I stink at wounds, please help!

[MomRN0913]

Wound care is not my thing. Staging wounds is not my thing. Now in home care, it;s more on my shoulders to figure it out.

I have an african-pt and today found a pink spot in her scaral-coccyx area ( had to dig for the area. The skin looks intact, but it's pink, so I am assuming it's a superficial ulcer, very small. Wound care. I don't know. She is ambulatory and continent, but she was laying on her back way too much. I suggested keeping the area clean with soap and water and applying balmex (balmex seems to cure everything in our agency) Pt also does mostly her own washing and cleaning as she lives with her son, who cooks and cleans and gives her her meds, but she washes herself.

Is barrier cream/ balmex appropriate for a barely superficial tiny pink spot?

[Double-Helix, BSN, RN]

You need to refer to your agency's policies and procedures for wound care protocols and notifying the MD of new wounds. Is it within your scope of practice at the agency to recommend balmex to the patient? Do you need to notify the doctor of the patient's new wound? Was the area blanchable?

Since you've said that wound care is a weak area for you, I highly recommend that you invest in either a text book or a class regarding wound care to develop some practical knowledge and skills. Being able to accurately assess and stage a wound is critical to ensuring proper patient care. It also can have some major implications for proper reimbursement from insurance companies. I recommend Wound Care Made Incredibly Easy for an easy to read breakdown of basic wound assessment and treatment. You should also discuss opportunities for further wound care education with your boss.

[MomRN0913]

Thanks for the suggestion. I'll get that book. Honestly, we don't have a particular policy and procedure. Doctors orders, who usually leave it up to us.I would have stuck a duoderm on this patient if she was laying in my icu bed. But this patient is at home, ambulatory, and bathes herself and lives with her son who doesn't do that kind of care. So it's not practical for her. my supervisor said keeping clean and applying blamed is appropriate at this stage, and of course, pressure relief.

[MomRN0913]

The area was very tiny , pink on black skin. Not even a shallow crater. Just a pink spot on the coccyx.

[LisaFlory]

Honestly, sounds like a scar. A lot of times, African American's scars are pink/white, as are ours, but ours are less noticeable, obviously. Did she have a previous area on her coccyx? If it's not a scar, then it's a stage 1, superficial area & cleaning + barrier cream + keeping the area dry will be best until/if it opens up.

[AweSmiles]

A tiny pink spot on the coccyx, then I would recommend placing a protective dressing to the area to keep it from breaking down more. Barrier cream would have been good before the skin actually began to breakdown. At my facility, we use a dressing called Mepilex. It is a heart shaped dressing with soft cushion-like material in the middle to alleviate pressure to the coccyx when the patient is sleeping, sitting, etc. and there is about a half inch of adhesive around it to help it stay in place. They are good for up to 4-5 days as long as they stay dry, completely intact, clean, and it's not bunched up or rolled up on the patient. If you look up Mepilex online you might be able to see a description of it. It's very handy. And if you don't have this particular dressing at your facility, then maybe you could get creative with other supplies. Good luck and I think you asked a wonderful question. :-)