gangrene of the scrotum

[nola1202]

Hi, tried posting this on the wound care forum and got no response. I guess they think I'm a nursing student.

or a total idiot! Anyway here's my problem 2 actually.

1 new admit with gangrene to the scrotum, I haven't seen him yet to assess, but I assume it's dry gangrene and his condition makes it a non-surgical option or he just wants comfort care. I'm hoping that it's been a surgical intervention or involves just the top layer of skin, but I am scared. My last pt with gangrene to the great and 2nd toe was a Hospice pt, we just painted it with genitian Violet. I know others use betadine. Any other products used for this type of problem? I read the thread on wound forum regarding dressings for the scrotum so I have a clue if I need a dressing. Anyway. any thoughts, experiences would be helpful.

the second is a pt who has developed a punched out "hole" on the skin of his member from repeated

pulling at and pulling out of his foley. Obvious answer pull the foley, not an option.

MD wants it in, so does family???? We have been applying a small dressing that has a

gel like quality on the dressing side, per wound care suggestion. Keeping it on is a challenge,

I'm wondering about applying hydragel with cath care and just keeping it open or bactroban.

any simular experiences? Any advice would be helpful thanks.

[brighella]

I can't say I have anything to suggest, but title was certainly eye catching! Hope you get the info you need!

[MissIt]

Do you have a wound care nurse? If so, have him or her come out and take a look. Ours is wonderful and if there is ever a time when we don't know what to do, she's happy to consult.

[leslie :-D]

yep, i've seen some nasty, nasty cases of fournier gangrene...

but these were advanced cases...

in one, the gangrene had spread to the entire perineal region.

for comfort care, it obviously wouldn't be surgical intervention...but broad spectrum abx treatment could be indicated.

obviously your pt has some unresolved comorbids, which ideally, those would have to be treated first...and likely, can/will not be.

what's his admitting dx?

as for the holey member, why the hell does the dr want cath continued???

why, why, why??? (and why does the family? what is their rationale?)

has anyone tried haldol or other psych agents?

leslie

[nola1202]

Hee hee a Holy member! lmao!

[curiousauntie]

When I was working in LTC, I had a patient with a "holy member". He had a neurogenic bladder, and refused a suprapubic cath. He had used foleys for years and the underside of his member had eroded away. The eroded area had healed edges, kind of like a stoma heals, so all we did was wrap his member with Kling BID and prn if soiled. The area slowly got bigger, and then he developed a split in the underside of the head of his member. Poor guy kept a good sense of humor about it though. Said that if it kept up, he would have 2 memberes, and wouldn't he be lucky! (ps. thank God that the problem was not painful for him, although we never did understand how having your member slowly split into two wasn't painful.)

[Hospice Nurse LPN, BSN, RN]

as for the holey member, why the hell does the dr want cath continued???

why, why, why??? (and why does the family? what is their rationale?)

has anyone tried haldol or other psych agents?

Haldol or other psych agents for the doc and family or the pt?

[Ginapixi, BSN, RN]

Haldol or other psych agents for the doc and family or the pt?

i do assume you were trying to be funny and oh yes: some times i so wish we could medicate the family! unreasonable requests and expectations! not open to rational explanations! change their mind 5 times in one hour..... docs who never lay an eye on their pts any more but insist medication is not necessary or warranted.....

my assumption is the family wants the cath so they do not have to change the pt multiple times, nothing new;

not versed at all any more in wound care, not sure what to do about the gangrene; back when i was a new nurse we had a pt with vulvar ca and they had surgically removed all the "bad tissue, but the wound remained open; we treated it with raw honey and it started healing quite nicely; no clue if it would work on gangrene

[leslie :-D]

Haldol or other psych agents for the doc and family or the pt?

i have to admit, i messed up with that post.

for some unknown reason, i was visualizing the pt w/a lot of agitation.

when i reread your post, i realized i lost my mind...again.

sorry about that, hospice.

leslie

[leslie :-D]

not versed at all any more in wound care, not sure what to do about the gangrene; back when i was a new nurse we had a pt with vulvar ca and they had surgically removed all the "bad tissue, but the wound remained open; we treated it with raw honey and it started healing quite nicely; no clue if it would work on gangrene

i am hearing a climbing number of anecdotal stories, about the healing powers of honey.

i'm going to have to read about that more...it fascinates me.

leslie

[Hospice Nurse LPN, BSN, RN]

i have to admit, i messed up with that post.

for some unknown reason, i was visualizing the pt w/a lot of agitation.

when i reread your post, i realized i lost my mind...again.

sorry about that, hospice.

leslie

LOL! I was thinking about a few family members who could use a good dose of haldol or even some diazepam.

[snuggler]

I have a pt who is NOT a hospice pt, but has experienced a domino-like cascade of problems in the past month. The most recent was a four day period where he was obtunded and only responsive to pain, but all of his tests (xrays, ct, eeg, etc) were normal or "no change from previous" (when he was up and talking). Last week we were cleaning him up and I noticed that the tip of his member was black. Told the Dr who got a consult - it was diagnosed as dry gangrene. They aren't doing ANYTHING about it. Can that be right?? It's gangrene for heaven's sake!