I need suggestions for my sons dressings

[sharann, BSN, RN]

I feel totally helpless as a nurse mom. My son has horrible acne on his chest which has been treated with accutane and antibiotics which now may have a strep or staph skin infection with open skin from scabs that opened. A real severe serious case. The doctors never saw such a bad case. His whole upper chest is a weeping wound with scabs interspersed. We are now using dressings of Telfa and Silvadene cream but I cant get them to stay on! The chest cannot be "wrapped". He is being treated as if he had a burn. So how do I deal with these crazy dressings. I flunked dressings in nursing school. Give me an airway problem, cardiac drip, no prob. But this. I want to cry every time I look at him(I do in my bathroom when Im alone).Thanks.

[BittyBabyGrower, MSN, RN]

Why can't they be wrapped? I had a similar case on the peds floor and we used guaze wrap or a stockinette body slip. Maybe someone else has a good idea....maybe a burns nurse. Sorry about your son...I would want to weep too!!!

[meownsmile, BSN, RN]

I agree, there shouldnt be any reason they cant be covered with a stockinette or even a loose Kerlix roll. If they are weeping ( i understand YOU are, but maybe the wounds are too) it will help absorb some of the drainage also, but wont keep it from airing and drying a bit.

I would think the telfa would cause even more problem because you wouldnt want the sticky tape on the wound or newly healed skin.

Is it possible that he is allergic to the adhesive of the Telfa and its causing more problems than helping?

I think i would rather use the silvadene, with 4x4 kerlix to cover areas weeping and wrap loosely with kerlix roll or stockinette,, he can always get in the tub and soak any stuck dressings off or you can douse them with sterile water to unstick them.

[sharann, BSN, RN]

Thanks I'll try the kerlix. I will try anyhting literally. It's so sad its ridiculous. He is in pain and I can't help him. He is handling it better than I am sometimes. He is like a frontal open wound right now.Plus he is having trouble with Geometry and I cant help with that either!grrr.

[WindwardOahuRN, RN]

thanks i'll try the kerlix. i will try anyhting literally. it's so sad its ridiculous. he is in pain and i can't help him. he is handling it better than i am sometimes. he is like a frontal open wound right now.plus he is having trouble with geometry and i cant help with that either!grrr.

go to a surgical supply store and get some surgilast tubular elastic bandage retainer.

it is a stretchy net product in tubular form that can be pulled up around the chest. i've used it in sicu and the burn unit---places where you often can't use tape because of extensive injuries. you can even fashion a sort of "single strap" that will hold it onto his shoulder, just by cutting or ripping the material. it comes in a lot of different sizes---the surgical supply place ought to be able to help you choose the correct size for your needs.

here is what the product looks like:

froogle product:surgilast tubular elastic bandage retainer

[prmenrs, RN]

I was thinking of the same thing, but I only know the stuff as "burn netting".

[sharann, BSN, RN]

thanks so much! I found out today he has what is called Acne fulminans, an extremely rare and horrid form of acne.This is causing the damage. Steroids will hopefully help.

[rsh3rn]

Often on the floor when we had such problems we would use the creams and then cover it with long john tops, always worked well, but got a bit warm in summer

[NRSKarenRN, BSN, RN]

Hadn't heard of this type of acne. Here's helpful link:

http://www.emedicine.com/derm/topic757.htm

Sending a {{HUG}} to help you and son get through this.

[KatieBell]

The burns stockinette is GREAT! You can actually make a shirt out of it- if you get the big size (cutting holes in it- I did have to experiment with it for a while.) we used to do that for people needing the sort of dressing you describe. You would not need to use tape then. It could then be worn under a regular shirt.

As for the Geometry...he is probably better at it than most of us.

I know you are really trying to get your son feeling better, and I'm sure he knows it too I hope the steroids really clear the chest up fast- so that all he has to worry about is the geometry.

[prmenrs, RN]

I just read Karen's link. OUCH.

I was going to suggest what KatieBell did--you just make a (well, 2 of them actually) vertical cut a little ways from the top to stick his arms thru, then the stickinette doesn't slide south, and it keeps the dressings on the upper chest in place. You can use safety pins over the shoulder area if necessary.

A multivit might be a good thing, too.

Give that kiddo a [very gentle] hug from allnurses!!

[sharann, BSN, RN]

Thanks again everyone for the support and hugs. I try to hug him alot but you know teenage boys!AwwMom! Thanks Karen I read that article too, it is very much on target. Wish us luck at the Derm tomorrow.Missing more work to take him but don't care because he is most important. Luckily the gals at work all are very understanding and are covering for me.