Chronic Wound Management Strategy
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This document summarizes a presentation on chronic wound management in primary care. It discusses identifying the etiology of chronic wounds, assessing systemic factors, executing basic treatment including wound bed preparation and dressing selection, providing patient education, and establishing long term management plans. Specific guidance is provided on managing common chronic wound types like diabetic foot ulcers, venous leg ulcers, and pressure injuries. Data on chronic wound cases in one primary care setting is also presented, showing most wounds are chronic and related to diabetes. The full presentation is accessible online for free.
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Chronic Wound Management Strategy
- 1. Dr Wan Zuraini Bt Mahrawi, MD, GCFM MSc in Wound Healing & Tissue Repair (Cardiff, UK) LUMUT WOUND CARE CONFERENCE 2018
- 2. CHRONIC WOUND MANAGEMENT WOUND IN PRIMARY CARE
- 3. C H R O N I C W O U N D INTRODUCTION 01
- 4. www.companyname.com 4 v LUMUT WOUND CARE CONFERENCE 2018 CONFERENCE PORTFOLIO DIABETIC FOOT ULCER VENOUS LEG ULCER PRESSURE INJURY ARTERIAL ISCHEMIC ULCER SURGICAL SITE INFECTION
- 5. www.companyname.com 5 v CHRONIC WOUND wounds do not progress normally through the stages of healing (often getting ‘stalled’ in one phase) and do not show evidence of healing within four weeks – Laurie Swezey Disclaimer : This presentation contain intermediate level of information of wound medicine
- 6. www.companyname.com 6 v CHRONIC WOUND MOLECULAR ENVIRONMENT
- 7. www.companyname.com 7 v WRONG DIAGNOSIS INADEQUATE WBP / INFECTION / INFLAMMATION IMPROPER TREATMENT LACK OF PATIENT CENTERED MANAGEMENT ErratumCHRONIC WOUND MANAGEMENT
- 8. www.companyname.com 8 v Answer 3 From healthcare personnel involve directly in wound clinic (HEALTH CLINIC) Answer 4 Answer from the speaker Answer 1 From healthcare personnel not involve directly in wound clinic (HOSPITAL) Answer 2 From healthcare personnel involve directly in wound clinic (HOSPITAL) ENGAGEMENT TESTQUESTION: PLEASE OUTLINE THIS WOUND MANAGEMENT PLAN
- 9. www.companyname.com 9 v 01 03 02 04 CONFIRM AETIOLOGY IDENTIFY SYSTEMIC FACTOR EXECUTE BASIC TREATMENT ADD ON SPECIFIC TREATMENT PATIENT’S EDUCATION & FOLLOW UP Management Strategy CHRONIC WOUND MANAGEMENT
- 10. www.companyname.com 10 v SPECIFIC SYSTEMIC BASIC 01 03 3 Steps of StrategyCHRONIC WOUND MANAGEMENT
- 11. C H R O N I C W O U N D M A N A G E M E N T SYSTEMIC FACTORS 02
- 12. www.companyname.com 12 v DIABETES INFECTION SYSTEMIC FACTORSTHE GENESIS OF DELAY HEALING Intracellular hyperglycemia Prolonged inflammatory cytokines
- 13. www.companyname.com 13 v DRUGS NUTRITION HYPOXIA SMOKING Glucocorticoid, NSAIDs, Chemo drugs Vitamin CEA, PUFAs, Protein
- 16. C H R O N I C W O U N D BASIC MANAGEMENT 03
- 17. www.companyname.com 17 v Treatment Dressing selection Wound Bed Preparation Assessment and DIME Approach Establish Goal Of Treatment Prognosis of healing Education To the patient and carer 02 01 04 03 Basic Management CHRONIC WOUND
- 18. www.companyname.com 18 v Sufficient resources? Treatable underlying cause? Ability of healing? Palliative wound? 01 Establish Goal of TreatmentCHRONIC WOUND
- 19. www.companyname.com 19 v Review behavior that works against desired outcome Motivation for healing potential / modify feelings Overview signs and symptoms of complications & how to report Reason for chosen plan of care Patient’s role in this plan of care Discuss plan of care 5 64 2 31 02 Educate Patient & CaretakerCHRONIC WOUND
- 20. www.companyname.com 20 v DEBRIDEMENT MOISTURE BALANCEINFECTION / INFLAMMATION EDGE EFFECT 03 Wound Bed PreparationCHRONIC WOUND – DIME APPROACH
- 21. www.companyname.com 21 v NON-SELECTIVE Large wounds Extensive necrotic tissue Non-surgical candidate SELECTIVE Minor to moderate debridement Painful wound Non-surgical candidate EXCISIONAL Wounds of varying size and depth Unhealthy wound edges Heavily necrotic wound DebridementCHRONIC WOUND (MECHANICAL) (AUTOLYTIC, ENZYMATIC, BIOLOGICAL) (SHARP, SURGICAL)
- 23. www.companyname.com 23 v 01 02 03 04 05 Ischemia with ABI < 0.4, TcPo2 < 30 mmHg Inability to comply with treatment Significant change over 24 – 48hr Severe change in wound pain Foot infection with T 38C or < 36C, HR > 90, RR > 20, SBC > 12000 or < 4000 CRITERIA FOR REFERRALCHRONIC WOUND 06 07 08 09 10 Exposed organ not previously exposed Wound bed discoloration to black Worsening redness around the wound Deteriorating flap or graft Worsening foul smell wound
- 24. Stimulate inflammation 2 No establish link between slough amount and biofilm3 Extracellular Polymeric matrix 1 About BiofilmCHRONIC WOUND
- 25. www.companyname.com 25 v DECREASE HEALING TIME COST EFFECTIVE IMPROVE PATIENT’S QUALITY OF LIFE 04 Treatment DRESSING SELECTION
- 27. C H R O N I C W O U N D SPECIFIC MANAGEMENT 04
- 28. www.companyname.com 28 v DIABETIC FOOT ULCER VENOUS LEG ULCER PRESSURE ULCER ARTERIAL ULCER Specific ManagementCHRONIC WOUND
- 29. www.companyname.com 29 v Offloading footwear Callous removal Educate patient on footwear Regular assessment Control diabetes Recommendations for follow-up care : DIABETIC FOOT ULCERSPECIFIC MANAGEMENT
- 30. www.companyname.com 30 v Long term application of compression stockings Consider referral for surgical ablation / injection Reduce pressure in the venous system of the LL Control obesity and exercise VENOUS LEG ULCERSPECIFIC MANAGEMENT
- 31. www.companyname.com 31 v Compression TherapyVenous Leg Ulcer ABI Bandage Sub- bandage pressure > 0.8 4-layer 35 – 40 0.7 2-layer 17 – 25 0.6 2-layer 17 – 25 < 0.5 Only with medical supervision - ABI: Ankle brachial index
- 32. www.companyname.com 32 v Repositioning Support surfaces Heel offloading devices Silicone foam and dressing to prevent pressure and shear Increase protein intake and calories Prevent and treat incontinence associated dermatitis PRESSURE INJURYSPECIFIC MANAGEMENT
- 33. Pressure Ulcer Risk Assessment Scale (PURAS) NORTON SCALE (England 1962, 5 parameters) – physical condition, mental state, activity, mobility, incontinence WATERLOW SCALE (England 1984, 8 parameters) – BMI, skin visual, sex, age, continence, mobility, appetite, medication BRADEN SCALE (USA 1987, 6 subscales) – sensory, perception, mobility, activity, nutrition, friction & shear GOSNELL SCALE (USA 1973, 5 parameters) – mental status, continence, mobility, activity, nutrition RAMSTADIUS TOOL (AUSTRALIA 2000, 2 questions) – skin integrity, mobility
- 35. www.companyname.com 35 v 01 02 03 04 Early referral to vascular interventionist (ABSI < 0.8, TcPO2 < 30mmHg) Lower extremity protection and assessment Exercise and smoking cessation Ensure adequate flow to the extremity ARTERIAL ULCERSPECIFIC MANAGEMENT
- 36. C H R O N I C W O U N D WOUND MANAGEMENT PRIMARY CARE05
- 37. www.companyname.com 37 v 22897 wounds 49% ACUTE 51% CHRONIC Wound Outcome Data 2017PKD KUALA LANGAT, SELANGOR
- 38. www.companyname.com 38 v 19% 81% INFECTED NON-INFECTED Wound Outcome Data 2017PKD KUALA LANGAT, SELANGOR
- 39. www.companyname.com 39 v 73% 7% 6% 4% DIABETIC RELATED WOUND VENOUS LEG ULCER PRESSURE INJURY ATYPICAL WOUND Chronic Wound by Aetiology PKD KUALA LANGAT, SELANGOR
- 40. www.companyname.com 40 v MANAGEMENT STRATEGY Short term and long term goals KNOWLEDGE Of different type of wound SUPPORTIVE THERAPY Systemic therapy, topical and adjunctive treatment in wound care PRE-ELIMINARY REQUIREMENT C H R O N I C W O U N D M A N A G E M E N T
- 41. www.companyname.com 41 v CHLORHEXIDINE 01 HYDROGEN PEROXIDE02 KMNO4 03 PVP - IODINE 04 ACETIC ACID 05 SILVER SULFADIAZINE06 THE OLD ARMY – What’s Common in Our Setting? S H A H A L A M H O S P I T A L W O U N D & O S T O M Y C O N F E R E N C E 2 0 1 8 4%, 5% 3% 1 : 1000/5000 1%0.25%, 0.5%7 - 10% ALCOHOL 07 METHYLATED SPIRIT08 ACRIFLAVINE SOLUTION09 0.1%96%70% *Full presentation is accessible @ www.slideshare.net, key word: wan zuraini, the old army
- 42. C H R O N I C W O U N D HOME CARE WOUND CARE 5.1
- 43. www.companyname.com 43 v SKOP PERKHIDMA TAN DCS • Perkhidmatan perawatan termasuk latihan teknik mencegah berlakunya kudis tekanan, pendidikan mengenai rawatan luka dan penjagaan kebersihan, menukar tiub nasogastrik, kateter urethral, pemeriksaan darah ujian gula darah dan mengambil tekanan darah dan penyediaan sokongan emosi. 1. Perawatan • Aktiviti rehabilitasi bagi kes yang memerlukan termasuk rehabilitasi pergerakan aktif dan pasif serta latihan activity of daily living. 2. Rehabilitasi • Perkhidmatan ini merangkumi perawatan yang melibatkan penjagaan paliatif. 3. Paliatif DOMICILIARY CARE SERVICES
- 44. C H R O N I C W O U N D CONCLUSION 06
- 45. www.companyname.com 45 v Focus Specific Treatment Knowledge Construction Determine Aetiology Checking Systemic Factor, Execute Basic Treatment Educate Follow-up Plan “A kind gesture can reach a wound that only compassion can heal….” CONCLUSIONCHRONIC WOUND MANAGEMENT
- 46. THIS PRESENTATION IS ACCESSIBLE FREELY THROUGH: C H R O N I C W O U N D M A N A G E M E N T www.slideshare.ne t Key term: wan Zuraini, wound, wound wound, wound dressing
- 47. www.companyname.com 47 THANK YOU Kuala Langat Menerajui Transformasi Perubatan Luka D R W A N Z U R A I N I | m r s . w a n z u @ g m a i l . c o m
Editor's Notes
- 1. Minta list nama 2. chill as a teacher….3. isi kan soalan pada kertas 4. introduce yourself
- 1. Combine 2 in 1 presentation 2. dilemma question
- Clump all management into 1 ..regardless any etiology and to reduce clumsiness
- To change the image behind the Mock up. Select the layer - > Right Click -> Send to Back -> Delete the image -> Drag & Drop your Own Picture -> Send to Back (again)
- Intrcellular Hyperglycemia – aldose reductase – increase sorbitol from glucose – abnormal management of matrix protein (collagen) bacteria and endotoxins can lead to the prolonged elevation of pro-inflammatory cytokines such as interleukin-1 (IL-1) and TNF-α and elongate the inflammatory phase. increased level of matrix metalloproteases (MMPs), degrade ECM
- Supression fibroblast proliferation and collagen synthesis – poor granulation, hypoxia-inducible factor-1 (HIF-1) Chemo drugs decrease RNA DNA – fibroplasia neutropenia, anemia, and thrombocytopenia, - impede inflammation
- If you want to change the picture background. 1) Select the shape (in front of the image) and send it to back 2) Delete the image and drag and drop you own // 3) Send to back the new image