Management Resources

Healthy ageing has become a global priority to add quality to our later years and reduce the morbidity associated with ageing. Entering older adulthood, however, increases the risk of frailty and sarcopenia — key factors driving age-related morbidity. Frailty is a multi-system impairment associated with increased vulnerability to stressors. Sarcopenia is the loss of muscle mass and function and is a major component of frailty. Skeletal muscle has a reduced response to stimuli such as protein intake and exercise with advancing age, driving the gradual loss in muscle mass seen in older adults. High protein diets, especially when paired with resistance exercise, can help to overcome this anabolic resistance and restore or maintain physical robustness. The commonly cited protein requirements for adults published by the Department of Health (DH) underestimate the needs of older adults. Other nutritional factors, such as weight loss and vitamin D status, also play important modulating roles in frailty and sarcopenia.

Lymphoedema is a long-term condition which is incurable at the present time. Due to the nature of the condition, being both long-term and manifesting in physical changes (swelling), its impact on the person and their lives can be hard to quantify. Management options need to be considered within a person-centred approach, with the four cornerstones of treatment being skin care, exercise, compression therapy and manual lymphatic drainage (MLD). Evidence for each is varied and practitioners need to determine their therapeutic benefit. Beyond the cornerstones of treatment, future developments are ongoing within the areas of surgery, such as venous anastomosis and pharmacological interventions, which may reduce the effects of continual inflammation. In the future, these developments may become part of the care delivered to those affected by lymphoedema. However currently, skin care, exercise, and compression therapy remain fundamental, with MLD included if therapeutically indicated, as well as educating and empowering those involved in selfmanagement with the support of practitioners.

Normal wound healing follows four distinct phases: haemostasis, inflammation, proliferation and finally, maturation. If any barriers to healing occur within these four phases, the healing process will be delayed or may even stall (Mitchell, 2021). One of the common barriers to healing is hyper or overgranulation, or ‘proud flesh’. Hypergranulated wounds can cause concern to both patients and healthcare professionals, and, although common in wound care, there is a limited evidence base and currently no guidelines for management. This article discusses the causes of hypergranulation, with suggestions on how it can be managed.

The first article in this two-part series looking at faecal incontinence (FI) outlined its effect on people’s quality of life, highlighted its prevalence, explained the different definitions
available and summarised the anatomy and physiology of the lower intestinal tract (Yates, 2023). Here, part two concentrates on the multiple causes/risks of FI, the knowledge and skills r equired to complete a basic assessment and initiate conservative therapies, including the role of medication and pelvic floor rehabilitation, and also discusses management options for FI.

Moisture-associated skin damage (MASD) is a term used to describe skin damage that is caused by prolonged exposure to moisture, such as incontinence-associated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis and peristomal moisture-associated dermatitis. MASD is a hugely prevalent issue in hospitals and long-term care facilities (Voegeli, 2019). Studies have shown that skin tone bias exists in the diagnosis and treatment of MASD, the impact of which this paper discusses as well as how to prevent such bias while assessing and diagnosing MASD.

This article looks at the cost and incidence of wound dehiscence, together with an overview of the most common operation sites where dehiscence is likely to occur. Patient factors predisposing to wound dehiscence are discussed, together with the most common cause, surgical site infection (SSI). The identification and management of SSI is explored, together with recommendations for wound management for both infected and non-infected dehisced wounds.

Non-cystic fibrosis (CF) (bronchiectasis) is a common chronic lung condition, which occurs due to damage to the airways leading to persistent cough, sputum production and recurrent chest infections (Hill et al, 2018). This article focuses on the adult patient and describes the pathophysiology, aetiology, investigation, and management of bronchiectasis in the primary care setting. The aim is to raise awareness of this disease, which is increasing in prevalence and to empower community nurses with information to support patients through the bronchiectasis disease trajectory.

Dehisced surgical wounds are a common occurrence and are seen both in primary and secondary care. The impact of a dehisced wound is far reaching. For the National Health Service, there are increased in-patient costs and additional resources in terms of an extended healing time, such as staffing and dressing materials and therapies. For the patient, a dehisced wound can impact significantly on their wellbeing and quality of life and for patients of working age, the economic impact of not being able to work can be enormous. This article discusses the incidence of wound dehiscence, outlines the types of wounds which are most likely to dehisce, and the most common reason for this, wound infection. Strategies for managing wound infection, including the use of antiseptic and antimicrobial products, together with a frequently used therapy, topical negative pressure therapy (TNPT), are also discussed.