Pressure Ulcer, CHF, & UTI r/t Foley

Nurses General Nursing

Published

Hello,

I have a pt. who was just told by her doc that they can't do anymore for her heart, she has to leave our med/surg floor and go to hospice. My question is:

Does anyone have any ideas on how to help a pressure ulcer (coccyx region) heal and a UTI? Pt. is 90 y.o. and bed ridden. Cannot switch to diapers b/c urine and BM would cause further skin break down on already lesioned skin.

Pt. also has COPD and pitting edema everywhere...:(

Thanks!

1st semester BSN student

(WildFlowers84)

leslie :-D

11,191 Posts

Does anyone have any ideas on how to help a pressure ulcer (coccyx region) heal and a UTI? Pt. is 90 y.o. and bed ridden. Cannot switch to diapers b/c urine and BM would cause further skin break down on already lesioned skin.

Pt. also has COPD and pitting edema everywhere

control edema/diurese

air mattress.

treat uti w/abx

meticulous foley/peri care

optimize nutrition

monitor ulcer and prevent further breakdown

how far have you gotten in school?

i know i read 1st semester bsn student...how far into your semester are you?

reason i ask, is not knowing how to treat uti?

i don't know what stage the ulcer is, but isn't there a treatment regimen in place?

what's going on here?

is this someone you cared for at clinical?

i'm just a tad confused as to why you're asking?

leslie

miss81, BSN, RN

342 Posts

Specializes in Surgery, Tele, OB, Peds,ED-True Float RN.

Maybe she's never had a UTI and if she is only in her 1st semester right now she is learning bed baths and basic anatomy... I commend her for asking the question. WildFlower, don't get intimidated... ask away!

leslie :-D

11,191 Posts

Maybe she's never had a UTI and if she is only in her 1st semester right now she is learning bed baths and basic anatomy... I commend her for asking the question. WildFlower, don't get intimidated... ask away!

that's why i asked how far she is into her semester...

to get a sense of where she is.

but even w/o schooling, i would say most folks know that uti's are treated with abx.

i found it an odd question, that's all.

and no wildflower, do not get intimidated.

my bark is worse than my bite.:)

leslie

HappyBunnyNurse

190 Posts

She should be on dry flow pads not "diapers". Sounds like she needs an airflow bed if you have those. If not at least an "egg crate" or decibitis pad. Sounds like she really needs a Wound Care Nurse consult. This nurse can make suggestions which will be useful even when she goes to hospice. If the Foley is in for staff conveince only then it needs to come out now. If it is medically necessary then it needs to be changed weekly and very good peri care given. Usually you would increase fluids for a UTI but not with this patient. Keep in mind that all her problems are complicated by her circulatory compromise. Good luck to you and your patient.

nerdtonurse?, BSN, RN

1 Article; 2,043 Posts

Specializes in ICU, Telemetry.

Is she also in renal failure? Because if she's not, that's likely to come soon.

Absolutely get a wound care consult/specialty bed as others have suggested. Get lots and lots of pillows, and keep the pt completely up on one side or the other as much as you can without being squarely on a trochanter -- get the stool to run to the side, not across the decube, even if you have to put pillows between her legs to make it happen. Also understand that as she gets sicker, she's not going to be able to breathe if you don't keep her as upright at possible, which will make the decube worse. keep her turned as often as humanly possible, because that edematous rafting of skin is a nightmare when it tears as it fills with fluid.

When in doubt, ABCs -- don't mess with airway or breathing or compromise her remaining cardiac function to try to mitigate a decube she probably won't live long enough to get rid of. Keep it clean, keep her clean, but worry first about the ABCs. The decube's not going to be what kills her (probably).

SunnyAndrsn

561 Posts

Specializes in LTC/Rehab, Med Surg, Home Care.

Chances are this will not heal before she dies.

When we have a pressure ulcer in our facility the protocol is as follows:

1. Nutritional: Add high protein supplements,

2. Request a multivitamin, zinc, and vitamin C order from the MD

3. Air mattress

4. Our wound nurse requests specific treatments based upon the stage of the wound. IE, aquacell, hydrofera blue, etc.

5. reposition hourly.

But again, it doesn't sound like she's going to survive much longer. CHF is horrible, coupled with COPD and the fact that her edema sounds pretty bad, poor thing!

Hello,

I have a pt. who was just told by her doc that they can't do anymore for her heart, she has to leave our med/surg floor and go to hospice. My question is:

Does anyone have any ideas on how to help a pressure ulcer (coccyx region) heal and a UTI? Pt. is 90 y.o. and bed ridden. Cannot switch to diapers b/c urine and BM would cause further skin break down on already lesioned skin.

Pt. also has COPD and pitting edema everywhere...:(

Thanks!

1st semester BSN student

(WildFlowers84)

catshowlady

393 Posts

Specializes in ICU.

Love skin care products - we use sensicare creams - there is one in a green tube that you put on intact skin to create a protective barrier against urine, and there is one in a blue tube that is for use on broken skin.

I doubt the ulcer will heal given pt's situation, but you can at least try to prevent further breakdown.

Daytonite, BSN, RN

1 Article; 14,603 Posts

Specializes in med/surg, telemetry, IV therapy, mgmt.

Problem solve this. This is why we have the nursing process. Use it to your advantage.

What is causing the pressure ulcer and what is going to make it worse? Then intervene in those causes. The pressure can be dealt with by keeping her off the pressure points as much as possible. If moisture and chemicals from the excretions against her skin are a cause of breakdown, then find strategies to keep them away from her skin or protect her skin from them.

If they are not going to treat the UTI with ATBs (sometimes Hospice won't treat any further disease) what non-medical things can be done for UTIs? Keeping urine acidic with things like cranberry juice sometimes helps. Encouraging a lot of fluid intake. Research treatment of UTIs.

MedSurgeMess

985 Posts

Specializes in Med/Surg, ICU, educator.
Problem solve this. This is why we have the nursing process. Use it to your advantage.

What is causing the pressure ulcer and what is going to make it worse? Then intervene in those causes. The pressure can be dealt with by keeping her off the pressure points as much as possible. If moisture and chemicals from the excretions against her skin are a cause of breakdown, then find strategies to keep them away from her skin or protect her skin from them.

If they are not going to treat the UTI with ATBs (sometimes Hospice won't treat any further disease) what non-medical things can be done for UTIs? Keeping urine acidic with things like cranberry juice sometimes helps. Encouraging a lot of fluid intake. Research treatment of UTIs.

If she's a CHFer, lots of fluids is a big no-no, but I see a great turn schedule along with using lasix for the edema can be a big help.

leslie :-D

11,191 Posts

If she's a CHFer, lots of fluids is a big no-no, but I see a great turn schedule along with using lasix for the edema can be a big help.

right, no increased fluids.

depending on where pt is in dying process, why not just treat uti w/abt?

you think it's comfortable having an infection, that could lead to sepsis?

give that pt some atc morphine and ativan.

right now, this is what is priority.

leslie

ChristyRN2009

146 Posts

I agree with other posts, abx for uti, skin protectant barriers, no diapers, and hospice/palliative care consults to give this woman comfort and dignity in death.

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