Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries.

GENERAL PURPOSE: To synthesize the literature regarding skin injuries that are found in patients at the end of life and to clarify the terms used to describe these conditions. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be better able to:1. Define the terms used to describe pressure injuries and skin changes at the end of life.2. Discuss the concept of skin failure as applied to end-of-life skin injuries and implications for practice. ABSTRACT: This article synthesizes the literature regarding the concepts of "terminal" skin injuries that are found in patients at the end of life, including Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, and skin failure. Also included is a discussion of avoidable and unavoidable pressure injuries as defined and differentiated by the Centers for Medicare & Medicaid Services and the National Pressure Ulcer Advisory Panel. To help clarify the controversy among these terms, a unifying concept of "skin failure" that may occur with an acute illness, chronic illness, or as part of the dying process is proposed. This proposed concept of skin failure is etiologically different than a pressure injury, although pressure injury and skin failure can occur concomitantly. These proposed concepts require further research and validated diagnostic criteria. Consensus around appropriate terminology is essential to reduce confusion among stakeholders and ensure appropriate patient care.

How to use PRICE treatment for soft tissue injuries.

Rationale and key points This article assists nurses to use the acronym PRICE (protection, rest, ice, compression and elevation) to guide the treatment of patients with uncomplicated soft tissue injuries to their upper or lower limbs. ¼ Treatment of soft tissue injuries to limbs is important to reduce complications following injury, alleviate pain and ensure normal limb function is restored promptly. ¼ Nurses should have an understanding of the rationale and evidence base supporting PRICE treatment of soft tissue injuries. ¼ Providing accurate information to patients and carers about the management of soft tissue injuries and anticipated recovery time is an important aspect of treatment. ¼ Further research is required to develop best practice in the treatment of soft tissue injuries. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice when managing patients with soft tissue injuries to upper or lower limbs. 2. Positive elements of your current practice and those that could be enhanced. Subscribers can upload their reflective accounts at: rcni.com/portfolio.

Lesões de pele decorrentes do posicionamento cirúrgico no cliente idoso / Skin lesions resulting from surgical positioning in elderly

Trata-se de um estudo descritivo, observacional, com abordagem quantitativa, que teve como objetivo levantar os fatores de risco para lesões de pele do cliente idoso decorrentes do posicionamento cirúrgico no período intraoperatório. Foram realizadas três etapas: levantamento das condições da pele do idoso no pré-operatório imediato; acompanhamento do cliente no intraoperatório (posicionamento e recursos de proteção); reavaliação das condições da pele do cliente na sala de recuperação pós-anestésica e no pós-operatório imediato...

Effect of an extended scope physiotherapy service on patient satisfaction and the outcome of soft tissue injuries in an adult emergency department.

OBJECTIVES: To evaluate the effect of introducing an extended scope physiotherapy (ESP) service on patient satisfaction, and to measure the functional outcome of patients with soft tissue injuries attending an adult emergency department (ED), comparing management by ESPs, emergency nurse practitioners (ENPs), and all grades of ED doctor. METHODS: The ESP service operated on four days out of every seven in a week in an urban adult ED. A satisfaction questionnaire was sent to all patients with a peripheral soft tissue injury and fractures (not related to the ankle) within one week of attending the ED. Patients with a unilateral soft tissue ankle injury were sent the acute Short Form 36 (SF-36) functional outcome questionnaire, with additional visual analogue scales for pain, at 4 and 16 weeks after their ED attendance. Waiting times and time spent with individual practitioners was also measured. RESULTS: The ESP service achieved patient satisfaction that was superior to either ENPs or doctors. Overall 55% of patients seen by the ESP service strongly agreed that they were satisfied with the treatment they received, compared with 39% for ENPs and 36% for doctors (p = 0.048). Assessment of long-term outcome from ankle injury was undermined by poor questionnaire return rates. There was a trend towards improved outcomes at four weeks in those patients treated by an ESP, but this did not achieve statistical significance. CONCLUSION: Adding an ESP service to the interdisciplinary team achieves higher levels of patient satisfaction than for either doctors or ENPs. Further outcomes research, conducted in a wider range of emergency departments and integrated with an economic analysis, is recommended.

Tap water or normal saline for cleansing traumatic wounds?

The aim of this review was to identify whether cleansing with tap water results in higher rates of wound infection or delayed healing compared with other cleansing solutions in adults or children with acute uncomplicated traumatic soft tissue wounds. The review utilized a systematic search of key databases (Cochrane Library, Medline, Embase, Cinahl, British Nursing Index and PubMed), bibliographies, and internet resources. Three controlled trials were found which studied 1281 people. One further study reported outcomes but could not be fully examined as only an abstract was available. Based on the studies reviewed, results suggest no clinically significant increase in the risk of wound infection in wounds irrigated with tap water when compared to sterile normal saline in uncomplicated soft tissue injury. However, the available evidence lacks strength because of the relatively low power and poor quality of studies.

Assistência de enfermagem ao portador de alterações na integridade cutânea: um relato de experiência de ensino-aprendizagem / Asistencia de enfermería al portador de alteraciones en la integridad cutánea: un relato de experiencia de enseñanza-aprendizage / Nursing asistence to the bearer of alterations in the cutaneous integrity: a learning education experience account

O Curso de Enfermagem da Faculdade de Medicina de Marília, vem empenhando-se na construção do Currículo Integrado, utilizando-se da metodologia problematizadora. No presente estudo, os autores apresentam os desempenhos esperados dos estudantes e a seqüência de atividades construída para o ensino dos cuidados de enfermagem ao adulto e idoso portador de alteração da integridade cutânea, a qual permite ao aluno implementar este conhecimento em sua realidade prática. No decorrer das atividades constata-se que tal desafio tem representado um avanço no processo de ensino e aprendizagem, no entanto, apontam-se algumas dificuldades a serem superadas.

The Nursing Course at the Medicine College in Marília, has been making every efforts to create the Integrate Curiculum, making use of the questionable methodology. In this study, the authors present the student' expected performances and the sequency of activities creat to teach the precautions of Nursing for the adult and elder people taking away some changes na the cutaneous integrity, that makes the student implement the konowlege. During the activities it was proved that this kind of challenge has showed a progress in the teachin and learning process, but there are some difficulties to be conquered.

El Curso de Enfermería de la Facultad de Medicina de Marilia se está empeñando en la construcción de un curriculun integrado, utilizándose de la metodologia problemática. En este estudio, los autores presentan el desarrollo esperado de los estudiantes y la secuencia de actividades construída para la enseñanza de los cuidados de enfermería al adulto y al mayor portador de alteración a la integridad cutánea, la cual permite que el alumno aplique este conocimiento a su realidad práctica. En el transcurso de las actividades se nota que dicho desafio representa un avance en el proceso de enseñanza y aprendizage, pero, algunas dificultades son apuntadas y deben ser superadas.

[Nursing care for the patient with disruptions in the integrity of the skin: an account of teaching-learning experience]. / Assistência de enfermagem ao portador de alterações na integridade cutânea: um relato de experiência de ensino-aprendizagem.

The Nursing Course at the Medicine College in Marília, has been making every efforts to create the Integrate Curriculum, making use of the questionable methodology. In this study, the authors present the student' expected performances and the sequency of activities create to teach the precautions of Nursing for the adult and elder people taking away some changes na the cutaneous integrity, that makes the student implement the knowlege. During the activities it was proved that this kind of challenge has showed a progress in the teaching and learning process, but there are some difficulties to be conquered.

Skin tears.

Skin tears are a serious, painful problem for older patients. Find out how your staff can recognize patients at risk, what they can do to prevent skin tears, and how to manage them effectively if they occur.

Cutaneous injuries in women athletes.

Positioned at the interface between the athlete and her sports environment, the skin bares the brunt of multiple forces, many of which result in cutaneous trauma. Although this subject has been reviewed in considerable detail, we wish to focus on those injuries which are unique to women competitors and fitness advocates either exclusively, or more commonly, with equal or greater frequency than their male counterparts. We hope that these topics will be of value to dermatology nurses in answering questions on the subject both in and out of the clinical setting.

Crush injuries to the hand and forearm.

Crush injuries to the hand and forearm from mechanical devices and heavy equipment are a frequently seen injury in heavily industrialized areas. These injuries are particularly difficult due to their unpredictability, individualized nature and often devastating results. To optimize the outcome for these patients, it is essential to educate the nursing staff on emergent as well as ongoing care, form a systemized plan of care, and recruit patient and family support. A multiskilled group effort will be required to allow the patient with crushed tissue to realize optimal potential and return to a functional position in society.