I have a pt. with stage4 wound with undermining to hip. is on q-turn bed, unable to turn and reposition per self. Is malnourished, and very poor appetite. am currently using atb ointment saturated strip packing without much improvement to undermining. any suggestions????
Dec 14, '03
Dang but I wish we could post pictures at present because wound care is one area where it would be SOOOO good to actually post a pic and ask advice.
In the meantime could you give us a little more on the wound
Colour - is it infected? (yellow/green) or clean (red/granulating)
What are the edges like? pink or red and inflammed?
How much ooze is being produced?
Does it smell and if so does it smell badly?
What is the surrounding skin tissue like?
What else have you tried so far and with what success???
Sorry for the third degree but the more information we have the better the advice we can give.
Ps Kudos for the holistic assessment so many people concentrate on the wound and forget the other impacting factors.
Dec 14, '03
But I do have a BS/MS in nutrition. What is this client eating? Please let me know if he is on any supplements like ensure or boost high protein. Makes a world of difference. How about Vitamin C/E? Daily Multi is needed.
Need to know more about the wound to guide you on that? CAn you respond to the other posts questions?
Dec 15, '03
I appreciate the third degree actually, am new to wound care, have been a charge nurse for 10+ yrs. on to the wound... entrance of wound is approx 3cmx2cm, undermining measured on clock formation ranges 1.5cm - 4cm..(no undermining from 4 oclock to 9 oclock). wound bed is red with pink granulation tissue to the edges. scant amt of lt yellow/green drainage without foul odor. surrounding tissue is pink scar tissue. Pt. has been treated since june2003 for decubs on every bony prominence and this is the last one to heal. have previously used sea-sorb packing. is being flushed out prior to packing with saline. Is actually a very clean wound, just can't get this last decub to respond to anything. Pt is on multiple vitamin supplements and 2cal oral supplement and takes this fair, maybe 60cc qid.
Dec 15, '03
I am more ICU than wound care but I have an abiding interest in the field so here are a couple of suggestions and I would not be surprised if some of our members had more and better ideas. Unfortunately, such is the nature of BB's - you might have to wait a couple of days to get the right person with the right answer.
Okay - I am assuming that when you talk of saline packs you are referring to saline soaked gauze. There are a couple of things against using saline soaked gauze the first is that cotton can and does set up an inflammatory response in the bed of the wound and the second is that people have a tendency to pack the wound too tightly delaying healing. I would be tempted to go with allevyn.
Dec 15, '03
Oh! and post 5 on this thread http://allnurses.com/t40241-10-1.html
I have listed some Australian websites for wound care - hope they help.
Dec 16, '03
Would this wound be a candidate for a wound vac? Just curious as that is what I have right now and it is doing miracles. I realize this may be different due too age, nutrition and overall health. Just wondering?
Dec 19, '03
Since wound bed is clean, I'd stop the antibotic and use hydrogel on ribbon gauze in undermind area--remember to place loosely--too much packing adds presure to wound and delays closing.
Not taking very much calorie wise---how is HGB/HCT, any anemia?? Might need to add Iron to help stimulate blood cell formation. Does Multivit include Zinic---our wound docs will add Zinci supplement.
One doc also adds l-arginine supplement; Resource now has a drink with this additive--helped my dad heal a necrotic toe wound complication after triple A surgery.
L-arginine is a non-essential amino acid which is abundant in protamines and histones, these are proteins associated with nucleic acids.
L-arginine is used by the immune system to help regulate the activity of the thymus gland, which is responsible for manufacturing T lymphocytes. (These are the T-cells, which assist the immune system and body defences).
Update us when you can.
Last edit by NRSKarenRN on Dec 19, '03
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