diabetic skin conditions

[bon149]

I need some advice on treating a skin problem, my patient has been undergoing dialysis for about 3 years 3 times a week and has recently developed a problem with access to her port, she has been unable to receive full treatment for about 2 weeks due to clotting and bp falling. She has received 2 new ports in this time. Now she has developed an area on the Right quadrent of her buttock that will not heal. It resembles an excoriation with several black patches measuring 1-2 cm in diameter. the surrounding tissue is pink but not warm. However it is very painful. She is on an antibiotic at this time for cellulitis of an extremity. I am at a loss as how to approach this. The pain seems to exceed what I would normally expect of this area in relation to the appearance. Any ideas?

Thanks in advance.

[grannynurse FNP student]

I need some advice on treating a skin problem, my patient has been undergoing dialysis for about 3 years 3 times a week and has recently developed a problem with access to her port, she has been unable to receive full treatment for about 2 weeks due to clotting and bp falling. She has received 2 new ports in this time. Now she has developed an area on the Right quadrent of her buttock that will not heal. It resembles an excoriation with several black patches measuring 1-2 cm in diameter. the surrounding tissue is pink but not warm. However it is very painful. She is on an antibiotic at this time for cellulitis of an extremity. I am at a loss as how to approach this. The pain seems to exceed what I would normally expect of this area in relation to the appearance. Any ideas?

Thanks in advance.

I am guessing based on a recent experience of my own but the black spot could be a spoy of necrotic tisse, I had a small area, on my calf, that grew in size. My PCP treated me with some heavy duty antibiotis, which helped the surrounding cellulitis but did nothing for the black area. Yesterday I was seen by an infectious disease guy, he diagnosed it as necrotic tissue and debrided the entire area. I have to change my dressings, wet to wet, twice a day. My PCP is no dumbie but even he missed diagnosed it for three weeks. And my pain level was high for the source of the injury. I would suggest an infectious disease consult.

Grannynurse:balloons: