need some wound advice

[Mandy LVN]

I need some advice! I have an 80 yr old chair-bound patient with what was reported to me as a Stage 2 pressure ulcer. I arrived at the home and found the wound to be more of a severe excoriation due to probably sitting in feces for too long. There are multiple open areas under the scrotum, on the buttocks and around the orifice. Most are small, less than .25 inch in diameter, but are red, oozing serosanguanous (sp?). What kind of dressing can I place on this? My thoughts are multiple small duoderms. My concern is possibly tearing the skin around the wounds. I will be placing a foley on my next visit (tomorrow) and will probably cover them with duoderm until I can figure out something else to help these heal. I am also going to educate the family to clean him AT LEAST every hour, if he has any feces thne clean him immediately. Any ideas as to what else I can use? All suggestions will be greatly appreciated! Thanks

[TVN2011]

What kind of pressure relieving devices are being used?

What is the nature of the wound beds?

These could be incontinence lesions?

Maybe some aquacel/aquacel ag under the duoderm may help. Or perhaps some mepitel with a secondary dressing, pending on the nature of the wound beds.

Also what is the patients nutrition like?

Hope this helps

[alphabetsoup]

I would not apply duoderm on open wounds that are around the orifice. Getting those dressings to stay in place will be next to impossible. In cases like this, if the wounds are due to incontinence, manage the cause. The patient needs to be frequently evaluated for incontinence and promptly cleaned. An appropriate barrier cream needs to be applied (I like Calmoseptine) every 8 hrs and with each episode of incontinence. Can the patient have some diaperless time to promote air flow to the skin? Would a toileting schedule help? Are there any indications that there is a superimposed candidiasis (red, satellite lesions) necessitating the use of an antifungal product? And lastly, is there any chance that these are shingles or herpes lesions?

[COUGAR101]

Schraggers ointment...........or paste....miracle cream....developed by schragger allentown pa (zinc oxide,nystatin,petroleum jelly,cold cream,hydrocortisone)

i need some advice! I have an 80 yr old chair-bound patient with what was reported to me as a stage 2 pressure ulcer. I arrived at the home and found the wound to be more of a severe excoriation due to probably sitting in feces for too long. There are multiple open areas under the scrotum, on the buttocks and around the orifice. Most are small, less than .25 inch in diameter, but are red, oozing serosanguanous (sp?). What kind of dressing can i place on this? My thoughts are multiple small duoderms. My concern is possibly tearing the skin around the wounds. I will be placing a foley on my next visit (tomorrow) and will probably cover them with duoderm until i can figure out something else to help these heal. I am also going to educate the family to clean him at least every hour, if he has any feces thne clean him immediately. Any ideas as to what else i can use? All suggestions will be greatly appreciated! Thanks

[COUGAR101]

Schraggers paste or ointment .....miracle cream...have used this ...love it....clears up like magic....had oozing sores myself.....friend recommended this....will never be without it....works wonders on my animals too...zinc oxide, nystatin,petolium jelly ,cold cream (or desitan).hydrocortisone

[mommy.19, MSN, RN, APRN]

Sounds like textbook IAD (incontinence associated dermatitis), which is quite often mistaken for a stage II decub. Unfortunately in many cases, these lesions can become complicated by pressure and are therefore dubbed 'decubs'. You've got the right idea with cleansing regularly and using barrier cream, but putting dressings on these is really an impossibility, and rectifying the cause will do more than dressings will at this point. Ensure that the patient has a functioning offloading surface such as a ROHO cushion or gel/alternating pressure pad on the bed/chair if possible. Offload offload offload! Did...I say offload? :) You've already received some great suggestions, so I'll leave it at that