Encountering Ostomies in Acute Care: Peristomal Skin Changes.

ABSTRACT: Up to 80% of individuals with an ostomy experience a peristomal skin complication, which can result in significant healthcare issues. All clinicians working with patients with stomas need to be aware of the signs and symptoms of peristomal skin complications and basic strategies to address the most common cause of skin complications: leakage of stool or other effluent onto the skin. Use of an evidence-based, standardized instrument to guide peristomal assessment and selection of appropriate interventions can improve patient outcomes and increase meaningful collaboration between all members of the healthcare team. This case study addresses dilemmas of care during a non-ostomy-related hospitalization.

An Integrative Review of Depression in Patients Receiving Hemodialysis for End-stage Renal Disease and the Relevance to Patients With Wounds.

End-stage renal disease (ESRD) often is treated with hemodialysis, which carries significant psychological impact along with risks for wound development. Depression is a constant concern. PURPOSE: An integrative review was conducted to examine studies regarding depression in adults receiving hemodialysis for ESRD. METHODS: PubMed and the Cumulative Index for Nursing and Allied Health Literature were searched for English-language publications from 2012 to 2017 regarding ESRD using the search terms epidemiology, hemodialysis, and depression and hemodialysis, depression, nocturnal, and wounds, respectively. RESULTS: Eight (8) of 152 articles found met the inclusion criteria and were categorized thematically. Depression was noted to affect 9.3% to 83% of persons receiving hemodialysis for ESRD. The occurrence of depression does not change across the course of ESRD. Although no publications on patients that included all search terms were found, ESRD and hemodialysis were noted to be independent risk factors for ulcer development, poor healing, and amputation. Wounds can be another source for risk of depression. CONCLUSION: Although the literature does not include studies that contain all components, ESRD, depression, and wounds are linked. Depression is a common occurrence in patients with ESRD and dialysis. Examining the effect of wounds on depression for these patients is critical. As such, additional research is warranted to explore the interconnections of ESRD, depression, and wounds to improve clinician awareness and patient outcomes.

Topical metronidazole for the treatment of wound odor: a review of the literature.

Unpleasant odor is a frequent and distressing concern of persons who have wounds, as well as their family members and caregivers. In some instances, standard nursing interventions such as increasing the frequency of dressing changes will not be sufficient to address wound malodor. A review of the literature to summarize research findings about topical metronidazole used to decrease wound odor was conducted. Fifteen (15) studies were identified: seven case reports/series; six descriptive longitudinal studies; and two controlled clinical trials. Metronidazole was used as a 1% solution or, more frequently, as a 0.75% or 0.80% gel. Two reported adverse effects were skin irritation and a burning sensation. Generally, topical metronidazole was reported to result in a reduction or eradication of wound odor, decrease in wound drainage, improvement in wound appearance, decrease in surrounding cellulitis, halting of tissue necrosis, and decrease in pain. Although nurses report success with sprinkling crushed metronidazole pills on wounds, no published reports of this method of topical application are available. Topical metronidazole may be considered as an option for the management of malodorous wounds and additional randomized controlled trials with adequate sample sizes and comparison to products noted to decrease odor are warranted. While topical metronidazole for the treatment of malodorous wounds presently is off-label, perhaps such studies will result in the addition of malodorous wounds to the list of its indications.

Ankle mobility in relation to chronic venous insufficiency in HIV-positive persons with and without a history of injection drug use.

The purpose of this study was to examine ankle mobility in relation to chronic venous insufficiency (CVI) in HIV-positive persons with and without a history of injection drug use (IDU) and to examine the extent to which peripheral neuropathy further reduced ankle mobility. A cross-sectional, stratified design with quota sampling was used to recruit 27 persons with no history of IDU and 46 with a history of IDU from an infectious diseases clinic. Goniometric measurements of forefoot inversion-eversion and dorsiflexion-plantar flexion were obtained. CVI was assessed on a clinical scale. Peripheral neuropathy was identified from chart review and self-report. Injection drug users had less ankle flexion-extension right, inversion-eversion left and right, and total ankle motion than those who did not inject drugs (p < .05). Neuropathy was not associated with less mobility of the ankle joint (p < .01). A causal model supported the hypothesis of ankle mobility as a mediator of the effect of IDU on CVI.

The impact of chronic venous insufficiency and leg function on the quality of life of HIV-positive persons.

Chronic venous insufficiency and subsequent difficulties in leg function are causally linked to injection drug use and quality of life. Because injection drug use is a risk factor for human immunodeficiency virus infection, chronic venous insufficiency would be expected to occur with a higher prevalence in HIV-positive persons, yet the impact of chronic venous insufficiency on quality of life has not been investigated in this population. A cross-sectional design with quota sampling was used to enroll 73 HIV-positive participants-- 46 injection drug users and 27 non-injection drug users -- in this quality-of-life study. Questionnaires were read to participants and their legs were assessed for evidence of chronic venous insufficiency. Leg function scores, comprising assessment of leg pain, interference, and difficulty in using legs, were significantly related (P <.05) to quality-of-life scores, controlling for comorbid health problems. Chronic venous insufficiency, injection drug use, and leg function were interrelated. The legs of HIV-positive persons who have injected drugs should be assessed for manifestations of chronic venous insufficiency and other functional impairments. Further research involving a larger sample and assessment of chronic venous insufficiency treatments, including quality of life and leg function in HIV-positive persons, is needed.