Dx Non healing wound

[americanTrain]

I have a patient with a diagnosed non healing wound to the sacrum. Complications include Diabetes, Bilat BKA, Colostomy, Urostomy, Spinal Stenosis, non compliance with diet, obesity. Stage 4, no tunneling, slough present one week, but gone the next. Daily wound vacc drsng changes. This has been an ongoing problem for 2 years for this patient. Now, I have started using Medela's wound vacc with Microbial gauze, going on 4 weeks, still no improvement. Iam just about at my wits end. I have tried everything. Dietary consultations, with added Nutritional supplements, only to be Dc'd by the nurse for refusal to take. LAL in use, turn schedule, chair cushion with proper inflation,wound cultures, antibitoics, etc. Im always thinking of ways to heal this, am I beating a dead horse. Should I just try to prevent the infections and keep odor down to minimum, just to keep them comfortable. I realize that everyone else has tried it all, but I feel like I should be able to do something more, as Iam obsessed with healing this thing up. This is my toughest case yet. Please comment

[VivaLasViejas, ASN, RN]

Two words: Hospice consult.

You can't fix this patient. I've had more than my share of them too, and I have seen only one heal up well enough to discontinue skilled services......and that was a 50ish paraplegic with a Stage IV coccyx wound I could stick my entire fist into. She loathed being in the nursing home, and it was enough to make her decide that she was going to do whatever she had to, including changing her diet, quitting cigarettes, and taking her insulin as prescribed, to get out of there. And finally, after nearly a year of painful, twice-daily wound packings and dressing changes, an 80-lb. weight loss, and getting her blood sugars under good control, she made it.

She came back to my facility only a few weeks later, with the wound reopened and infected. She confessed as I was re-admitting her that she'd "celebrated" her homecoming by allowing herself to slack off a little on her diet and exercise program, and she'd started smoking again because her boyfriend refused to not smoke around her. That was all it took for disaster to strike again, and nine days later, sepsis claimed her life.