need a good idea for this patient

Nurses General Nursing

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Specializes in LTC.

I have a patient in my facility that is being tapered off psych meds. She has continual movements of pelvis, legs, etc. In addition to this, she was admitted to us with some pretty fragile skin on her coccyx area. When we got her she was pretty sedentary, but the tapering of meds has "awakened " her. Now this fragile skin has broken down due to shearing and incontinence. They first had tried Duoderm on the site, but that really didnt work because it had to be changed so frequently, and it acutally made things worse because of the gooey mess it made. She is not a candidate for the usual "keep in bed T&P" type of treatment. Any suggestions for a good product to try to get this lady back in good skin condition?

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Specializes in NICU, PACU, Pediatrics.

what about sheepskin for her to lie or sit on? There are those cushions that take the pressure off the coccyx that leave it open and are covered with sheepskin.

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Specializes in LTC.

Thats a good idea but I am not sure it would work for her - I know that the sheepskin is pretty soft, but with her constant pelvic thrusts from meds (or coming off her meds) I think she might do more damage than good. Last nite at work they tell me that now they are gonna do whirlpool baths every nite and put her to bed with T&P, but I really don't know if that will work either. I appreciate your idea though and will present it to her care plan coordinator.

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Specializes in Hospice.

Don't know what T&P is so maybe this has already been suggested ... what about a transparent dressing like op-site? Might be a little pricey, but there are large size transparent film dressings available ... we use 'em on my hospice unit. It might help with the friction problem.

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Specializes in Emergency, outpatient.
Don't know what T&P is so maybe this has already been suggested ... what about a transparent dressing like op-site? Might be a little pricey, but there are large size transparent film dressings available ... we use 'em on my hospice unit. It might help with the friction problem.

I was thinking that, too. It would take care of the shearing and the incontinence issue.

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Specializes in Home Health/PD.

What is this lady's MD saying about this? Is it possible for her to get on something to decrease the amount of movements she is having? Is is possible to keep her on that medication (increase the dose) to decrease the movements until her skin heals? I think getting the area healed should be priority because of the infection risk, but I also do not know her hx or reason for decreasing the meds

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i guess i'm still not fully understanding the problem with duoderm...

esp if you put a protective dsg over it, or tape it on all 4 sides.

that way, only tape/protective dsg needs to be changed on daily basis.

the duoderm s/b changed q3d, if only to check on progress.

letting a duoderm stay on too long, has actually caused wounds to worsen.

i've seen it.

if that's not feasible, then i'd go w/the opsite.

(doesn't that become messy with incontinence also?)

leslie

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Specializes in med surg-oncology-progressive care-Rehab.

First I would call Md. and obtain an order to insert foley cath, consult for PT, they can get the patient a special pad for her chair. Pt. needs to be on some type of air mattress along with T&P Q2 hrs. Zenaderm is a good product that helps to heal the skin along with improving the friability.

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Specializes in Cardiac Telemetry, ED.

The wound care nurses at my hospital are really big on leaving the wound open to air and using Calmoseptine ointment to protect the skin.

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