Work in LTC, Last night nurse from other unit ask me to come and look at a heel of a Resident that was admitted 16 days ago. (Not my Resident, so I don't know any Dx, or history)
Residents heel was Black and hard from the back of his heel all the way to the beginning of his arch.
He has had (or not) 3 skin assessments, since being admitted. Initial assessment when admitted 16 days ago, one sched weekly 5 days after being admitted, and one sched weekly 7 days later. (4 days ago) Also he gets a shower every other day, (last one 1 day ago) Res. also wears TED Hose, that are put on and taken off daily. His skin assessments are sched during 11-7 shift, showers are during 7-3 shift, and TEDs are taken off during 3-11 shift. Therefore, no less then 5-6 nurses and countless aids have provided care for this gentleman, without ever mentioning, or documenting an issue.
My question is how long does it take for a wound to go from nothing to unstagable? Did the admitting RN most likely miss this with the initial skin assessment 16 days ago? Did the shower team really not see anything the day before and it just showed up last night?
I know heel wounds are different, but I have not had any experience with them, if I see redness, or fell that it is soft, I apply skin prep and order a heelz-up cushion and that resolves the issue.
Im just really curious as to How fast can they change?
Thanks for any enlightment...