Neuropathy, also known as lower extremity neuropathic disease, interferes with the normal neurologic function of the lower extremities. Patients with vitamin B12 deficiency, hypothyroidism, overproduction of growth hormone, spinal cord injury, Lyme disease, diphtheria, and Hansen disease (leprosy) are at a higher risk for peripheral neuropathy. However, diabetes mellitus accounts for the majority of peripheral neuropathic ulcerations in the United States (Varnado, 2016) and thus, the diabetic foot ulcer will be the focus of Chapter 2.
Thermal injuries, which result from exposure to either heat or cold, are unique from other wounds because of their pathology, evolution, and management. Consider major burns, for example, which are some of the most complicated wounds sustained by the body. The trauma caused by thermal injuries raises thoughts of pain, fluid and electrolyte imbalance, altered metabolism, infection, and disfigurement. Care to patients with thermal injuries is complex and includes assessment of damage, fluid and nutrition needs, prevention of extended damage, local wound care, and rehabilitation. These primary goals for care are discussed in Chapter 3.The goal for managing most wounds, such as edema, neuropathy, or thermal injuries, is to achieve closure and restore tissue integrity with the least amount of disfigurement.
However, the goal for managing end-stage diseases that present with malignant wounds has a different focus. These chronic wounds must be managed with a palliative approach that addresses the complications associated with the specific wound type and minimizes suffering associated with disease symptom. Care should focus on improving and sustaining the best possible quality of life for the patient. Chapter 4 reviews common types of malignant wounds and approaches to care.
The wound management for each of these types of wounds requires an interdisciplinary team approach. Although nurses remain the primary professionals providing direct care and education to patients, collaboration with colleagues is key in formulating appropriate and individualized plans of care. Patients and their caregivers trust healthcare providers, especially nurses, to be knowledgeable and well-informed. The holistic approach to successful wound care is representative of the nursing discipline’s approach to care delivery. Nurses must be aware that the impact of the wounds discussed in this course can have a profound effect on the patient related to image, self-esteem, quality of life, and also effects the family and caregivers.
This course provides nurses with key concepts and principles vital to the care plan for patients with thermal injuries or ulcers resulting from alterations of the integumentary system. The assessment and management of edema, lymphedema, neuropathic ulcers, and thermal injuries are discussed as well as the palliative care needs of the patient with a malignant wound.