End of life wound care

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End of life wound care

• OTN nov.09
• Dr. Rosemary Kohr, RN,PhD, ACNP(cert)

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GOALS FOR WOUND CARE

• Heal the wound (if possible)
• ALWAYS
• Protect the wound from
• Further breakdown
• infection
• Provide comfort
• Decrease pain associated
• with dressing changes

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Excoriated skin, edema, pain
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PROSHIELD PLUS
AREAS OF USE

• On intact or injured skin (up to including
  Stage II pressure ulcers)
• Protection for irritated or at risk skin due to
  feces and incontinence.
• Prevention of excoriated skin (e.g., diaper
  rash)

DESCRIPTION BENEFITS

• Proshield Plus is a no-rinse total body
  cleanser that comes as a spray, foam or cream.
• It is easy to apply and remove and can also be
  applied over antifungal products such as Mitrazol
  Cream and Power to treat patients with yeast
  infections.
• Proshield contains glycerin to moisturize skin
  and also contains a surfactant that aids in
  cleansing skin without drying it out.
• Proshield also contains a solubilizer that
  breaks down dried stool, eliminating need to
  scrub.
• Can be used to shampoo hair.

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How To Use Proshield

• APPLICATION
• If using new bottle Prime sprayer by squeezing
  pump several times before initial use. For foam
  turn nozzle to the on position and pull tip
  forward. For spray push tip back.
• For incontinence Cleansing Spray Foam Spray
  Cleanser onto affected area and wipe off. The
  Spray Foam Cleanser is used prior to
  application of Proshield Plus Skin Protectant and
  or an Anti-fungal cream or powder.
• For total body cleansing Spray Proshield Foam
  Spray Cleanser directly on skin and wipe off. No
  need to rinse or use moisturizer.
• To use as shampoo Spray Proshield Foam Spray
  Cleanser directly on hair and lightly work
  through with a towel. Comb hair out. No rinse or
  conditioner required.

PRECAUTIONS When using this product avoid
contact with eyes. If condition worsens or does
not improve within 7 days, consult wound care
specialist or primary healthcare provider. Do
not apply over deep or puncture wounds,
infections or lacerations.
Visit http//www.lhsc.on.ca/wound/ for more
information.
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MEPILEX Absorbent soft silicone dressing
AREAS OF USE

• Low to moderately exuding wounds
• Leg and foot ulcers
• Pressure ulcers
• Painful wounds
• Traumatic wounds
• Wounds with compromised/fragile surrounding
  skin
• Difficult-to-dress areas

DESCRIPTION BENEFITS

• Minimizes trauma to the wound and pain to the
  patient at dressing changes.
• Safetac technology prevents Mepilex from
  sticking to the wound bed but adheres gently to
  surrounding skin allowing easy secondary
  application.
• Mepilex absorbs exudate, wicking away from
  peri-wound and wound bed to ensure a low risk of
  maceration.
• Mepilex is ideal for cutting for
  difficult-to-dress areas.

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How To Use Mepilex
1. Clean wound area. Remove release film.
2. Mepilex should overlap the wound bed by at
least 2 cm onto the surrounding skin. Apply the
adherent side to the wound. Do not stretch.
3. When necessary secure Mepilex with a
bandage/fixation.
NOTE In case of infection Mepilex may be
continued with properly initiated infection
treatment.
Visit http//www.lhsc.on.ca/wound/ for more
information
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SHEEPSKIN DOES not PROVIDE PRESSURE RELIEF!
NO DONUTS, PLEASE!
PRESSURE RELIEF SURFACES ARE IMPORTANT.
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Pain Management

• Local/topical
• Systemic need to ensure adequate breakthrough
  pain management
• Dressings non-adherent
• New dressing Biatain-IBU
• Contains ibuprofen
• Downloads into wound
• Effective pain relief
• When issue is inflammation

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Dressing (generic with examples)
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Clinical discussion

• What are issues around palliative/end of life
  wounds?
• How do you treat these wounds?

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End of life often an opportunity to connect and
share moments.
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Next Wound Care RoundsCELLULITIS THE GOOD,
THE BAD AND THE DRAINING

• November 17 (Tuesday)
• 2-3pm
• Also visit the archived wound care rounds on the
  OTN website.