Wound Care 101

Atlanta legal nurse consultant Liz Buddenhagen attended the 2016 South Carolina American Association of Legal Nurse Consultants (SC AALNC) held in Hilton Head, SC on February 20. 2016.

Wound Care 101 by Dale Daneker, MD and Nancy Daneker, RN:

The skin is the largest organ of the body. Skin provides protection from ultraviolet injury, pathogens, mechanical injury and fluid and electrolyte loss. Skin also provides temperature regulation and is instrumentally involved with metabolism and sensation.

Daneker talked about biofilms. Biofilms are communities of bacteria encased in a self-produced matrix of polysaccharides, protein and DNA that provides high levels of tolerance to antibodies, antibiotics and antiseptics.

Biofilms are present in a high percentage of chronic wounds and they impair healing by stimulating chronic inflammation, leading to elevated levels of proteases and reactive oxygen species that degrade proteins and are essential for healing.

Dr. Daneker mentioned that it takes approximately 12 hours for a biofilm to form on teeth, hence brushing twice a day, approximately 12 hours apart, or more often, is desirable.

2014 NPUAP Guidelines:

The 2014 National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers was reviewed by Daneker. He discussed “areas of concern:”

• The most common causes of stage I and stage II pressure ulcers is shearing and/or friction and not pressure. This makes it difficult to argue that stage III or IV have evolved from lesser stages.
• The concept that ulcers naturally progress from lower stages to higher stages is false.
• The most serious problem with NPUAP system is that the numeric nature of staging implies that a stage IV pressure ulcer is preceded by stages I, II and III.
• It cannot be overemphasized that the NPUAP stage refers only to the type of tissue visible at the base of the wound.

Avoidable versus Unavoidable NPUAP 2014 Consensus Panel:

Unavoidable pressure ulcers Do occur.

Identified non-modifiable intrinsic and extrinsic factors within an organ framework that may contribute to an unavoidable wound. These risk factors include low oxygenation, hypotension, hypovolemia and anemia. Additional factors are immobility, head of bed elevated more than 30 degrees, nutrition, hip fractures, non-adherence, refusal and neurological impairment.

Atlanta Legal Nurse Consultant:

Liz Buddenhagen assists Atlanta lawyers with medical legal cases. For more information, view Legal-Nurse-Consultant-LNC.com, email Liz@BuddenhagenLNCcom or call 770-725-2997.

Contact Information

Liz Buddenhagen, RN

Principal

Buddenhagen and Associates

(1) 770-725-2997

Liz@BuddenhagenLNC.com