Abstract
The growing medical and psychosocial implications of wound care reflect the increasing complexities facing practitioners in long-term care (LTC). Wounds are classified as a medical problem, a geriatric syndrome, or part of a larger systems-based problem. Understanding wound formation and healing is critical to preventing and treating wounds. Treatment plans for wound care need to address not only the wound itself, but also complexities ranging from comorbidities and medications that may hinder healing or predispose patients to wounds. The psychosocial and ethical principles of caring for patients who may no longer be able to participate in their own care also play critical roles in treatment success or failure. Although wounds may have more than one etiology, the four common types of wounds will be discussed: pressure, diabetic, ischemic or arterial, and venous. Pressure ulcers will be emphasized due to their implications in the LTC environment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Brandeis GH, Morris JN, Nash DJ, Lipsitz LA. The epidemiology and natural history of pressure ulcers in elderly nursing home residents. JAMA. 1990;264(22):2905–2909.
Bergstrom N, Horn SD, Smout RJ, et al. The national pressure ulcer long-term care study: Outcomes of pressure ulcer treatments in long-term care. J Am Geriatr Soc. 2005;53(10):1721–1729.
Bergstrom N. Litigation or redesign: Improving pressure ulcer prevention. J Am Geriatr Soc. 2005;53(9):1627–1629.
Stillman R. Wound care. Available at: http://emedicine.medscape.com/article/194018-overview june 14, 2009.
Centers for Medicare and Medicaid Services. Action plan for further improvement of nursing home quality. Available at: www.cms.hhs.gov/quality/nhqi/2009 june 14, 2009.
Centers for Medicare and Medicaid Services (CMS), HHS. Medicare program: Changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist. 2007;72:47379.
Centers for Medicare and Medicaid Services. Guidance to surveyors for long term care facilities. CMS manual. Washington, DC: CMS; 2004.
WOCN Society. Wound, ostomy, and continence nurses society position statement on avoidable versus unavoidable pressure ulcers. J Wound Ostomy Continence Nurs. 2009;36(4):378–381.
American Medical Directors Association. Pressure ulcers in the long-term care setting clinical practice guideline. Columbia, MD: American Medical Directors Association; 2008.
Gosnell DJ. An assessment tool to identify pressure sores. Nurs Res. 1973;22(1):55–59.
Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care. 2002;15(3):125–131.
Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatr Soc. 1992;40(8):747–758.
Horn SD, Bender SA, Ferguson ML, et al. The national pressure ulcer long-term care study: Pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52(3):359–367.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217–228.
American Health Care Association. Medical condition – mental status. CMS OSCAR data current surveys. 2007.
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Nursing home data compendium; Baltimore, MD. 2008. https://146.123.140.205/DataCompendium/16_2008DataCompendium.asp TopOf. Page. Accessed June 22, 2009.
Hyde J, Perez R, Forester B. Dementia and assisted living. Gerontologist. 2007;47(Spec 3):51–67.
Wishin J, Gallagher TJ, McCann E. Emerging options for the management of fecal incontinence in hospitalized patients. J Wound Ostomy Continence Nurs. 2008;35(1):104–110.
Young ME. Malnutrition and wound healing. Heart Lung. 1988;17(1):60–67.
Stratton RJ, Ek AC, Engfer M, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: A systematic review and meta-analysis. Ageing Res Rev. 2005;4(3):422–450.
Heyman H, Van De Looverbosch DE, Meijer EP, Schols JM. Benefits of an oral nutritional supplement on pressure ulcer healing in long-term care residents. J Wound Care. 2008;17(11):476–478.
Reddy M, Gill SS, Kalkar SR, Wu W, Anderson PJ, Rochon PA. Treatment of pressure ulcers: A systematic review. JAMA. 2008;300(22):2647–2662.
Kosiak M. Etiology of decubitus ulcers. Arch Phys Med Rehabil. 1961;42:19–29.
Schoonhoven L, Haalboom JR, Bousema MT, et al. Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. BMJ. 2002;325(7368):797.
Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Lopez-Medina IM, Alvarez-Nieto C. Risk assessment scales for pressure ulcer prevention: A systematic review. J Adv Nurs. 2006;54(1):94–110.
Ayello E, Lyder C. A new era of pressure ulcer accountability in acute care. Adv Skin Wound Care. 2008;21(3):134.
Ratliff CR; WOCN. WOCN’s evidence-based pressure ulcer guideline. Adv Skin Wound Care. 2005;18(4):204–208.
Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273(9):721–723.
Takahashi P. Chronic ischemic, venous, and neuropathic ulcers in long-term care. Ann Longterm Care. 2006;14(7):26–31.
Bergstrom N, Allman R, Alvaraez O. Treatment of pressure ulcers. Rockville, MD: U.S. Department of Health and Human Services; 1994.
Bergstrom N, Allman R, Carlson C. Pressure ulcers in adults: Prediction and prevention. Rockville, MD: Agency for Health Care Policy and Research, Public Health Services, US Department of Health and Human Services; 1992.
Ayello EA, Lyder CH. Protecting patients from harm: Preventing pressure ulcers in hospital patients [reprint in Adv Skin Wound Care. 2008 Mar;21(3):134–140; quiz 140–142; PMID: 18388668]. Nursing. 2007;37(10):36–40.
Wound Ostomy Continence Nurses Society. Guidelines for prevention and management of pressure ulcers. Glenview, IL: Wound, Ostomy, and Continence Nurses Society (WOCN); 2003:12.
Ayello EA, Thomas DR, Litchford MA. Nutritional aspects of wound healing. Home Healthc Nurse. 1999;17(11):719–729.
Witkowshi J, Parish L. The decubitus ulcer: Skin failure and destructive behavior. Int J Dermatol. 2000;39:894.
Black JM; National Pressure Ulcer Advisory Panel. Moving toward consensus on deep tissue injury and pressure ulcer staging. Adv Skin Wound Care. 2005;18(8):415–416.
Defloor T, Schoonhoven L. Inter-rater reliability of the EPUAP pressure ulcer classification system using photographs. J Clin Nurs. 2004;13(8):952–959.
Takahashi P, Chandra A, Kiemele L, Targonski P. Wound care technologies: Emerging evidence for appropriate use in long-term care. Ann Longterm Care. 2008;16(12). Available at: http://www.annalsoflongtermcare.com/content/wound-care-technologies-emerging-evidence-appropriate-use-long-term-care june 22, 2009.
Hopkins A, Dealey C, Bale S, Defloor T, Worboys F. Patient stories of living with a pressure ulcer. J Adv Nurs. 2006;56(4):345–353.
Moore Z, Cowman S. Reviewing the evidence for selecting cleansing fluids for pressure ulcers. Nurs Times. 2009;105(5):22–24.
Bates-Jensen BM, Guihan M, Garber SL, Chin AS, Burns SP. Characteristics of recurrent pressure ulcers in veterans with spinal cord injury. J Spinal Cord Med. 2009;32(1):34–42.
Pieper B, Langemo D, Cuddigan J. Pressure ulcer pain: A systematic literature review and national pressure ulcer advisory panel white paper. Ostomy Wound Manage. 2009;55(2):16.
Smith DM. Pressure ulcers in the nursing home [see comment]. Ann Intern Med. 1995;123(6):433–442.
Bryan CS, Dew CE, Reynolds KL. Bacteremia associated with decubitus ulcers. Arch Intern Med. 1983;143(11):2093–2095.
Allman RM, Goode PS, Burst N, Bartolucci AA, Thomas DR. Pressure ulcers, hospital complications, and disease severity: Impact on hospital costs and length of stay. Adv Wound Care. 1999;12(1):22–30.
Lyder CH. Implications of pressure ulcers and its relation to federal tag 314. Annals Longterm Care. 2006;14(4):19–24.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Rosenzweig, A., Lee, M. (2011). Wound Care. In: Fenstemacher, P., Winn, P. (eds) Long-Term Care Medicine. Current Clinical Practice. Humana Press. https://doi.org/10.1007/978-1-60761-142-4_10
Download citation
DOI: https://doi.org/10.1007/978-1-60761-142-4_10
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-60761-141-7
Online ISBN: 978-1-60761-142-4
eBook Packages: MedicineMedicine (R0)