In this case I was just hired by family members as a case manager to help with issues around a hospitalization and (now) SNF care. There was no skin damage when the patient entered the SNF about 6 weeks ago. I not a WOCN and am not up on the current state of dressings and treatment (other than unloading and debridement) for pressure ulcers, and there is no WOCN on their staff-- wound care is done by a staff member who is their facility resource, but she appears to have no power to order changes, and doesn't seem to know much about anything other than skin barrier spray and those big bandaids you put on your kid's scraped knee. She described this "callus" as a hard dry area with no discoloration, and when she saw it a week later it was red and purple with black eschar. Then she had a physician look at it and that's when the debridement was done. A week after that was when I saw the heel for the first time, with bandaid and fluffy boot, but the boot comes off when the shoes go on for PT. (Since the patient can't walk I don't see the point of the shoes.)
She means well but it's clear that this went really rotten in a week because nobody was watching it. I would like some information on what ought to be happening from here (other than unloading), such as dressings, dressing changes (how often), and such so I can monitor the situation. So I came here to ask a real WOCN for some ideas.
Last edit by GrnTea on Dec 26, '12
Dec 26, '12
by sirI, MSN, APRN, NP
In this case I was just hired by family members as a case manager to help with issues around a hospitalization and (now) SNF care.
There are WOCN nurses who can help you with some of the questions you have about monitoring present situation.
"Helping with issues around a hospitalization".... " but it's clear that this went really rotten in a week because nobody was watching it." ..... we just have to ensure that your inquiry is for present/future care to maintain/improve the situation for your patient and not gathering information to try and (medically/legally) answer what could have happened before he became your client.
Last edit by sirI on Dec 26, '12