for the heels - isn't sheepskin used anymore?

[GingerSue]

how to protect a patient's heels on those feet that lie for hours on the bed and now have discoloured areas - diabetic feet, recent cellulitis

what can be used to prevent heel decubitus ulcers? BEFORE the heels turn purple with those blistered-looking areas that become deep decubitus ulcers.

I remember the use of sheepskin either on the bed, or the sheepskin heel protectors - is there a reason why these might not be used currently?

And for elbows that are now getting purple and skin is breaking down - what helps protect these area?

[vampiregirl, BSN, RN]

We use a thick quilted cotton "bootie" for heal protectors. They are very thick on the back (where the heel rests) and under the bottom of the foot. A padded velcro strap goes across the top of the foot to keep them in place. We still use "sheepskin" (I think it may be synthetic) if needed to pad between a resident's lower legs.

[GingerSue]

We use a gel lift heel boot. I don't know the brand but they work well. Why is this person not OOB to w/c?

thanks for the idea about the gel boot.

why not OOB? - that's what I would like to know too - I figure that maybe it's because the care staff aren't prepared to do the transfer? It's been the physiotherapy people who have been doing this all along and they are off for the holidays. I don't know why they don't use a mechanical lift, it's easy!! (for today - as the staff person coming around explained - she's the only one working today on this side of the unit because the staff all phoned in sick)

[P_RN, ADN, RN]

And this is a hospital? What's the nurse staffing like? Can the patient pivot to a chair? Can you use a lift? Can you at least reposition him? Having a lot of call ins stinks, but it's not the patient's fault.

[GingerSue]

I agree - it is not the patient's fault

(my thoughts are that when a person is in bed - that person should be repositioned every two hours)

[leslie :-D]

(my thoughts are that when a person is in bed - that person should be repositioned every two hours)

thank you.

old-fashioned common sense.

decubs are readily preventable with a little vigilance and planning.

it baffles me to see the trauma inflicted on pts because the q2h protocol wasn't followed.

it's simple, takes 2 minutes and a highly effective intervention.

leslie

[GingerSue]

prevent decubitus ulcers

there's no need for them to occur

if this individual goes into long-term facilitiy, then the patient is responsible for the cost of supplies - therefore these should be prevented while the person is in hospital (not to mention the person's health and well-being re: intact skin). Why should the person have to pay for the supplies for dressings if skin breakdown could have been prevented by staff - as this is the responsibility of staff to take measures?

[leslie :-D]

when my mil was a pt in the hospital, she developed a stage III sacral ulcer that eventually ended up requiring myoplastic surgery.

when i had visited her, i had told the nurses that she was complaining of (sacral) pain and needed to know if she was being repositioned?

i was assured that her skin was not only intact, but she was on a regimented schedule.

when i saw the opening when she came home, it was approx 10 cm dia x 5 cm deep; perimarginal inflammation; lots of purulent and serosang drainage as well as lg amts of yellow sloughy tissue.

i also noted 2 areas of tunneling.

my husband's family does not like to make waves; plus they have all been loyal patrons of this hospital including all of their outpt services.

well, this dil called up FURIOUS, finally got the DON on the phone with my findings.

i ended the conversation with the legal implications of such blatant neglect.

not only did this hospital arrange for nsg care, the hospital paid for all medical expenses and have given her star treatment ea time she's a patient there (remarkable cardiac hx).

she is automatically placed on an air flotation mattress and is diligently inspected, repositioned and some of the bigwigs, ask how i'm doing....:)

my husband finally agrees with my 'intervention' but it took him a long time to get there.

other family members clearly let me know i crossed the line and i clearly let them know, i'd do it again.

decubs are one of my pet peeves for most are so avoidable yet they can wreak major havoc, esp the III's and IV's.

so unless we're ensuring proper repositioning, proper nutrition, adequate circulation and mobility, then these assistive devices will do little to prevent ulcers.

we need to look at the big picture and our parts in it.

leslie

[bethin]

We rarely use sheepskin but I'm not sure why.

We use eggcrate foam boots. But they must be taken off at least every eight hours and legs rubbed down. The problem with these boots is that they leave marks on pt's skin. I prefer to prop lower legs on pillows so the feet are not touching anything. I also massage the area (if it isn't open) to get blood flowing.

[bethin]

thank you.

old-fashioned common sense.

decubs are readily preventable with a little vigilance and planning.

it baffles me to see the trauma inflicted on pts because the q2h protocol wasn't followed.

it's simple, takes 2 minutes and a highly effective intervention.

leslie

I agree completely with you leslie. It only takes a few minutes and it can really help the pt.

I read an article a few years ago in a nsg journal about research that had been done on decubs. It said that most decubs start in surgery. Makes sense, they don't turn you during surgery and if a pt is having a long surgery such as open heart surgery, I can see how that can happen.

But alot of it is pure laziness.

[vampiregirl, BSN, RN]

We rarely use sheepskin but I'm not sure why.

We use eggcrate foam boots. But they must be taken off at least every eight hours and legs rubbed down. The problem with these boots is that they leave marks on pt's skin. I prefer to prop lower legs on pillows so the feet are not touching anything. I also massage the area (if it isn't open) to get blood flowing.

Curious nursing student with a question... I was taught as a CNA to never rub a resident's legs. I think my CNA text discussed the possibility of dislodging clots. I haven't read anything different in my nursing texts so far, but I can see the rationale of increasing blood flow to an area. Are there specific circumstances when massage is used on legs, and when it is not be used? Or is it used in specific circumstances, such as eggcrate foam boots? Thanks!

[bethin]

Curious nursing student with a question... I was taught as a CNA to never rub a resident's legs. I think my CNA text discussed the possibility of dislodging clots. I haven't read anything different in my nursing texts so far, but I can see the rationale of increasing blood flow to an area. Are there specific circumstances when massage is used on legs, and when it is not be used? Or is it used in specific circumstances, such as eggcrate foam boots? Thanks!

I would never rub a pt's leg who was diagnosed with any type of clotting disorder. Yikes, I'm careful when I get a BP - I'm so scared I'll dislodge the clot. On admission where I work every pt is screened for clotting disorders and the nurse will let me know if there is a problem. Also, before I do pt care I review their history. I don't know if this screening is JCAHO or not. I apply lotion to the legs before reapplying TED's as you have to watch for skin breakdown and when I do ROM.

I should clarify: when I say rub I'm not giving them a deep tissue massage. The pressure is more like what you would do if you were applying lotion to your own extremities. I do apply more pressure when doing back rubs.

[GingerSue]

i was assured that her skin was not only intact, but she was on a regimented schedule.

when i saw the opening when she came home, it was approx 10 cm dia x 5 cm deep; perimarginal inflammation; lots of purulent and serosang drainage as well as lg amts of yellow sloughy tissue.

i also noted 2 areas of tunneling.

my husband's family does not like to make waves; plus they have all been loyal patrons of this hospital including all of their outpt services.

well, this dil called up furious, finally got the don on the phone with my findings.

i ended the conversation with the legal implications of such blatant neglect.

i'd do it again.

decubs are one of my pet peeves for most are so avoidable yet they can wreak major havoc, esp the iii's and iv's.

so unless we're ensuring proper repositioning, proper nutrition, adequate circulation and mobility, then these assistive devices will do little to prevent ulcers.

we need to look at the big picture and our parts in it.

leslie

i admire your determination and abiltity to advocate for the patient.

what you describe indicates the needs of the patient re:prevention of decubitus ulcers.

it really only takes a few minutes to reposition, to check,