Preceptor Guide

Skin Ulcers and Wound Care Products

Printable Versions of Materials needed to create station:

• Preceptor Guide
• Skin Ulcer Staging

Guide for Preceptors:

NOTE: the information posted just below is identical to that in the printable version of the preceptor guide above.

This station was designed to be highly interactive for the learners. It can be applied to a variety of learners ranging from medical school and nursing school students to residents. We divided this station into four activities, each is hands-on and encourages participation. Two are described below, the remaining two are on separate sheets.

1. Activity 1 is a matching game of 10 pictures of ulcers: 1 for each stage of ulcer and 2 diabetic, 2 arterial and 2 venous ulcers. Due to copyright issues, we are unable to post our pictures, but you should be able to find small 2x2 inch pictures of the ulcers mentioned above. We laminated our pictures, cut each one to size to allow for repeated use and made two copies to ensure adequate resources for the learners.

Preparation:

1. Arrange the students at your station in pairs
   
2. Place a pair of laminated blank “Pressure Ulcer Staging” and “Lower Extremity Ulcer Staging” sheets for each pair of students
   
3. Scatter one set of the laminated pictures of ulcers around the sheets
   
4. Have the pairs of students race against each other to place the correct picture in the correct ulcer category
   
5. The first pair to have the pictures in the correct places wins a token prize

Discussion:

• Upon completion of the matching task, review characteristics of each type of ulcer and prevention techniques:
  
  • Pressure Ulcers: from continuous pressure on any part of the body
    
    • Stage I: non-blanchable erythema, no skin breakage
      
    • Stage II: To dermis and epidermis
      
    • Stage III: To subcutaneous tissue, above fascial plane
      
    • Stage IV: Muscle, bone, tendon, below fascial plane
      
  • Arterial Ulcers: Lateral malleolus, darker in color due to venous circulation, more painful, less drainage than venous
    
  • Venous Ulcers: Medial malleolus, ruddy/more red in color due to existing arterial circulation, less painful, more drainage than arterial
    
  • Diabetic Ulcers: Worst ulcers due to poor wound healing, vascular compromise from chronic hyperglycemia and later presentation due to neuropathy. Have both venous and arterial involvement.
    

Prevention: Turn every 2 hours, minimize bedrest, avoid “donut” cushions, frequent visual inspection, ambulation, proper nutrition.

2. Activity 2 involves displaying common wound care products including dressings, gels and Wound Vac’s. Explain the use of each, the indications and allow the learners time to pick up and explore the various supplies. Be sure to emphasize the importance of moisture control. Highly draining wounds would not work well with dressings such as Duoderm’s as maceration would soon ensue. Correspondingly, dressings such as Aquacel are very helpful with highly draining wounds since they can absorb 20 times their weight in fluid. The silver in Aquacel- Ag is helpful in breaking the bacterial cell lining to encourage bacterial demise. It is helpful to display the various thicknesses and types of dressings, including foam dressings.
   

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