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.

Development of the middle-range theory of wound itch.

The problem of itch occurring with chronic wounds has been recognised, but is often ignored in practice. This paper describes the process of how the 'theory of wound itch' was formulated from Levine's conservation model. Concepts and propositions from the conceptual model were used to develop the theory. The theory will provide a basis for nursing research and practice.

Itch: association with chronic venous disease, pain, and quality of life.

PURPOSE: The purpose of the study was to examine the symptom of itch and its relationship with chronic venous disease, pain, and quality of life. DESIGN: The study used an exploratory, cross-sectional design. METHODS: One hundred and sixty-one participants completed demographic, health, substance abuse, itch, and pain questionnaires and the SF-12v2 Health Survey to measure health related quality of life. RESULTS: Participants were mostly men (n=95, 59%), African American (113, 70.2%), and had a mean age of 44.19 years. A history of injection drug use was reported by 91.4%. Using the clinical score of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP) Classification of the worst leg, the most common classification was Class 3, edema without skin changes (45.9%); 18.6% had severe venous disease (Classes 5 and 6). Eighty-eight participants (54.7%) reported itch somewhere on their body with 74 of them (45.9%) reporting itch on the legs or feet. Fourteen participants who reported itch of their legs or feet had wounds on the legs or feet. A positive correlation between magnitude of reported itch and CEAP clinical classification was noted (0.26, P =.025). This relationship was not strictly linear with itch increasing at a faster rate at higher levels of the CEAP classification. Persons with leg or feet itch had poorer health related quality of life, more comorbidities, and higher leg pain than those without itch. Because the SF-12v2 Health Survey is norm based, persons with itch were more than 1 standard deviation below the mean for the United States for their mental and physical health scores. CONCLUSIONS: Itch on the legs or feet is a clinically relevant problem that is related to the level of venous disease. Persons with lower extremity itch have higher pain ratings and lower quality of life.

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.