Keeping My Parents Happy

Chronic wounds refer to those that are resistant to treatment and wounds that do not heal. Examples of chronic wounds are stasis ulcers, which are wounds typically caused by poor circulation and diabetes, and pressure ulcers. While low-grade pressure and stasis ulcers generally do not require skilled nursing interventions, those chronic wounds that are deep, infected, or have damaged the muscle, tendons, or bones do require skilled nursing interventions. Here are some effective skilled nursing interventions to treat chronic wounds that are performed in nursing homes so that the healing process can be expedited. 

Intravenous Medications

Chronic wounds can become infected with a type of infection known as methicillin-resistant Staphylococcus aureus, also known as MRSA. This type of infection is typically resistant to common oral antibiotics such as penicillin. Because of this, skilled nursing interventions such as starting an intravenous line, administering special MRSA antibiotics via the IV route, monitoring the tubing and IV site on the patient's arm, and changing the dressing will be necessary.

The registered nurse will also remove the IV catheter if signs of tissue infiltration or infection are noticed around the entry site. Infiltration means that the IV fluids have seeped out of the vein and into the soft tissues, causing pain and swelling near the intravenous site. After the infiltration has been treated, the nurse will restart the IV. 

Removing Necrotic Tissue

Another skilled nursing intervention that may be performed on chronic wounds is using a sharp object known as a debridement instrument to remove necrotic tissue from the wound. This is done so that the unhealthy necrotic tissue, also known as dead tissue, can be eliminated from the wound so that new healthy tissue can grow in its place.

While removing necrotic tissue from a chronic wound is often performed by the physician, registered nurses who have been certified in wound care can also perform this minimally invasive procedure. After the procedure has been completed, the nurses will assess the wound on each shift and report the findings to the attending physician. The doctor will recommend the appropriate treatment orders based on the condition of the wound.

If you or your loved one have chronic wounds and are residing in a nursing home or assisted living community, talk to the physician or registered nurse about the above interventions. These treatment options can help promote wound healing and lower the risk for complications such as infections, permanent tissue damage, excessive pain, and scarring of the skin.