Ideas for keeping dsg on

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Ok, i need some assistance from all you knowledgable nurses out there. Just a little background. I have an elderly lady in the advanced stage of dementia. Diabetic,not very well controlled d/t her noncompliance with diet and meds. She can be behavorial with care, frequently refusing. Over the last 4-5 months,she has declined quickly and developed a gangerous toe. Well. to make a long story short she has had the second and third toe amp'ed. There is no circulation to the foot at all, despite anigograms and the like. Currenly she is on hospice care, but,her left foot needless to say is deteriorating very quickly. All of the toes and most of the foot is affected. My problem currently is the little darling will NOT keep a dressing on. She removes every dressing ive come up with to protect the foot. Ive wrapped with coban, ive tried ace wraps, ive tried 3-4 kerlexs, ive tried no kerlex, using minimal coverage. Nothing works! more concerned with her banging the foot than anything, i know healing isnt an option, or even at this point,staying the process. She is currently on scheduled roxanol,and a pretty hefty dosage at that. Difficult to asses, painwise r/t to the dementia,but will sit an PICK at her affected foot causing more damage! HELP!!! Besides keeping someone with her 24/7 im out of options. Does anyone have any ideas at all for something that will help me keep that foot dressed without restraining her hands? Thanks

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Specializes in pure and simple psych.

How about putting a pair of loose panty-hose or tights? Sort of like Dr. Denten's pj's with feet. I used to put a complicated, cotton-ball, kling-wrapped mess on top of the panty hose, and then put the pt. at a table. By the time he worked his way far enough back to get to his foot, it was meal time. Then at bedtime, he would spend his time picking at the artificial dressing. Just be sure the depends are changed often.;)

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We've done the same. We used a multipodus boot on the foot and put a dressing on top of the boot so that they could pick at that one.

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what bothers me more about removing her dsg, is the need for her to constantly pick at it.

to me, it sounds like she's still in alot of pain.

even if the gangrenous areas are dead, tissue death is still spreading and that's what is causing the pain.

leslie

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How about putting those big bulky mittens on her hands. We have to do that to keep residents from scratching rashes. (of course she could probably get those off but it's worth a try!)

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Specializes in Acute, subacute and Geriatric.
what bothers me more about removing her dsg, is the need for her to constantly pick at it.

to me, it sounds like she's still in alot of pain.

even if the gangrenous areas are dead, tissue death is still spreading and that's what is causing the pain.

leslie

I agree.

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