need wound advice

  1. I have a patient that is a monoplegic and had fx his femur one month ago. Dr put on compression bandage (left it on for one month), pt took it off the other day and had alot of swelling in his left foot, open area on top of foot, and entire heel is a stage II. Alot of clear serous fluid from wound. Patient is already on a diuretic. I put abd pads and covered it with kerlex and told pt to elevate foot etc. What would be good to put on the large wound on the heel?? This is patients bad leg, no feeling or movement in leg. Thanks for any suggestions.
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    About melissahunter2

    Joined: Sep '06; Posts: 31; Likes: 2

    10 Comments

  3. by   caliotter3
    I would call the doctor and ask for an order. Perhaps he needs to go in so the doctor can see it.
  4. by   melissahunter2
    He did. Doc gave him antibiotics and referral to home health to eval and treat.
  5. by   caliotter3
    I've never done any treatments without a doctor's order. Too risky. Does your agency have a wound care specialist who can recommend a treatment for the doctor to write an order for?
  6. by   berube
    if the base of the wound is clean -pink with drainage, i would use an alginate and dry dsg, change it daily for a few days to see the response and then you can decrease the freq., if the base has yellow slough you could use mesalt to help debride it and it will absorb the drainage, same thing, change it daily for a few days then decrease the frequency,,,once the wound bed is drying switch to a hydrogel .... you should have good results from either of these,,,you can also use a silver base alginate/gel .
    good luck
  7. by   melissahunter2
    Thanks Berube!!Callicotter--you always have to get an order for any kind of wound care. Most docs just want you to suggest to them what to use. I feel like I need to be wound care certified to work in home health. We do have a wound nurse in another office that I get suggestions from. But it doesnt hurt to get other opinions. Thanks for the help!
  8. by   caliotter3
    Your posts didn't indicate that you intended to get a signed order. None of my employers allow nurses to treat without an order. I will write an order for the doctor to sign, but I won't implement it without a signature. "Evaluate and treat" is too vague and would require clarification before implementation.
  9. by   berube
    i sure understand the concerns of doing something without the signed order, but we get alot of "eval and treat" orders from MD's that do not know what to use and they depend on us to figure it out,,,when i get one of those patients, i call the md with my recommendations and write the verbal order, seems it is the way of HH, if we waited for a signed order, the patient would be either healed or in more of a mess! just my opinion
  10. by   melissahunter2
    Kudos Berube!!Most of the docs in our area are this way. The only thing they usually order is the antibiotic!
  11. by   annaedRN
    If there is a alot of drainage you could consider a foam dressing...the Allevyn heel dressing is fantastic. I agree that a calcium alginate with silver may work well too. If infection is present, possibly using the AMD Kerlix to wrap with. We get alot of eval and treat too - we see the wound and call the doc...they usually admit we often know more about how the treat the wounds than they do, and they want us to "do our thing". If it is really complex, we refer them to the local wound clinics.
  12. by   HmarieD
    Ha! I just made a comment on another thread about how the docs usually told me to do whatever I thought appropriate because I knew more about wound care than they did! And berube is right (I also just said that on another thread) about waiting for a signed order. The MD has 30 days to sign the order. You can't wait until you get it back. I would report to the MD what you are planning to do, get the V.O. ok, and proceed.

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