powered foot warmers or electric blankets on your feet

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Treat a wound as soon as it occurs As a part of your daily foot care, look for any signs of a wound. Cuts, scratches, cracks, blisters or even redness are signs of wounds. If you find any sign, tell your nurse right away. Treatment needs to start as soon as a wound occurs. This will help keep it from getting larger or infected. Your nurse will set up a treatment plan for your wound. It most likely will include the following steps: • wash and dry your hands (or use a waterless alcohol-based hand rub) before you touch your wound or the area around it • avoid wearing tight clothes (these tend to cut off blood flow)

5

• avoid heating pads (these may cause burns or other injury due to neuropathy)

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• avoid soaking the area where the wound is

• clean the wound to remove any dead skin or debris • take any medicine ordered

• change your dressing (if ordered) • eat a well balanced diet

Follow your nurse’s or doctor’s advice about how to treat your wound to help it heal as soon as possible. If your wound does not heal as it should, it can lead to the loss of a leg or foot.

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Relieve pressure from wound area Your doctor may order a special shoe or support for you to wear to relieve pressure from the area around your wound. This step is called “off-loading”. Because pressure is one cause of a diabetic ulcer, relieving the pressure can help restore blood flow to the tissue. This will help the wound heal faster. Pressure can be caused by sitting or lying with your legs crossed. When you sit or lie, do not cross your legs. This can cut off blood flow to your lower legs and feet. When blood flow is reduced, a wound cannot get the oxygen and nutrients needed to heal.

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When lying, use pillows to raise the wound area away from touching the furniture to avoid putting pressure on it. If needed, use a pressure reduction device, like a density foam, inflated or air powered mattress overlay. (You can get these from a home medical equipment company. Ask your nurse about this.)

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Cleaning a diabetic ulcer Diabetic ulcers or wounds heal best when they are clean. They should be free of dead tissue (which may look like a scab), excess fluid and other debris. If not, healing can be slowed and the wound can become infected. Follow these steps to clean your wound: 1. Get your supplies ready: cleaning solution, clean (exam) gloves, disposable plastic bags and a bowl to drain away the cleaning solution. 2. Wash and dry your hands well with soap and water, or use a waterless alcohol-based hand rub. Put on the gloves. 3. Check the wound for signs of infection. Signs of infection are: • foul smell from wound

• pus

• dark area around wound

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5

• swelling

• drainage

• fever

• redness

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cleaning a diabetic ulcer

page 2

4. Clean the wound with a clean gauze pad and cleaning solution.

top

Cleaning involves rinsing or irrigating the wound. Loose matter may be wiped away. Wipe gently from the top of the ulcer to the bottom. Use a new pad with each wipe.

bottom

It is important to clean the wound the right way. If too much force is applied when rinsing, tissue can be damaged. If too little force is used, it may not clean out all the dead tissue.

Ask your nurse for the best solution to use. Most likely it is saline.

Your nurse will show you how to clean your wound each time. 5. Use only cleaning solutions that your nurse or doctor has advised you to use. As a rule, saline is best for rinsing the ulcer.

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5

Saline can be bought at a drug store with a prescription or made at home. (Tap water is not used on an open wound.) Your nurse may give you saline and dressing material ordered by your doctor or nurse.

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cleaning a diabetic ulcer

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Recipe for making saline at home: 1. Use 4 cups of distilled water or boil 1 gallon of tap water (city or county water only) for 5 minutes. Do not use well water or sea water.

Ask your nurse about this.

2. Add 2 tsps of table salt to the distilled or boiled water. 3. Mix well until the salt is all dissolved. Be sure storage container and mixing utensils are clean (boiled). Keep in a tightly sealed container for up to 1 week. 4. Store the saline in the refrigerator. Take it out 30 minutes before using it, to let it warm to room temperature.

TRASH

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7. Remove gloves. Put all used gauze pads and gloves in a plastic bag and throw away.

5

6. Pat the wound dry with a clean gauze pad.

8. Wash your hands, or use a waterless alcohol-based hand rub.

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Dressing a diabetic ulcer Your doctor or nurse will decide which dressing is the right one to be used on your wound. Choosing the right dressing is important. Where and how bad your wound is will help in deciding what dressing to use. The most common dressings are: • gauze (moistened with saline) • film (see-through) • hydrocolloid (moisture and oxygen retaining) • alginates (to absorb excess drainage)

5

You must keep gauze dressings moist with saline. The body naturally releases fluids that speed the healing process. By keeping the gauze moist, you maintain these fluids. This also keeps the gauze from sticking to the wound and prevents any damage to the healing tissue when the gauze is removed. Use saline before changing the dressing, and ask the doctor how often the dressing should be changed.

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Unless the ulcer is infected, you can leave film or hydrocolloid dressings on for several days to keep the wound’s natural moisture in. The choice of dressing is based on:

• what material will help your wound heal best

• how often your dressing will need to be changed • whether your wound is infected

The purpose of the dressing is to keep the wound moist and the area around it dry. As your wound heals, a different type of dressing may be needed.

Wound Care ✒

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Changing a diabetic wound or ulcer dressing Change your dressing as often as your doctor says to keep the wound clean and to check for infection. 1. Get your supplies together: dressing, scissors (if needed), cleaning solution, surgical tape, saline water, ointment or powder, clean (exam) gloves or sterile gloves, disposable plastic bags, irrigating equipment like a syringe (if needed) and baby oil. 2. Have the new dressing and strips of surgical tape (if needed) ready. The nurse will give you information for any special type of dressing. 3. Wash your hands well with soap and water, or use a waterless alcohol-based hand rub. Dry them well. Put on clean gloves.

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5

4. Slowly remove the old dressing tape. If the tape sticks, put a little baby oil on it. Remove all the tape. Pull tape toward the wound to keep from tearing the skin around the wound. Do not get oil on the wound. 5. Carefully remove the old dressing. If it sticks to the wound, put a little saline water on it to loosen it. Place the old dressing in the plastic bag. 6. If your wound has a lot of drainage, your nurse may ask you to estimate the amount of drainage. To do this, write down how much of dressing is saturated (example: 50%, 25%, all). If so, record the amount on your drainage record chart.▲ (Ask your nurse for this.) Continued on next page.

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▲ RK, 42

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changing a diabetic wound or ulcer dressing

page 2

7. Take off gloves, put them into the plastic bag and throw them away. 8. Wash and dry your hands well (or use a waterless alcohol-based hand rub), and put on fresh gloves. 9. Check the wound for signs of infection: swelling, pus, drainage,pain, redness or darkness. 10. If your doctor or nurse has told you to clean and flush the wound with a special solution and a syringe, do this now. 11. Pat the wound dry with a clean gauze pad. 12. If you have been told to put cream, gel, ointment or powder on the wound, do it now. Don’t let the bottle or tube touch the wound.

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5

13. Put on a new dressing. Don’t touch the area of the dressing that will touch the wound.

14. Remove gloves. Tape down the 4 sides of the dressing, if needed. Put all used gauze pads and gloves in a plastic bag, and throw away.

TRASH

15. Wash and dry your hands well, or use the hand rub. 16. Put away remaining supplies.

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Causes of arterial ulcers An arterial ulcer is a wound to the skin and tissue below it. When the blood flow to your legs and feet is blocked, you may develop an arterial ulcer. These are most often found on the areas of your legs and feet that are bony, such as your ankles and the tips of your toes. These areas rub against other things and cause friction on your skin. An arterial ulcer is the hardest type of wound to heal. If it does not heal as it should, it can lead to the loss of your foot or leg. You need to follow your doctor or nurse’s advice about how to treat your wound to help it heal as fast as possible. As part of your daily foot care, you need to look for any signs of an arterial ulcer. If you have one, it will most likely: • have a regular shape • not drain, or drain just a little • be very painful, causing burning, throbbing and stabbing pains (unless you’ve lost the feeling in your legs or feet)

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• be dry to the touch

5

• be pale pink, gray or black

• have little or no pulse in the area around it • cause the skin around it to be cool or cold

• be found on the top of your foot, close to your ankles or on your toes

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Preventing arterial ulcers Although arterial disease can’t be cured, it can be managed. If you have diabetes, keeping your blood glucose (sugar) under control is very important. Also, eating a low-fat, lowcholesterol diet will help keep you healthy. Other ways to manage and treat arterial disease are: • Avoid wearing tight clothing. • Avoid hitting or bumping your feet or legs. • Stop smoking. Tobacco reduces blood flow to all parts of your body. • Keep pets away from your feet and legs so they don’t scratch you.

5

• Keep your skin clean and dry. Use a fragrancefree, dye-free lotion to keep your skin moist.

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• Take your medicines as ordered by your doctor or nurse.

By controlling this disease, you can help prevent problems such as arterial ulcers or wounds. Treatment of arterial disease includes controlling the risk factors you can, as well as following your treatment plan. In some cases, surgery may be needed to open or replace a clogged artery.

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Treatment of arterial (chronic) ulcers It may take months for a chronic ulcer or wound to heal since there is less blood supply to these cells and tissues. Your main goal is to increase blood flow to your wound. Your wound will heal best when it is kept clean. If you see any signs of an arterial wound, tell your nurse right away. Your treatment plan should start as soon as possible to keep the wound from getting larger or infected. To care for your wound, use infection control guidelines.▲ Always: • Wash your hands before touching your wound or the area around it (you may use a waterless alcohol-based hand rub instead of soap and water). Keep anything that touches your wound clean. This will help prevent infection.

5

• Avoid heat. The sun, hot baths, saunas and other sources of heat can decrease your blood flow.

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• Change your dressing as your nurse tells you. • Take your medicines as ordered.

• Avoid wearing tight clothes (such as tight socks or shoes, garters, pants with an elastic waist).

• Eat a well-balanced diet low in fat and cholesterol. Be sure you get vitamins A and C, protein, iron, calcium and zinc in your diet. You may need to take vitamin supplements. Ask your nurse or dietitian about healthy food and drink choices. Continued on next page.

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aa

treatment of arterial ulcers

page 2

• Don’t elevate (prop up) your leg. Your blood flow is better when you keep your leg down. • Don’t cross your legs.

• Avoid soaking your feet.

If your wound shows signs of infection, you will most likely be given an antibiotic (a medicine to help kill germs).

If your wound does not heal, your doctor may suggest angioplasty to open your blocked artery. In angioplasty, a small balloon is fed into your artery. The balloon is inflated several times to push back the plaque and widen the space in which the blood flows. Then the balloon is removed. fatty buildup

a

artery

blood flow

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5

BALLOON

If this does not work, your doctor may suggest bypass surgery to go around the blocked artery or “bypass” it. A leg vein or artificial (man-made) tube is used to bypass the blocked area. This will improve the blood flow to your legs and feet.

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Causes of venous ulcers If you have had venous disease for a long time, you are at risk of getting ulcers (wounds) on your legs. A venous ulcer is the most common type of leg wound. When blood “pools” in your lower legs and ankles, your veins and smaller blood vessels swell. When this happens, they may leak blood cells and fluid into the nearby tissue. Over time, this tissue breaks down and a wound forms. Venous ulcers are most often found on the inside of your leg, just above your ankle. As part of your daily foot care, look for signs of a wound. If you have a venous ulcer, it will most likely: • be moist to the touch • be shaped with irregular (jagged) edges • be dark red or yellow in color • drain a lot

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5

• be large

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Preventing venous ulcers Although venous disease doesn’t go away, you can help manage it or keep it from getting worse. You should: • Control the risk factors you can. • Exercise regularly. This will improve your blood flow and help keep your feet and legs healthy. • Wear compression hose. These help push the blood back to your heart and keep blood from pooling. • Walk as much as possible. • Avoid standing in one spot for long periods of time. • Keep your legs raised higher than your heart when you are sitting or lying down. • Avoid bumping or hurting your legs and feet.

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5

• Eat a healthy diet (with less salt).

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Treatment of venous ulcers Treatment of venous ulcers or wounds can take a while and may cause you stress. Your goals are to: • Wear compression bandages as ordered. • Keep your wound clean to avoid germs and infection. • Stay as active as you can to help your veins pump the blood back to your heart. • Raise your leg 6 inches above the level of your heart to reduce the swelling in your legs and ankles. • Rest so your body has the energy to heal. • Drink 8-16 (8oz) glasses of water a day (if your doctor says it’s OK). • Be sure you get vitamin A and C, protein, iron, calcium and zinc in your diet. You may need to take vitamin supplements. Ask your nurse about healthy food and drink choices.

5

Fo C rM al l 8 or 00 e I .2 nfo 41 .4 92

• Take your medicines as ordered.

compression bandage

• Lose weight—if you need to.

8oz

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treatment of venous ulcers

page 2

• Stop smoking. Tobacco reduces the blood flow to all parts of your body. • Don’t scratch or hurt your wound or the skin around it.

OKE

• Don’t cross your legs.

SM

• Avoid heat from the sun, hot tubs and saunas. Heat makes your veins expand even more.

DO N

OT

• Don’t wear tight-fitting clothes. These can cut off your blood flow. • Avoid standing for long periods of time. • When sitting, move your legs often. Just bending your knees helps your muscles. • If you cannot move around, try these several times a day: bend your ankles back and forth or pick your leg up and slowly lower it.

5

• Wash your hands before you touch your wound or the area around it. Keep anything that touches your wound clean. This will help prevent infection.

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• Elevate your legs as often as possible unless your doctor or nurse tells you not to. This helps move the blood back to your heart. • Change your wound dressing the way your nurse tells you. • See your doctor on a regular basis.

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Compression therapy About compression therapy The most important part of your treatment involves the use of compression therapy. This is the use of snugfitting stockings (hose), bandages or special pumps to apply pressure to the veins in your feet, ankles and legs. This pressure helps push the blood back up to your heart so it does not pool in your ankles and legs. Compression hose and bandages are made to fit snugly, without bunching around your ankle. The pressure is greater at your foot and ankle and decreases as it goes up to your knee. They should be: • prescribed by your doctor • fitted properly to your feet and legs • checked often so they don’t “roll up” or bind If you have an ulcer you will most likely be given a compression bandage to wear over it. Then once the wound is healed, compression hose are used.

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5

CAUTION

The bandages or hose should be fairly comfortable. You should let your doctor or nurse know if you have: • more pain that does not go away • more swelling in your toes • purple, white or cold toes

• loss of feeling in your feet or legs

If you are on fluid pills, take them as you were told. If you become short of breath or have chest pain, take off your bandages or hose and call your doctor right away.

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compression therapy

page 2

When using compression hose: • put them on each day before you get out of bed • take them off each night before you go to bed • always pull them up right away if they roll down • make sure your legs are clean and dry (Powder may make your hose go on easier.) • remove any rings, and be careful not to punch holes in the hose with your fingers • put lotion on your legs after taking them off • wash them at least once or twice a week, more often if soiled • buy new ones every 6 months or as directed (having more than 1 pair will allow you to always have a clean, dry pair available.) • don’t fold hose down at the top

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5

• wear them as instructed

You may find that using a sock donner can help in putting your hose on. Ask the nurse about this.

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About surgical wounds Surgery means cutting through skin and tissues. Proper healing is very important after surgery. Incisions can fill with fluid which can lead to infection. Fluid can cause pressure and reduce blood flow and healing. For these reasons, your surgeon may have placed a drain in the incision or near it to help get rid of the fluid. The fluid should change from red to pink to straw-colored over a period of days. The amount of drainage should get less and less over time. The area around your stitches may be a little red and swollen. But the skin should be normal in color and temperature. Call your doctor or nurse if you have: • warm skin around the incision

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• increased drainage from incision

5

• hard, purple or dark areas near the incision

• a bad smell coming from the wound • a fever

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about surgical wounds

page 2

Most of the time, signs of infection don’t show up until the third to fifth day after surgery. They include: • redness, firmness, itching or darkness around incision • swelling at the site • excess drainage and bad odor at the site • increased pain and tenderness at the site • fever • nausea • loss of appetite • increased tiredness If you have any of these signs, you need to let someone on your health care team know. Ask your nurse who to call.

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5

Call: Phone number:

Signs of infection to report:

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Changing a dressing (with a shower) Change your dressing as the doctor or nurse tells you. This is to keep the wound clean and to check for infection. 1. Get your supplies together: dressings (gauze pads), scissors, cleaning solution (ask your nurse), surgical tape, ointment or powder, clean (exam) gloves or sterile gloves (if needed), disposable plastic bags, two bowls and baby oil. 2. Have the new dressing and strips of surgical tape ready.

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4. Slowly remove the old tape. To do this, hold your skin with one hand and with the other hand gently pull the tape toward the wound. If the tape sticks, put a little baby oil on it. Remove all the tape. Do not get oil on the wound.

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3. Wash and dry your hands well, or you may use a waterless alcohol-based hand rub.. Put on clean (exam) gloves.

5. Carefully remove the dressing. If it sticks to the wound, first put a little cleaning solution or saline water on it. Or, get in the shower with dressing on and remove it in the shower. 6. Take off gloves, put in a plastic bag and throw them away.

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changing a dressing (with a shower)

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7. You are now ready to shower. Let the warm water and soap (liquid antibacterial) run down gently over your incision line. Rinse off well. 8. When you get out of the shower, gently pat around your wound with a clean, dry towel.

Call your doctor or nurse if you see any signs of infection.

9. Wash and dry your hands well (or use the alcoholbased hand rub), and put on clean gloves. 10. Check the wound for signs of infection: swelling, pus, drainage, redness or darkness, etc. 11. Put ointment or powder on the wound if your doctor tells you to. Don’t let the bottle or tube touch the wound.

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13. Remove gloves. Tape down the 4 sides of the dressing. (If the tape you are using bothers your skin, tell your nurse. She can help you with this.) Put all used gauze pads and gloves in plastic bag, and throw away.

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12. Put on new dressing. Don’t touch the area of the dressing that will touch the wound.

14. Wash and dry your hands well or use the hand rub.

TRASH

15. Write down the color and amount of any drainage on the dressing. Your dressing change may be different. Ask your doctor or nurse what is right for you.

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Changing a dressing (without a shower) Change a dry dressing at least once a day, or as the doctor or nurse tells you. This is to keep the wound clean and to check for infection. 1. Get your supplies together: dressings (gauze pads), scissors, cleaning solution (ask your nurse), surgical tape, ointment or powder, clean (exam) gloves, sterile gloves (if needed), disposable plastic bags, one bowl and baby oil. 2. Have the new dressing and strips of surgical tape ready. 3. Pour saline water or cleaning solution in the bowl where it is easy to reach. 4. Wash and dry your hands well, or you may use a waterless alcohol-based hand rub if your hands are not dirty. Put on clean (exam) gloves.

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5. Slowly remove the old tape. To do this, hold your skin with one hand and with the other hand gently pull the tape toward the wound. If the tape sticks, put a little baby oil on it. Remove all the tape. Do not get oil on the wound. 6. Carefully remove the dressing. If it sticks to the wound, first put a little cleaning solution or saline water on it from your bowl.

7. Take off gloves, put in plastic bag and throw them away.

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changing a dressing (without a shower) 8.

9.

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Wash and dry your hands well or use a waterless alcohol-based hand rub. Then put on clean gloves.

Call your doctor or nurse if you see any signs of infection.

Check the wound for signs of infection: swelling, pus, drainage, redness, darkness, etc.

10. Clean the wound with a clean gauze pad and cleaning solution. Wipe gently from the top of the wound to the bottom. Use a new pad with each wipe. 11. Pat the wound dry with a clean gauze pad. 12. Put ointment or powder on the wound if your doctor tells you to. Don’t let the bottle or tube touch the wound. 13. Put on new dressing. Don’t touch the area of the dressing that will touch the wound.

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14. Remove gloves. Tape down the 4 sides of the dressing. (If the tape you are using bothers your skin, tell your nurse. She can help you with this.) Put all used gauze pads and gloves in a plastic bag and throw away. 15. Wash and dry your hands, or use a waterless alcohol-based hand rub.

TRASH

16. Write down the color and amount of any drainage on the dressing.

Your dressing change may be different. Ask your doctor or nurse what is right for you.

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Jackson-Pratt drain A Jackson-Pratt drain is a tube that comes out of a surgical site. It suctions the fluid from your incision and helps it to heal. It also helps prevent infection and decrease pain by reducing swelling. Empty the Jackson-Pratt drain when it is about half full or when there is no vacuum. Also check the tube often to make sure there are no kinks in it. Your nurse will show you how to care for your Jackson-Pratt drain. He or she will help you do the following: 1. Get a measuring cup to collect the fluid. 2. Wash and dry your hands well. Put on clean (exam) gloves.

cap

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4. Open cap on the bulb. Squeeze the fluid into measuring cup until bulb is empty. Do not let the bulb touch the measuring cup.

bulb

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3. Unpin the bulb from your clothes and take it off the tube.

5. Milk the tube to make sure you get all the fluid out of it (your nurse can show you how).

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Jackson-Pratt drain

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6. With one hand, squeeze all of the air out of the bulb, while putting the tubing back on with the other hand.

tubing

Make sure all the air is out of the bulb as you connect it to the tubing or the wound will not drain.

7. Pin bulb back on clothing below the level of the wound to promote drainage. Use infection control guidelines.▲ 8. Ask your nurse for a chart● to record the date, amount and color of the liquid each time you empty your drain bulb. Take this record with you for your follow-up visit.

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10. Take off gloves, and throw them away. Wash and dry your hands, or use a waterless alcohol-based hand rub.

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9. Empty the fluid from the measuring cup down the toilet. Rinse cup and wash clean.

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▲ PC, 3-4

● RK, 41

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Staying active While your wound heals, it is important that you move around and stay active as much as you can. This will help you keep up your strength.

Do as much as you can • Do as much of your normal routine as you can. Do what you can by yourself. If you need help with things like bathing and dressing, ask your caregiver. • Stay out of bed as much as you are able. Blood flow is better when you are up, helping your skin stay healthy.

Breathe deeply every 2-3 hours

• Deep breathe (or use your incentive spirometer) and yawn every 2-3 hours to improve the amount of air flow to your lungs. • If you can, walk or do other exercise to keep up a good blood flow. Ask your nurse about range of motion exercises and physical therapy.

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• Change chairs once in a while. This will increase activity and help prevent pressure ulcers (bed sores). If you must sit for a long period of time, raise your feet and legs.

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• No pushing, pulling or lifting.

• To keep from feeling dizzy, slowly change positions from lying to sitting to standing.

• Your nurse will show you how to do controlled coughing and how to splint your incision (with a pillow or folded blanket) so it doesn’t hurt. • Plan activities you will do when you feel better.

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Handling stress Having surgery can be stressful. Worry and stress can keep you from healing as fast as you would otherwise. So you want to find ways to manage this stress. There are different ways to do this. What works for someone else may not be the best for you. Try some of these, then pick what’s best for you: • leisure walks • reading • exercise • a funny video • meditation • a short rest or nap • visualization

a • massage

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Ask your nurse about other ways to cope with stress and worry.

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• a chat or visit with a friend

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Hygiene While you are recovering from surgery and caring for a wound, it is important to take good care of yourself.

Bathing • Bathe often. Ask your nurse when you can take a shower. • Use warm water, a soft washcloth and a gentle soap. • Wash slowly, and be gentle around your incision. • Dry off with a soft towel. • Don’t use bath powders until your incision is healed.

Washing your hair • Ask for help if you can’t raise your hands above your shoulders.

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Taking care of your skin and nails Your skin may have red or dark places and be dry, itch or peel around the wound site. • Avoid soaps and powders that dry your skin. Cornstarch (instead of bath powder) can relieve itching. Do not put cornstarch on the wound.

• Put lotion on dry skin.

• Don’t use after-bath perfumes or colognes that have alcohol. • Keep your nails clean and trimmed, and don’t use nail polish. Cut and file nails straight across. To prevent infection, avoid professional manicures and pedicures.

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Eat a healthy diet Eat a well balanced diet. Foods high in protein, iron, zinc, Vitamin A, Vitamin C and B vitamins promote healthy skin. Here is list of foods that can give you these nutrients:

Foods Protein

meats, poultry, eggs, fish, dairy products, whole grain breads and cereals in combination with dried peas, beans or nuts

Iron

liver, meats, oysters, whole grain breads and cereals, dried fruits, nuts, dark green leafy vegetables

Zinc

liver, meats, oysters, eggs, whole grain breads and cereals liver, cheese, butter, carrots, cantaloupe, sweet potatoes, spinach, broccoli, other yellow and dark green fruits and vegetables

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Vitamin A

Vitamin C

citrus fruits, strawberries, cantaloupe, tomatoes, sweet peppers, potatoes, cabbage, broccoli, dark green leafy vegetables

B Vitamins

meats, poultry, fish, eggs, dairy foods, whole grain breads and cereals, dried beans and peas, dark green leafy vegetables

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eat a healthy diet

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If you cannot eat a normal diet, talk with your nurse about supplements. If you are overweight or underweight, ask about a special diet. Unless your fluids are restricted, drink plenty of water, at least 8-16 (8oz) glasses a day. Drink more water if you can. Some hints: • Eat 5 - 6 small meals instead of 3 big ones • Eat when you feel like it. Don’t worry about eating 3 meals a day. • Increase the amount of protein and calories with foods such as cheese and peanut butter and crackers. The main idea is to stay healthy and maintain your weight. This is not the time to go on a diet to lose weight.

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Ask your nurse for a chart to keep track of what you are eating, how much and how often.▲ Note foods you like and those that disagree with you.

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▲ RK, 6

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Follow-up care Follow-up care is different for each person. Your doctor or nurse will tell you how often you need to have a checkup. It is very important to keep your follow-up appointments. This is to: • Make sure you do not have any long-range side effects from your wound. • Decide (together with your doctor) any lifestyle changes to make. • Discuss any changes needed in your diet. • Decide what activities you can do. • Talk about problems or other concerns.

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You may also want to keep a daily journal and write down any concerns or questions you have about your wound healing, or your health.

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Resources For more reading material, listings of support groups and other information contact: Wound Ostomy and Continence Nurses Society 15000 Commerce Parkway, Suite C Mt. Laurel, NJ 08054 (888) 224-WOCN (9626) www.wocn.org

a

a National Pressure Ulcer Advisory Panel 2300 N Street NW Suite 710 Washington, DC 20037 (202) 521-6789 www.npuap.org

American Red Cross 2025 E. Street, NW Washington, DC 20006

(800) 342-2383 www.diabetes.org

(202) 303-5000 www.redcross.org

American Cancer Society National Headquarters 1599 Clifton Road NE Atlanta, GA 30329

Your local hospital’s Wound Care Clinic Check your local directory for phone number, or ask your nurse.

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American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311

(800) 228-4327 www.cancer.org

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