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Addressing the Whole Problem

Online Exclusives

Addressing the Whole Problem

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This new section online provides clinician-tested, readily applicable tips and timesavers related to care management. We encourage you to contribute your ideas and/or to comment on these suggestions. Send email to The Editor: bzeiger@hmpcommunications.com.   As a CWOCN, I often see clinicians begin to treat a wound without successful effort to identify and address the wound etiology. Many providers will use various products from silver-containing dressings to foam to hydrofiber to various skin equivalents, becoming perplexed when the wound doesn’t progress. Wound care is not just about the topical dressing choice. Stasis ulcers require compression (not just lots of diuretics). Arterial ulcers require perfusion. Malnutrition must be corrected. And the most important treatment for a pressure ulcer is to relieve the pressure.   Another common problem is that providers don't understand the “look” of healing. The use of enzymatics or other various types of debridement strategies will certainly improve the appearance of the wound by removing devitalized tissue thus controlling odor and infection risk. But clean tissue (see Figure 1) is not granulating tissue (see Figure 2). Figure 1 actually shows a wound on a malnourished patient. Although clinicians achieved a clean wound with enzymatics and sharps and it does look better for those reasons, this is not a healing wound.   Clinicians: address etiology and recognize the difference between an improved looking and an actually healing wound. Jenny Hurlow GNP, CWOCN Memphis, TN