Large man wound care

[zacarias]

Hey all!!

Just poking my nose in and saying hi to everyone. Just one day off and I'm back for more 12s tomorrow!

I do have a question/comment about a patient that I just don't know what to do with.

This patient is over 350 lbs with several leg neuropathy and can't move his own legs really. He is on a barimax bed and prefers to sit up because of his CHF I guess (although he sats 97% on 2L laying flat). He gets severely anxious and won't let us do much care for him that involves moving him. He's like 58 and acts like a two year old. He is slightly confused and perseverates a lot. One nurse had him two days and refuses to work with him anymore. I've worked with him three days and I say it's so tiring emotionally. He's ungrateful and he'll yell out for you every time you go by his room because he gets upset if someone is not in his room 24/7. He feels abandoned by nurses who leave the room and sometimes he starts crying. I worked two days trying to get a fan to him that he wanted because he said he was hot. Finally we got him one and he was hardly grateful and didn't even want it on really. I give him 20 min I don't have in the morning talking to him about his concerns and then he says I abandon him when I leave.

As you can see, this is a trying patient. This issue is this. He has massive excoriation, stage 2 like ulcers all around his bottom. It takes three to four people to turn, move this guy if he will even let us. He's mostly incontinent and stool gets in his deep skin folds and it's colossal job cleaning him up. Sometimes stool gets under the dressing so we have to change it which is bad because they shouldn't be taken off anyway. I have been serious with him telling him that if he doesn't get off his bottom, he will not fair well and his ulcers will get worse and worse. He hardly will let us turn him or move him and if we do, he sits up to breathe and sits on the bed. To turn him takes 30 min, not 5 min because he stops us and talks about irrelevant things.

He's set to go to a SNF nearer to where he lives soon although I doubt the SNF knows how much care he really is. I am most worried about this guy's wounds. What can we do? I feel that it's just going to get much worse no matter where he is. He doesn't help and he's huge and is incontinent. Are these people just screwed for life?

This post is both a vent and also a plea for suggestions. Put yourself in his and the nurses' place before making suggestions so as to know the severity of the situation. The first year resident says that he just needs good wound care. Well DUH!

Zach

[tlynsmith]

Where are the MSW, Psych Eval, etc. I used to do HH ... specialized in wound care. We would use hyperfix tape and tegaderm to keep these wounds clean. Have you tried to use these supplies. I have dealt with obese patients with complicated wounds many times before. Does he have a foley? Is he turning every two hours/ PRN? Is he ambulating at all? I have had to change wounds with the patient standing up.... This is a sad story... I do not think anything you will say or do will make him happy. It sounds like your a compassionate nurse keep on pushing on :)

Teresa

[vemiliob]

Zacarias.

As I can see there are no essential differences between your job and ours when we get on that field. In my actual jobplace we are so shortaged that unfortunately if pts like this one don't have a caregiver to help you, the whole work must be done by yourself alone.

Of course whatever description related to those cases will be of no importance right now. Enough to say that in Surg-Med area we have about a 10% of pts of that kind, permanently.

It becomes dangerous for your own mental health to stand too much on it. Do your best in the moment. Remember you have other pts. And leave your pt back when you cross his/her door out.

Time will show you that they are huge not only in the physical but in the psyche as well. That is, they tend to occupy too much space sucking our energy. No one can stop that process except us.