Wound assessment and evaluation: documentation of pressure ulcers.
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Biomedical subjects
Publications and source records attributed to J Cuzzell.
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The "Wound Assessment and Evaluation" series includes a short case presentation and differential diagnosis. It is followed by a discussion of the disease or condition and the rationale used in each step of the assessment.
A clinical pathway is a written sequence of clinical processes or events that guides a patient with a defined problem toward an expected outcome. Clinical pathways are tools to assist with the cost-effective management of clinical outcomes related to specific problems or disease processes. The primary obstacles to developing clinical pathways for wound care are the chronic natures of some wounds and the many variables that can delay healing. The pathway introduced in this article was modeled upon the three phases of tissue repair: inflammatory, proliferative, and maturation. This physiology-based model allows clinicians to identify and monitor outcomes based on observable and measurable clinical parameters. The pathway design, which also includes educational and behavioral outcomes, allows the clinician to individualize the expected timeframe for outcome achievement based on individual patient criteria and expert judgement. Integral to the pathway are the "4P's" which help standardize the clinical processes by wound type: Protocols, Policies, Procedures, and Patient education tools. Four categories into which variances are categorized based on the cause of the deviation from the norm are patient, process/system, practitioner, and planning/discharge. Additional research is warranted to support the value of this clinical pathway in the clinical arena.
Skin care clinicians must accurately assess progress towards wound healing and identify appropriate therapies to hasten wound closure. Perhaps the most practical method for facilitating assessment and guiding intervention is the red, yellow, black (RYB) classification system.
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With more than 2000 wound care products on the market, choosing an appropriate dressing for the geriatric patient can prove to be a difficult task. Age-related changes in skin structure and decreased resistance to noxious stimuli in the environment place the elderly patient at higher risk for wound complications. Understanding the principles of moist wound healing and how dressing materials can be used to promote healing outcomes gives the clinician a foundation upon which to base treatment decisions. Assigning products to generic dressing categories further facilitates dressing selection, allowing the treatment protocol to be individualized to the patient, the wound, and the setting.