Anyone know anything about wound care please help

Erin RN · Nov 30, 2003

Angelbear..

If it needs to be changed daily, it should be. When I did home health I had 2 different pts both were nurses. I changed their dressings twice daily until the wound started to heal then once a day then I taught the hubbies how to do it. I would ask your gyn if she would make a referral out for home health so you don't have to travel..if you are bleeding and oozing that badly I would think you would / should be considered to be homebound?? 72 hours sound slike a long time esp if you are already saturated..what a good breeding ground for little bugs!! Erin

Noney · Nov 30, 2003

Angelbear

I agree that you can't wait until monday to have this dressing changed. I've seen a few infected surgical wounds, and believe me when I say you do npt want to wait that long. A trip to ER would be better then an extensive hospital stay later on. It's early Sunday morning now, but I think you atlest need it changed once on Sunday. If nothing else sent your husband to the drug store for supplies and change it yourself in front of a mirror, If you do change it yourself wash your hands good and use good technique.

I know you were worried about having the surgery in the first place. How are you handling your son though all this? ((((((HUGS))))))))))))

Noney

angelbear · Nov 30, 2003

Thanks for the responses. And yes noney I was concerned and it seems rightly so. Absolutely nothing has gone right from the beginning. So far so good with my son. My dad had him the first week and he only had one seizure while with my dad. He has had one here at home but did not vomit and was in a good position. Thanks for asking.

Home Health Columnist / Guide · Nov 30, 2003

PSSSSSSSSSSTTTTTTTTTTTT....

Anyone ever hear about homecare????

I receive referals for homecare for your scenerio several times a week in my agency. This is coovered by all insurances I'm aware of! Yes you are considered homebound, but only medicare and medicare HMO's has the homebound requirement. We even provide bid wd care, however some agencies don't have the staffing for that.

1. Call the hospital you had your surgery at and ask the operator for the number for homecare agency affilitated with them. If they

have no homecare, ask to leave a message with discharge planning /social service department as having post op complications and need a visiting nurse. Expect a callback by tomorrow.

2. Get out your phone book, look in the yellow pages under home health services for a agency in your area and call em NOW!

Any reputable agency should have 24/7 oncall intake staff. Explain your problem, have gyn's name and phone number, insurance information available to facilitate them getting orders for homecare. Tell em you need bid care. You should expect a return call within 30 minutes of calling the agency.

They should be able to have someone come out by tomorrow at the latest.

3. If having problems getting homecare arranged, PM me and I'll asssist you.

My homecare agency has set up an ER to Home program just for clients like you that don't need hospitalization but followup care and instruction.

Will checkback here latter today.

sphinx, BSN, RN · Nov 30, 2003

I too am surprised that homecare hadn't been brought up before now. I work in homecare, and we get cases like yours *all the time*. I know that not every agency is the same, but we have homecare coordinators in every local hospital that can generate referrals, even same day and from the ER! And it is much cheaper than frequent trips to the ER for dressing changes! (Where I am, there is no copay at all for home visits, but it can depend on your insurance). We also get referrals from MD offices. Your MD should be able to do this, I would think. We usually do the dressings BID and teach the primary caregiver to do evening changes once the wound has healed up some. Of course, not every agency is the same, but I bet that it is done very similarly everywhere else....And I do think 72 hrs is an awfully long time to wait........seems like an infection waiting to happen. Keep us posted!

jnette, ASN, EMT-I · Nov 30, 2003

You just got some wonderful advice and assistance there, Angelbear...please look into it, and above all, please do not wait to have the dressing changed.

Sooooooooo sorry you're having to go through all this, as if the surgery itself wasn't enough. I do so hate this for you. Please take care of yourself, and keep us posted... you know we're here for you in any way we can help !!!

Big warm (((hugs))) to you.

kids · Nov 30, 2003

Personally (meaning if it were me) with a gaping would, I would go back to the ER today and DEMAND a surgical consult. They (the ER) can also get home care set up, the social worker can help with setting it up.

ktwlpn, LPN · Dec 1, 2003

Originally posted by angelbear
Hi, I had a TAH Mon Nov 17 staples removed on the following Mon. Was running a low grade temp(99.8) at the office and c/o of continued extensive pain. She just said to wash incision daily with half NS and half peroxide. She opted not to put me on another ATB as the one i had in the hosp gave me nasty case of thrush. She did give me nystatin swish and swallow and changed pain med from percocet 7.5/500 2 every 4 hrs to mepergan 50/25 Q 6hr to switch back and forth with the percocet. On Wed I began to bleed rather badly from the incision but the incision was not open it was just seeping rather quickly. So off we go to our local ER day before TG. ER MD did ct scan and phoned my gyn in the city to tell her I had a rather large hematoma. She told them that noone from her office would see me before mon but to either open it himself or send me to the city ER. He opted to open it himself as he felt I was bleeding to badly and in to much pain to make the trip. Ok so that done the ER md that did the draining and packing told me to have it redone daily. When we got home I called my gyn office myself they said the same thing that I could come to the city ER for dressing change but they would not see me til mon. So hubby tried to get me into urgent care(cheaper ya know) They will not touch it. So back to ER TG night and again on Fri night. Finally on Friday night we asked that ER md to show my hubby how to do it or if one of my nurse friends could do it. He said that he did not think we understood just how bad this was so he showed my hubby now my hubby wont do it at all and doesnt want my friends to either. I cant see it but he says it is horrible and deep. Anyway this ER md said I did not need to have it changed until Mon which will be 72 hrs. That was great news they bandaged it with packing 3 4x4's inside 6 4x4's ontop and 2 ABD pads over that and the whole thing is covered with clear plastic tape. Problem is we can see that it is completely saturated again though the plastic taping is keeping it from leaking so far. My question is, Is this normal for it to drain that much and to wait that long for dressing change. The gyn said dressing change needed done BID but of course they cant do it and I would have to go through ER with all those charges each time. I am simply at a loss. The first ER md did put me on ATB and the pain is controlled to 4or5 with the mepergan but I am just scared to death this thing is going to get worse. And I am totally peeved at my gyno. Any thoughts or advise welcome.

Oh girly girl! Hugs to you-----I know you must be freaked out....I can't believe your GYN did not order you home health nurses........I would find a new one after this is resolved.I think they just shined you on due to the holiday....buttheads..

Home Health Columnist / Guide · Dec 1, 2003

Angelbear....sending you a hug. Hope you post soon and let us know what's happening.

I'd also find a different GYN. Inform your insurance company too of the "after care" this doc DIDN'T provide.

Jay-Jay, RN · Dec 1, 2003

:eek:

HELLOOOOO????!!!

PAGING THE HOMECARE TEAM!!??

PAGING YOUR DOCTOR'S BRAIN....which MUST have been AWOL to not think of ordering home nursing for you!

UNBELIEVABLE!!!

{{{{{{{HUGS}}}}}}} to you, Angelbear. Hope you're feeling better soon!

And hematomas DO tend to produce a lot of discharge, so I'm not suprised the dressing is soaked. It's just the body trying to break down the dead tissue and clots. Got to keep a careful eye out for infection, though. Watch for a change in the colour or odour of the discharge.

Don't worry about the size of the wound, and the complexity of the dressing. I've seen HUGE abdominal wounds being treated in the community. Worst I've seen was at least 2" deep x 10" long x 3.5 " high. I forget what the original surgery was for, but it WAS the result of an infected abdominal incision.

angelbear · Dec 1, 2003

Hi, Just wanted to let all you caring souls know that one of my nurse friends from work came by tonight and changed the dressing with my husbands help. She did a great job maintaining a sterile field and she did not inflict nearly the pain that the ER docs do. I have an appt with my gyno tomorrow and I intend to give her a piece of my mind. I am glad I have the appt as I am having a temp of 99.2 and feeling like total crap. Thanks for your advice and for caring.