Wound Care Made Incredibly Easy

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Moisture-associated skin damage

The key to preventing dermatitis related to stool or urine effluent due to ostomies or fistulas is con sulting a certified ostomy nurse preoperatively. Often an appropriate location for the stoma can be marked to increase the likelihood of success in pouching postoperatively. An ostomy pouching system that fits with fewest leaks is necessary and definitely in the wheelhouse for a nurse certified in ostomy care. Lastly, an education plan for the patient and caregiv ers regarding the effects on the skin of the various effluents and the containment of these as well as the protection of the skin is essential.

This ileostomy stoma is recessed and with a crease, making leaks more frequent, and ICD is evident. Small bowel fistula below and lateral to the ileostomy and one in the healed midline incision complicate the situation. Patient was on immune suppressant medications due to Crohn disease, making healing of any denudement slower. Also note this gastrostomy tube needs securement or soon there will be corrosive stomach contents leaking too due to enlargement of the opening.

Wound effluent

As discussed, any moisture on the skin for too long can cause ICD, in cluding exudate from a wound. This can cause inflammation and we must determine if the inflammation is due to ICD or another cause. Two other possibilities are local wound infection (or regional if the inflamed area is larger than 2 cm; please refer to Chapter 3 for deter mination of wound infection) and allergic contact dermatitis. A patch test may be ordered to determine if the person is allergic to one of the dressings, wound cleanser, skin protectant, or tape. If it is not an infection or allergic contact dermatitis, the likely cause of periwound inflammation is ICD from the wound effluent oozing onto the skin. Refer to Chapter 2 for wound exudate compo nents, which can be very irritating to skin. Chronic wounds such as leg ulcers due to poorly controlled lower extremity edema and neuro pathic foot ulcers have been found to be especially high in proteases (which break down proteins including exposed skin), and when the limb is dependent, gravity makes it more likely to increase exudate amount. Therefore, they are the two wounds most likely to result in ICD due to wound exudate.

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