Hello all, I was hoping a more seasoned nurse might be able to help!
I have a hospice patient with prostate cancer and decreased short-term memory who has developed a stage 2 pressure ulcer on his coccyx. He gets a local morphine/ketamine/bupivicaine cream on it twice a day, and Q2H PRN. At this point, he is quite dyspneic when he tries to ambulate, so he is becoming increasingly bed bound. We have tried bolstering him to lay on his side to offload, but he keeps pushing himself onto his back. We have also tried putting a duoderm on the non-involved skin and then attaching the mepilex to the duoderm, so that we are not removing the dressing directly from the skin. Additionally, he is getting breakthrough cream quite often throughout the day, which also makes the dressings difficult (we have been adhering the dressings only on three sides and then applying the cream under the fourth). Unfortunately, these dressings seem to sheer and the wound appears to be getting worse.
Does anyone have any ideas for me? Aside from the short term memory issues and increased fatigue, this patient is actually quite stable, and I hate that this wound is the biggest issue for him right now.
the purpose of a foam or hydrocolloid dressing (duoderm) is to maintain a moist environment for healing. by adding cream you are macerating the wound which will make the stage 2 larger. I suggest doing one or the other. apply the cream and not a foam or apply the foam and not the cream. since this is a hospice pt wound healing is possible but what is the goal. the foam itself will help with pain by covering the area. stage 2 pr ulcers can be painful since they are only partial thickness. I would not apply a cream under a foam.
I agree, it sounds like it is staying too wet. Is he on a regular mattress? An air type matees may help relieve pressure if he won't remain off of the back. Good luck!