Just Gross

Achoo!, LPN · Nov 9, 2005

I had to help with a decubitus ulcer in CNA training. They put some kind of cream on to help debride it and then rewrap. The poor woman was in so much pain. That is what gets me, I empathize with their pain so much it sometimes makes me woozy.

MIA-RN1, RN · Nov 10, 2005

I saw a stage 4 that had to be debrided, packed, etc on a person actively dying of cancer. It was her entire right buttock. THey sent her to the ED from the nursing home and when I questioned why someone in hospice would go to ED the nurse I was working with told me its because she should die from the cancer, not from something like this. It was unbelieveable how awful the wound was and the smell permeated everywhere.

Nascar nurse, ASN, RN · Nov 10, 2005

Do not assume that the wound started at the nursing home. Many times we get people ADMITTED IN with horrible wounds. We also send residents to the hospital with intact skin and they come back a week or so later with pressure wounds. Don't assume it's the nursing homes fault. If she did get this wound in the facility, what are the underlying factors; ie poor nutrition/hydration, non-complaince with turning programs, disease process such as DM or end stage process, impaired circulation (which is very often the cause of leg/foot wounds). BUT, unfortunately sometimes it really is the NH fault due to poor care. This is not how it is in all facilities and again don't assume they (nursing homes) are all the same. Also as an FYI, stage IV wounds "down to the bone" usually aren't painful as the nerve endings have been destroyed.

Sorry if this sounds defensive, I tried to reword a bit to keep that tone out of it. Nursing homes in general seem to get a very bad rap and it just ain't fair. It is not fair to judge all of us based on a few bad apples.

luvmy2angels · Nov 10, 2005

Do not assume that the wound started at the nursing home. Many times we get people ADMITTED IN with horrible wounds. We also send residents to the hospital with intact skin and they come back a week or so later with pressure wounds. Don't assume it's the nursing homes fault. If she did get this wound in the facility, what are the underlying factors; ie poor nutrition/hydration, non-complaince with turning programs, disease process such as DM or end stage process, impaired circulation (which is very often the cause of leg/foot wounds). BUT, unfortunately sometimes it really is the NH fault due to poor care. This is not how it is in all facilities and again don't assume they (nursing homes) are all the same. Also as an FYI, stage IV wounds "down to the bone" usually aren't painful as the nerve endings have been destroyed.
Sorry if this sounds defensive, I tried to reword a bit to keep that tone out of it. Nursing homes in general seem to get a very bad rap and it just ain't fair. It is not fair to judge all of us based on a few bad apples.

:yeahthat: I couldn't agree more!!! The few pressure ulcers we have at our nursing home came back from the hopsital like that. I have spent the last few weeks in an acute care setting at our hospital and the care that they are getting is aweful! It isn't anyone's fault in particular. They are just so under staffed and the nurses don't have the time to be turning all their patients every 2 hours! All LTCFs and hospitals need more nurses!!! This of course is just my :twocents: !!

LWildman · Nov 10, 2005

I understand, and I wouldn't have assumed that she came to the hospital from a nursing home except for the fact that they told me that she had. If anything-I would have thought it would have been from her being at the hospital I have clinicals at. ha. notice I'm not a fan.

ZASHAGALKA, RN · Nov 10, 2005

I was pulling an femoral artery sheath once (once it's out, you have to hold pressure for like 20 minutes or you get a shooting spray of blood.) Well if a patient vagals down - a common side effect of holding pressure on an artery, they can get nauseous.

So this little little sits bold right up in bed while I have 2 fists buried in her groin and procedes to vomit all over my arms.

I have vomit running down my arms, but I can't stop holding pressure.

She's like "I'm so sorry!"

What could I say, "It's ok, don't let it worry you."

but theres nothing like somebody else's vomit dribbling off you and being powerless to do anything about it. . .

(the thread was titled - just gross.)

~faith,

Timothy.

LPN1974, LPN · Nov 10, 2005

Do not assume that the wound started at the nursing home. Many times we get people ADMITTED IN with horrible wounds. We also send residents to the hospital with intact skin and they come back a week or so later with pressure wounds. Don't assume it's the nursing homes fault. If she did get this wound in the facility, what are the underlying factors; ie poor nutrition/hydration, non-complaince with turning programs, disease process such as DM or end stage process, impaired circulation (which is very often the cause of leg/foot wounds). BUT, unfortunately sometimes it really is the NH fault due to poor care. This is not how it is in all facilities and again don't assume they (nursing homes) are all the same. Also as an FYI, stage IV wounds "down to the bone" usually aren't painful as the nerve endings have been destroyed.
Sorry if this sounds defensive, I tried to reword a bit to keep that tone out of it. Nursing homes in general seem to get a very bad rap and it just ain't fair. It is not fair to judge all of us based on a few bad apples.

You are right. And I have also seen patients go to the hospital with skin intact and come back from the hospital with a decubitus ulcer.

It's a 2-way street and we must all work diligently to prevent them. They are horrible.

But skin can break down in a hospital bed just like a NH bed.

I'm not pointing fingers at hospitals either......we all know it can and does happen, in hospitals as well as nursing homes.

Daytonite, BSN, RN · Nov 10, 2005

it's been a long time since i've seen a stage iv decubitus. i've seen them over the coccyx, the greater trochanter area of the hips, and on the heels of the feet. just to be fair, i've also seen a couple of decubitus on the ears, but they had only gotten to a stage iii. i've also seen huge stage iv craters on the butts of paraplegics that required extensive surgical repair (skin flaps). over the years i've seen several paraplegics who were very belligerent and just absolutely refused to stay turned while in bed and insisted on being up in their wheelchairs for hours and hours on end. yes, it's a pretty sour kind of rotting smell that these kinds of wounds have. it usually permeates the room. we used to be able to get a room freshener from central supply that was like a large plug-in. it had a large solid air-wick deodorizer tube in it that fit into a little machine we sat on the floor, plugged in and blew the air freshener into the room continuously. it helps until you actually have to do a dressing change.

before some of you go jumping the gun and blaming the ltc for this ulcer, you need to understand that there are severe penalties for any nursing home that allows this to happen to one of their patients. all decubitus in the state of ohio have to be reported to the state and their progress monitored. i imagine this is probably done in a lot of other states as well. the don of a facility should know the specific regulations on this. anyway, the nursing home has to show that they are actively attempting to treat and heal the decubitus through a multi-discipline approach. that means dietary has to also be involved in the care of these wounds. there are situations where a patient's general state of health is so bad that their bodies are unable to heal these despite treatment and turning. because of this reporting requirement, we went over a newly admitted resident with a magnifying glass (i'm being metaphorical to emphasize the significance of this) looking for any skin breakdown or open wounds that someone forgot to tell us about. we occasionally got patients from their own homes who came in with the worst ulcers. some of these patients are immobile in their homes and for some reason or another end up in the hospital and then the nursing home, or go directly from home to the nursing home. it is unlikely, although not impossible, that a person was admitted to the acute hospital with no skin breakdown, but came out with a stage iv decubitus. most patients aren't in the acute hospital long enough for this serious a decubitus to happen. today, most of the acute hospitals get patients discharged and out as soon as possible due to the way the prospective payment system is set up. i'm sure there are instances of it happening, but i doubt it happens as frequently as you would think.

this is one very good reason why you should always do a thorough assessment of a patient, especially on admission. this is particularly true of all elderly, immobile or bed-bound patients. we should do skin checks on them--period. after awhile you become very tactful at making skin inspections and still maintaining a patients dignity.

by the way, the nip/tuck episode entitled "mama boone" which is about a morbidly obese lady who is stuck to the chair she has been sitting in for 3 years because her skin has grown in and fused with the chair is being re-broadcast on friday evening, november 18th. in the episode, the plastic surgeons work to separate the skin on her legs from the fabric of the chair in order to attempt to get her out of the chair. it is based on a true incident.

LPN1974, LPN · Nov 10, 2005

It is unlikely, although not impossible, that a person was admitted to the acute hospital with no skin breakdown, but came out with a Stage IV decubitus.

Just to verify, I didn't say they came back from the hospital with a stage IV.

I have seen them come back with stage I or II.

I should have said that in my post.

HappyJaxRN · Nov 11, 2005

I had my first "wow I'm going to be sick" moment yesterday at clinical.
*WARNING: GROSS!*
We were walking around looking for things to do because we were all bored. Well one of the nurses asked if we wanted to watch a dressing change and we said sure and she said "I don't mind wounds-but this one is pretty bad". We went in and she uncovered the wound and I about came unglued. It was a stage 4 down to the bone and oh man. It needed to be debrided really bad-I thought I was going to get sick because it looked like flesh hanging off a corpse or something. The smell was gross too-I had to go into the hall and the second time I had to just leave. How could nursing homes let their patients get like that?? Do you ever get use to that kind of thing, cause now I'm dreading wound care.

I don't know the situation at this nursing home. I have seen overflow patients come to my floor from nursing homes and their decubs are horrible. I had one guy the other night. Poor thing. He had a foley cath in for over several months. I believe you're suppose to replace them after like 3 or 4 days...something like that...at our hospital anyway. I don't know what happened, but his member was ulcerated. It looked as if someone may have stepped on the foley and snagged it causing the member to rip. So he had a significant ulcer as well as a tear. I felt so sorry for the man. His PICC line was horrible too. It was obvious that no one has been doing the dressing changes. It too was infected. So tragic.