not healing

[2bnurse15]

A pt's stage 3 ulcer has not improved for the last six months despite dressing routines.can somone suggest any reasons for this failure to progress???

[daveintexas8]

I would think it's a problem with tissue perfusion, i.e. not getting adequate O2 or nutrients to the wound (which probably caused it in the first place). Is the site getting adequate circulation?

Also, I would wonder if pt. is getting adequate nutrition, i.e. protein, vitamins, etc.

Overall poor health could prevent healing. A chronic condition such as diabetes or PVD can make it very difficult to manage ulcers. That's why there are a number of amputations (with diabetes, anyway).

[2bnurse15]

nutrition is adequate and she doesn't have diabeties or PVD. overall she is in her 60's, she had a cerebral aneurysm resulting in huge haemorrhage and now dependent on right side and is immobile.

[daveintexas8]

Where is the ulcer?

[2bnurse15]

Stage 3-4 pressure ulcer on her heal

[morte, LPN, LVN]

if she is being adequately perfused, i would be thinking of some sort of low grade infection.....has silvadene been tried?....presuming this is her Right heel, have doppler or other studies been done to ascertain adequate perfussion? perhaps maggot therapy?

[Purple_Scrubs, BSN, RN]

Has it been cultured lately?

[Daytonite, BSN, RN]

Infection, edema, poor circulation, pressure applied to the healing area. High blood sugars could still be the problem.

I had a stasis ulcer for a year on my mid-calf that wouldn't heal and my blood sugars were running in the 90s and 100s. When they finally decided to put me on Glucophage the ulcer began healing immediately.