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  • Nursing
  • Advanced Practice Nursing
Hours: 6 Contact Hours
Author(s): Linda Stricker, MSN, RN, CWOCN
Peer Reviewer(s): Barbara J. Hocevar, MSN, RN, CWOCN
Item#: N1806
Contents: 1 Course Book (78 pages)
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Thermal Injuries and Ulcers Resulting From Integumentary Alterations

Price $33.95
Item # N1806
When available, the Online Course format is included with the hard copy, eBook, or audio book formats!

Release Date: April 24, 2017

Expiration Date: January 31, 2020

Integumentary injuries can result from a number of environmental factors and conditions intrinsic to the person. Edema, lymphedema, neuropathy, thermal insults and malignant conditions can cause tissue injury and in the presence of comorbid conditions produce wounds or ulcers that negatively affect a person’s life and present a challenge to treat. 
The presence of edema, or swelling, in any wound and skin care situation has a direct effect on tissue integrity and its ability to repair, and increases the potential for skin breakdown. Wounds tend to heal slower, or not at all, in an environment where edema is present. Edema associated with the lymphatic system is called lymphedema. Because lymphedema hinders patient’s ability to perform normal activities and produces a greater degree of disfigurement,  early identification and treatment is imperative in order to minimize tissue disfigurement. Managing swelling and protecting extremities from trauma are paramount to prevention of this injury, as discussed in Chapter 1.

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.



This course is an extract of, and should not be taken in conjunction with N1737 - Wound Management: A Comprehensive Guide for Nurses.


Course Objectives

  • Compare and manage generalized edema and lymphedema, the effect of edema on wound management, and important aspects of edema management.
  • Identify key concepts in the assessment and management of neuropathic ulcers.
  • Identify types and classifications of heat- and cold-related thermal injuries and the wound management  needs for each.
  • Assess the person with a malignant wound and plan for the unique palliative care needs of the patient.


Linda Stricker, MSN, RN, CWOCN, has over 25 years of experience in wound, ostomy, and continence (WOC) nursing. She earned her Bachelor of Science degree in nursing from the University of Akron and a Master of Science degree with a minor in education from the University of Phoenix. She is the current program director of the R.B. Turnbull, Jr. MD School of WOC Nursing Education at Cleveland Clinic. Linda also serves the Wound Ostomy Continence Nurses Society™ in a variety of roles and is the current President-elect of the WOCN® Mideast Region. She has authored or coauthored publications on stoma construction, fistula management, and WOC nursing subjects, and presented on a variety of wound management topics.

Barbara J. Hocevar, MSN, RN, CWOCN, graduated from St. John College with her BSN in 1978. She attended the R.B. Turnbull School of WOC Nursing in 1982. She received her MSN from the University of Phoenix in 2012. Barbara has worked at a tertiary care facility in the acute care and outpatient areas as staff, clinical manager of the ostomy/fistula team, and now serves as the Assistant Director of the R. B. Turnbull, Jr. School of Wound, Ostomy, and Continence Nursing Education. She has published on WOC nursing topics and is a past section editor for the Journal of Wound, Ostomy and Continence Nursing. She has presented on a variety of ostomy and wound care topics locally, nationally, and internationally.


Yvonne L. Weideman, DNP, RN, CNE, CWON, CFCN, has more than 30 years of diverse nursing experience in home care, home infusion, nursing administration, and nursing education. Currently, Dr. Weideman is a full-time Assistant Clinical Professor at Duquesne University. Her primary area of clinical focus is wound and ostomy nursing, and she is board certified as a wound, ostomy, continence, and foot care nurse. Dr. Weideman earned her BSN from Duquesne University, her MBA from Robert Morris University, and her DNP from Duquesne University.

  • Courses must be completed on or before the expiration date noted in the course description above.
  • You must score 75% or higher on the final exam and complete the course evaluation to pass this course and receive a certificate of completion.
  • Through our review processes, Western Schools ensures that this course content is presented in a balanced, unbiased manner and is free from commercial influence. It is Western Schools’ policy not to accept commercial support.
  • All persons involved in the planning and development of this course have disclosed no relevant financial relationships or other conflicts of interest related to the course content.