Need help please ..........
Pt had skin graft to L hip >40 y ago. r/t deep, non-healing abscess. Area healed nicely s/p graft originally. Left area measuring approx 12 x 9 x 2cm scar tissue/graft site. Never had any issues till now. Appears skin has separated (wound bed/wound edge) in an area and measures approx 1.6 x 0.4 (appears to be almost tunneling depth/sinus track?) but couldn't measure bc so painful to pt). The wound edge thats involved also has induration extending approx 3cm each way along wound border (to left and to right). However, pt reports area has always been "hard to touch" Exudate is purulent/foul smelling and moderate in amt. Wound bed 100% yellow slough (that I could visualize) . On day 5/7 of levaquin for URI. Diabetic. Complains of severe pain to area, unable to lie or sit with pressure to area. Ambulatory, continent.
Its difficult for me to really describe. Imagine a 2-3cm crater...100% healed...then someone takes a scapel and basically cuts a linear area at where base of wound meets edge (bottom of wound). Kind of like undermining. ..but not really....
What trmt would be appropriate? I put silver alginate rope along wound edge separation, and used mepitel bordered foam drsg. And of course skin prep periwound bc i love skin prep. And, how would I categorize this wound? I dont want to use "old skin graft site"....
Thanks in advance for any and all suggestions. .....and.....I guess I should add....this is a HOSPICE patient. ...palliative care...though this is an ES Cardiac pt, so wound not r/t terminal dx....but our wound formulary is very limited
Wow. I would love to know why you feel my choice of dressing would be inappropriate, or "curative". Im trying to cure infection. ..absolutely. we still use abt in hospice...and as I said this wound is NOT RELATED TO HER TERMINAL DX. She needs an abt to help reduce pain.
I used silver alginate for antimicrobial aspect....and bc of amt of exudate. I used foam in hopes of sparing pt frequent dressing changes (along with alginate) . The supplies I used were also my own personal wound supplies, as our formulary is very limited. We would only provide ca alginate and guaze. I gave her enough to do several weeks worth of the silver. I also asked her dr for an antibiotic (and provided description of wound, s/s of infection). He wouldn't order an abt bc pt currently taking levaquin. I also obtained an order for pain medication. so, please ....tell me why you feel what I did was not appropriate? Yes this is a hospice pt....who is still rather functional.
I think this would be a different scenario if the pt was actively dying....then I likely would cover area with a basic dressing.
Last edit by NC29mom on Jul 28, '13