What should I do????

  1. we have a patient in terminal illness. he has a wound at the coccyx. I decided to treat the wound but the boss (who's not a nurse) told me not to treat it. she said the doc decided not to treat it.
    what do you think about that???? Is it normal to let a pressure wound phase 2 or 3 without treatment???
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  2. 7 Comments

  3. by   BadBird
    Is the patients death imminent? Unless the patient is expected to die in a day or so I would treat it. As a nursing measure you could at least do a wet to dry dressing and position the patient off the wound. Of course adequate pain medication is a must.
  4. by   aimeee
    Quote from BadBird
    Is the patients death imminent? Unless the patient is expected to die in a day or so I would treat it. As a nursing measure you could at least do a wet to dry dressing and position the patient off the wound. Of course adequate pain medication is a must.
    We always treat wounds but often the goal is merely to prevent further deterioration or distress resulting from the wound.
  5. by   moemcp
    Quote from nursy_ann
    we have a patient in terminal illness. he has a wound at the coccyx. I decided to treat the wound but the boss (who's not a nurse) told me not to treat it. she said the doc decided not to treat it.
    what do you think about that???? Is it normal to let a pressure wound phase 2 or 3 without treatment???
    I would agree with the response from Badbird! I am a hospice nurse, I would treat it but not aggressively or extensively. Medicate with MS04 or similar 10-15 minutes before DSG change and clean it and do a light cover sponge or something, you may need lyofoam for odor control. Keep in mind that it is not going to heal, so keep him comfortable!
  6. by   tlmhospice
    That depends on what stage the patient is in at the time. Is he/she actively dying? Is this tx aggressive, or is it pallative? Number one priority in hospice is comfort and pain management.

    Tonia
  7. by   Scififan
    When in doubt I always go back to what I would want for my nearest and dearest and myself, and I would definately want it treated a) for comfort and b) to prevent further deterioration.
  8. by   nursy_ann
    Finally, the wound is so deep we can see the coccyx bone and there's an infection. The doc came and said it is ok to treat the wound
    he said that is what we call in french gangrene. he said the infection is eating the flesh and it's a question of time that his intestine content will get out by the wound. We insisted that he could have a medication better than Tylenol for the pain. He said the patient doesn't suffer. what kind of doc is this??? We insisted again saying it is not because he is not able to say "it hurts" that it doesn't hurt. Then he gave him Duragesic patch.

    what should we do with docs like him????

    Today we had a woman with a pressure 59/49 and pls 158/min he didn't want me to send her to the hospital....I was sooooooooo upset, I hung up the phone and called 911 for an ambulance. I don't care what will happened if he dosn't like this. I'm tired of him being rude like that in his manner to treat ppl. :hatparty:
    Last edit by nursy_ann on Feb 22, '04
  9. by   mayumi
    ??hmm...do you have a nurse supervisor that you can bring up your concern about this doc?is the administration knows about this? you can't just stand there and allow these and wait for something worst to happen. talk to your supervisor, you can document all your observations, and concerns.
    Quote from nursy_ann
    Finally, the wound is so deep we can see the coccyx bone and there's an infection. The doc came and said it is ok to treat the wound
    he said that is what we call in french gangrene. he said the infection is eating the flesh and it's a question of time that his intestine content will get out by the wound. We insisted that he could have a medication better than Tylenol for the pain. He said the patient doesn't suffer. what kind of doc is this??? We insisted again saying it is not because he is not able to say "it hurts" that it doesn't hurt. Then he gave him Duragesic patch.

    what should we do with docs like him????

    Today we had a woman with a pressure 59/49 and pls 158/min he didn't want me to send her to the hospital....I was sooooooooo upset, I hung up the phone and called 911 for an ambulance. I don't care what will happened if he dosn't like this. I'm tired of him being rude like that in his manner to treat ppl. :hatparty:

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