Tag: Holly Hovan

Unavoidable Skin Breakdown Versus Pressure Injury: Continued Discussions

Holly Hovan

Pressure injuries (PIs) typically are the result of unrelieved pressure, shear, or force. In an inpatient or hospital setting, interventions are put into place to prevent pressure injuries based on evidence and patient risk. However, PIs still develop in some patients despite interventions. Experts agree that most PIs are in fact avoidable; however, some patients may experience unavoidable skin breakdown at end of life (EoL).1 Kennedy terminal ulcers (KTUs), skin changes at life’s end (SCALE), and Trombley-Brennan terminal tissue injuries (TB-TTIs) are some of the common terms used to describe unavoidable skin changes at EoL.1 A notable feature of these terminal ulcers is their sudden and rapid development on body locations that may be free from pressure, shear, or trauma and in the presence of PI prevention interventions. In contrast to terminal PIs, standard PIs typically develop … read more

Ouch! Assessing and Managing Acute and Chronic Wound Pain

Pain has been a prevalent health care challenge in the United States for some time, with data from the Centers for Disease Control and Prevention showing that approximately 16% of men and 20% of women experience pain on most days or even every day.1 As health care providers, we understand that unrelieved pain and suffering have direct results on the healing cascade and impair both physical and mental health. The topic of pain is almost always addressed in the health care setting, with pain even at one time being recognized as the “fifth vital sign.” … read more

Lower Extremity Arterial Disease (LEAD) Awareness and Discussion

By Holly Hovan, MSN, GERO-BC, APRN, CWOCN-AP

Peripheral artery disease (PAD) is also known as lower extremity arterial disease (LEAD), peripheral arterial occlusive disease (PAOD), or arteriosclerosis obliterans.1 LEAD is a disease that impacts the circulatory system, specifically the arteries (narrowing, which can result in a decreased supply of blood flow to the limb), and can eventually lead to limb loss or amputations. It is important to bring awareness to LEAD and its diagnosis, treatment, and prevention to improve access to care and screenings and ultimately to prevent limb loss … read more

Medical Adhesive-Related Skin Injury: Treatment and Prevention

by Holly M. Hovan MSN, APRN-ACNS-BC, CWOCN-AP

Medical adhesive-related skin injury, or MARSI, is a common type of skin injury, often seen in inpatient settings and in vulnerable populations with fragile skin such as older adults (decreased elasticity, usually multiple pre-existing comorbidities) or pediatric patients (skin is not fully developed). MARSI is caused by trauma to the skin from medical adhesives (think of things such as… tape used to secure a dressing after a blood draw, clear film dressings, ostomy pouches, external catheters in men, tube securement devices, surgical dressings, etc.). MARSI is not a pressure injury and is not caused by pressure.

 

Anytime we are consulted or asked to follow up on a new wound, one of the things we are assessing for is the cause of the wound or injury—trauma, pressure, moisture, friction, shear, impaired blood flow, etc. It is important to look at the big picture and what caused the wound or skin injury. Many variables can and do make wounds and skin conditions worse, but when determining the true etiology, we must look at what initially caused the problem … read more