Patient came to us with a stasis ulcer on the shin, about the size and depth of a penny, non-draining, yellow wound bed. There's not much skin there, and the entire wound doesn't look too far from the bone.
Of course this was on the weekend when the ET nurses were off.
Doc ordered antibiotic ointment at first ((which I thought was a little weird, actually, seemed to me that a debrider might've been a better choice, so I'd also like your thoughts on that). Then I noticed that Patient has practically shredded the skin around the site because "it itches."
Apparently someone was picture-framing a 2X2 to the leg with paper tape. However, the area where the tape touched looks red and she's c/o itching. She states that the wound did not itch prior to the tape.
So we started putting a small wet-to-dry 2X2 and wrapping the whole shin in kerlix, but she's still scratching it, and with her scratching at the dry Kerlix, it is still macerating the skin around the wound. The Kerlix would fall down when she sat in the chair for any length of time.
I started using the stretchy webbed stuff that we use to stabilize IVs, but other than that, I'm at a loss.
Should we get an order for some Benadryl or topical ointment for the area around the wound? Think we need a debrider for the wound itself till it's got a better wound bed, then switch to Intrasite?
She's scratched the area to the point that it really looks like she was attacked by a cat or something, and I'm really worried about her giving herself a case of cellulitis or infecting the wound. Or worse, since the skin is so shallow and close to the bone.
I'd put her hands in mitts, someone else suggested wrist restraints as she's mildly demented, but that seems pretty harsh.
That's why I'm posting the question, which is actually about 2 issues.
She still has the original wound and the care of which I questioned.
In addition, the wound has become complicated by what appears to be a tape allergy.
Sorry if I didn't make that clear.
Last edit by UM Review RN on Feb 9, '07