Fungal infection

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    I have a patient that has a very angry rash on her buttocks and groin. The nurses said it all started when she was on antibiotics. The doctors ordered Nystatin cream for her groin and Baza anti fungal for her bottom. When I saw her today, her groin was moist, warm and very red. I suggested switching to Nystatin powder and putting pillow cases in her groin folds.

    As for her bottom, she is denuded in some areas, red and almost purple in some areas. It also looks swollen. I suggested calmoseptine ointment since it is soothing and a barrier.

    I also suggested a different surface with more air exchange because the mattress has a vinyl cover.

    I am second guessing my recommendations (except the bed)...does anyone have any alternate suggestions? Is this all due to antibiotics? She is not incontinent.

    Thanks!
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  4. 1
    it is definately possible this is due to the antibiotics and that she has gotten a superinfection. if the area is constantly moist then this is going to persist and get worst, the fungi love the moist areas. she most definately needs more air exchange so don't second guess yourself and keep fighting for your pt. hearing things like this makes me think some doctors (and even some nurses) got their licenses from home shopping network.
    sharlynn likes this.
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    oh and make sure if she can't turn herself to turn her q 2 hours, and i would go with the powder to absorb the moisture.
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    Quote from codypatody
    i have a patient that has a very angry rash on her buttocks and groin. the nurses said it all started when she was on antibiotics. the doctors ordered nystatin cream for her groin and baza anti fungal for her bottom. when i saw her today, her groin was moist, warm and very red. i suggested switching to nystatin powder and putting pillow cases in her groin folds.

    as for her bottom, she is denuded in some areas, red and almost purple in some areas. it also looks swollen. i suggested calmoseptine ointment since it is soothing and a barrier.

    i also suggested a different surface with more air exchange because the mattress has a vinyl cover.

    i am second guessing my recommendations (except the bed)...does anyone have any alternate suggestions? is this all due to antibiotics? she is not incontinent.

    thanks!

    sometimes those vinyl mattress can be a pain in the butt! frequent position ie., side to side when in bed. verses on her bottom. open to air helps.
    how about stools? constantly loose? any tx to decrease that; ie., prophylactic tx. does she have c diff of something? decrease irritation to area promotes healing. pat dry, don't rub vigorous. calmoseptine works good, you can mix with antifungal if infected.

    don't use pillow case, use abd pads and change it. get away from creams if not healing (i'm referring to folds), rationale: to decrease moisture (the area is warm too) use pwdr form.



    Last edit by mandykal on Nov 6, '08 : Reason: I wrote incontinent care, and she's not incont.
  7. 0
    try unbleached, rerinsed linen.....wouldnt be a likely cause, but perhaps a contributing factor on the butt?
  8. 0
    Quote from mandykal
    sometimes those vinyl mattress can be a pain in the butt! frequent position ie., side to side when in bed. verses on her bottom. open to air helps.
    how about stools? constantly loose? any tx to decrease that; ie., prophylactic tx. does she have c diff of something? decrease irritation to area promotes healing. pat dry, don't rub vigorous. calmoseptine works good, you can mix with antifungal if infected.

    don't use pillow case, use abd pads and change it. get away from creams if not healing (i'm referring to folds), rationale: to decrease moisture (the area is warm too) use pwdr form.


    she didn't have diarrhea, just reaction to antibiotics i am told. we got a lal mattress for her and they stopped the cream. i am working on getting an anti fungal barrier paste through our pharmacy...criticaid paste. have you heard of it? got a good recommendation for it from another wound rn.

    i will try the abds or i heard washclothes work good. thanks!
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    Hada similar problem some time agoe. Took along time to get rid of the fungal rash. May also need to remeber/be aware that Calmoseptine is not easily removed. Soap and water does not remove the cream completely, you need a special wash to remove it. Thus they will alsways be some of the cream on the skin. We foun Hydrozole cream very effective. Not sure if it is availabble to you but works well when applied BD.
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    Is it worth taking a culture swab of the area, just to see if anything else pops up that you could be treating?
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    When our residents are on antibiotic we always give them yogurt to help offset this exact problem. It actually works on most of the residents (9 out of 10) and most of ours are incontinent. We too use mycolog cream. And yes AIR is the best possible answer. We keep them propped up on their side (with a pillow not one of those vinyl wedges) and keep the back of their brief open to allow air circulation.
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    We use nystantin power in the folds. I cringe when I see thick creams applied in already damp and dark area.
    As far as the buttocks...try to keep the diaper off and turn side to side. I like critic paste or baza cream , but we don't keep this in stock. We use a antifungal cream or even use the power mixed with zinc oxide.

    I would test for C diff too and try to get a pro biotic ordered.


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