coccyx wound question...please help!

[mc3, ASN, RN]

I'm a hospice nurse and have a question about my pt. She is very cachetic - basically has no body fat left at all on her coccyx and buttocks. Just found 2 very small ~1cm stage 2 ulcers. Quarter-size reddish-brown drainage. However, the odor was very foul - not body odor, but wound odor - you know what I mean. I feel like the whole area could "cave in" at any time. Is it possible the odor is from an infection underneath the skin that I can't see, perhaps from tunneling? Skin is beefy red in color, but is still blanching. Our MD gave me an order for an ABT solution c wet-dry dsg changes qd x 5 days and bed rest c repositioning q2hrs for the next 4 days (at my request- the facility refuses to let this lady rest in bed...on her nice specialty mattress... Please advise if above is a possibility. I've asked around, but nobody really knows for sure..

Thanks,

mc3

[leslie :-D]

how much drainage is there?

yes, it sounds as if there is something brewing underneath.

if the skin is that friable, then the w-d will likely debride the wound bed and you'll get to peek at what lurks below.

it won't heal until you treat the source of the infection so somehow, you have to see the full picture of what's actually occurring.

leslie

[SsgKen]

I concur with Leslie. I would ask Dr. to request a bacteria culture. Pt has an infection of some kind. Wounds that are otherwise clean should not smell.

[mommy.19, MSN, RN, APRN]

Generally with drainage, they are *likely* stage III's (not that I've seen these wounds). Is there necrotic tissue? If not, then wet-dry is only going to damage the "good granulation" tissue you are describing. Topical ABT's are not considered advanced wound care, which is often the "Ego button" I will use to persuade the physician to take my recommendation for dressings :) Also, the above posters are smart to recommend a wound culture (not a drainage culture, as this will just tell you what is sitting on the patient's skin, not what is causing pathogenic tissue changes). Do you all carry anything like alginates with silver? If the wound has moderate drainage that would be appropriate. Wet to dry's are so archaic, we've advanced so far in wound care there is no reason that a physician can't spend 10 minutes in a good wound care product guide (they even have "guides for dummies" with color coded choices like yellow-enzymatic/autolytic debrider, pink-hydrocolloid, red-absorbent alginate or collagen). GL!