Lady admitted to facility with a stage 4 pressure ulcer on coccyx. Bone is noted in wound bed. Drainage is now a problem (heavy serous). I think it something like 5cm x 6 cm x 3.5 cm with undermining from 6 to 3, undermining measures between 5 to 7 cm. I swear she is 90 pounds soaking wet. Poor nutritional intake. I am thinking it really is a failure to thrive and in a catabolic state. Doing the normal turn and reposition, specialty mattress, barrier cream, RD involved, however with not really eating, this wound is not going to heal. I just am kinda at a loss as to how to manage it.
Tried aqaucel CE, skin prep, cover with abd pad, but that was when drainage was minimal. Until I can figure out something else, I decided to have nurses unroll and gently pack kerlix, skin prep, cover with abd and change daily. I was really trying to avoid daily d/t comfort reasons but I don't believe this is possible. No matter what I throw at this wound, if she isn't going to eat and continues to lose weight, it will continue to worsen. Has foley placed. Request trial of arginaid, but again, she really isn't drinking anything either, including fluids such as water, med pass, juice, soda. She really should be placed on hospice which I think she will ultimately go, but I still need to figure out what to do with this wound.
The goal isn't for it to heal, but really that the resident will allow wound care to be performed and that she is comfortable. Unavoidability statement requested. She is also refusing to get out of bed...more of a passive refusal. She really is not awake that much.