Index: Ostomy Wound Manage. 2012;58(1):24–34

Abstract
  The number of people requiring palliative or hospice care who have a fecal or urinary diversion is increasing, but the literature about the number of persons with a stoma receiving end-of-life care, or research to help guide that care, is very limited. A broader review of the literature and clinical experience indicate that several progressive changes will affect the ability of persons with a stoma to provide self-care, including motor, sensory, vision, and cognitive deficits. It is important for the wound ostomy continence nurse (WOCN) to anticipate these changes and take steps to address them. The latter may include simplifying the equipment or accessories used and identifying and teaching caregivers how to manage the stoma or empty a continent diversion or neobladder. A thorough assessment and stoma care adjustment also are needed when peristomal complications such as a change in the abdominal plane, mucocutaneous separation, or caput medusa are observed. Medication absorption and its effect on fluid and electrolyte balances must be considered at all times, especially in persons with an ileostomy, and the elimination side effects of commonly used medications in the palliative and hospice care environment must be monitored and addressed. The Advanced Practice WOCN with knowledge about end-of-life care can help prevent complications and improve patient quality of life. Research is needed to increase understanding about the scope of these problems and best practices to address them and to understand the experience of patients with a stoma at end-of-life.

Wound Care Means First Wound Prevention

Nutritional Aspects in the Management of Skin Ulcers

Muscaritoli M, Gioia, Esposito M
Rome, Italy

Abstract
  Although the pathogenesis of skin ulcers (SU) varies largely depending on the reason that caused them, their ability to heal or, to the contrary, their tendency to become chronic or delayed healing depends on the combined effect of several common factors that can significantly influence the prognosis of the wound and the patient. Among these, the most common are represented by care of the wound, hygiene, and nutritional condition. It is widely recognized that protein-calorie malnutrition acts as a factor that favors the onset of SU and at the same time slows healing. The nutritional condition can in fact significantly influence the phases of the wound repair process, namely inflammation, proliferation (anabolic phase), and tissue remodeling. The pivot of nutritional support in the multidisciplinary care of skin wounds is based on an adequate intake of fluids, calories, and proteins. However, very often the diet, even when integrated with specific nutritional supplements, is not able to maintain an optimal state of nutrition and hydration to favor wound repair. In addition, the dietary intake of certain nutrients that are particularly useful in the wound healing process may be sub-optimal. This makes exogenous supplementation necessary, in order to promote and accelerate the healing process, thereby giving way to a pharmaco-nutritional approach for the prevention and cure of SU.

Administration
William Ennis, DO, MBA
Chicago, IL

Education
Sharon A. Aronovitch, CWOCN, APRN, PhD
Tallahassee, FL

Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN
Cherry Hill, NJ

Barbara Chamberlain, PhD, APRN, MSN, CCRN, WCC
Williamstown, NJ

Nancy Muller, PhD, MBA
Charleston, SC

  According to the Centers for Disease Control and Prevention (CDC),¹ smoking is the leading preventable cause of death in the United States, where every year it is the reason for one out of five deaths.

  What is it about smoking that causes such negative health outcomes? The byproducts of smoking — carbon monoxide and nicotine — pose a double threat to the body. Once inhaled, they increase heart rate, blood pressure, and the body’s demand for oxygen. It doesn’t take long to feel the effect; just 10 seconds after inhaling smoke, the brain is bathed in nicotine and carbon monoxide hinders red blood cells from carrying adequate amounts of oxygen. The lungs cannot work to full capacity because smoking narrows the small airways of the lungs, making smokers more prone to lung collapse, infection, chronic coughing, and breathing complications. Despite efforts to squelch smoking with mandatory smoke-free public buildings and clean-air laws, an estimated 46 million adults 18 years and older still choose to light up.¹