Patients who are not candidates for surgery can be managed

conservatively with oral medication. Antithrombotics, such as pentoxifylline (Trental) or cilostazol (Pletal), are used in pa- tients who do not experience leg pain at rest.4,18


is contraindicated in patients with clinically significant arterial disease. It is also important that the patient participate in regular physical activity, weight reduction, and smoking cessation. The patient needs to work closely with the provider to ensure chronic diseases, such as hypertension, hyperlipidemia, and diabetes, are controlled.

Interprofessional roles in ulcer healing Many factors need to be considered when caring for lower ex- tremity ulcers, and many conditions and comorbid factors affect wound healing. An interprofessional team approach to managing lower extremity ulcers is considered “best practice.” The IP team can include nurses, nutritionists, radiology professionals, sur- geons, social workers, and orthotists, as well as other healthcare professionals. This team approach must engage the patient and family members as a crucial part of the team. The wound-care coordinator/liaison functions as the contact

person for patients and family, answering questions, discussing concerns, or finding resources. This coordinator/liaison also ensures that treatments provided by individual IP team members are communicated to the entire team. They often coordinate team meetings at which patient cases can be reviewed. This helps to avoid duplication of services or prevent missed opportunities for additional services, and ensure that the delivery is cost-effective and efficient. Each team member focuses on his or her role while understanding how the patient should be treated holistically when collaborating with other members of the team. Assessing and treating the wound will not be enough; the

patient needs a thorough assessment. Wounds can impact a patient’s quality of life and self-esteem negatively, and can have psychosocial implications. Wounds can be isolating socially, cause body image disturbances, and lead to depression.5


tients may have strict treatment regimens that require them to elevate the lower leg several times each day. The wounds may have purulent drainage with foul odor. Patients must understand that there is a high recurrence rate that can lead — depending on the etiology — to amputation. Due to the increased number of missed workdays and frequency

of medical visits, these wounds can have negative financial impli- cations for the patient. Social workers have an integral role in the patient’s treatment plan and can help patients find community resources to ease financial burdens.16

They provide counseling

services to patients and families to help them cope with the body image disturbances and the mental health effects of the wounds.5 Patients can be better prepared for what to expect during the wound-healing process. Interventional radiologists and their staff are necessary for

performing diagnostic tests. These tests provide an etiology of the wound that will guide the treatment plan. These same diag-

nostic tests assess the outcomes of the treatment and are used for surveillance. Vascular surgeons perform surgical interventions that help

reduce the symptoms of venous hypertension. Vascular surgeons perform procedures that restore the blood flow to extremities affected by PAD. Surgeons also may perform large debridements and amputations. Orthotists help patients with custom inserts or footwear that is constructed to eliminate pressure.19

supply store to be fitted properly for compression hose, when indicated. PT and OT may assist patients with gait training and home modifications.19,20 Evaluating a patient’s nutritional and hydration status is

crucial when trying to heal wounds. Registered dietitian nu- tritionists have a valuable role in the wound-healing process. Impaired nutritional status and inadequate intake of nutrients, vitamins, minerals, and fluids impair wound healing despite choosing the appropriate wound-healing regimen. Patients require adequate caloric intake, protein, and hydration. Vi- tamins C and A, zinc, and iron have been shown to have a valuable role in the wound healing process. RDNs can assess a patient’s diet and help tailor a meal plan with any supplemen- tation that will aid in wound healing.19

Many chronic diseases

that pose risks for patients developing lower extremity ulcers, such as diabetes or hypertension, are better controlled with diet modification. Primary care, cardiology, and endocrinology are equally

important with helping control for the chronic illnesses. These providers assist the patient in getting tighter control of blood glucose, blood pressure, and lipid levels. These same providers can assist the patient in losing weight and in smoking cessation. Most wound-care treatments occur in a wound-care center and

are performed by certified wound-care staff. Home health nurses assist with wound assessment and dressing changes between wound-care center visits.19

home modifications or wound-healing devices and help with elevating the extremity if necessary. They assist patients with gait and reinforce PT and OT regimens. Each profession brings skills to assist with a common goal of

addressing the patient’s needs and healing the wound. Although members of each service cares for the patient in their area of specialty, all of the services are linked closely and may often overlap. The IP approach to wound management allows for better continuity of care and increased patient satisfaction, and is more efficient and cost-effective.20

been shown to decrease morbidity and mortality rates, as well as wound recurrence.19,20

This is considered the standard of care and will lead to better patient outcomes. •

Tanya Munger, DPN, FNP, RN, CCHP, is a family nurse practitioner at OSF Saint Anthony Medical Center, Rockford, Ill. She holds a certificate in forensic nursing with a special interest in correctional healthcare and wound management.

To see the references and take the test, go to 2016 • Visit us at 25 They also provide assistance with

Patients can use a medical

IP wound management has

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