Is this a possible misdiagnosis? Disgnosed as "pressure area" but looks rash-like

Nurses Safety

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Specializes in immunization, gerentology.

Hi guys! I'd really appreciate some help with this one. A little background; my client is home care, 83y/o female with Hx of stroke, seizures, P.A.D. As well as VERY sensitive and thin skin.

She has an ever growing amount of red blotches on her thoracic spine as well as bilateral posterior thighs. It almost looks cheetah print-esque on her thighs. Deep red to purple in color depending on the area. Circular and semi circular clusters of reddened areas. Client is unable to pinpoint areas of discomfort or pain but facial cues of such are present at times. Blotches are blanchable but have been noted for 3+ months and continue to worsen despite being turned q2-4h while in bed.

Her physician has recently diagnosed it as "pressure sore" (I put quotations around it because only one of our team of nurses is allowed to report to and speak with the Doctor, as per the family's wishes. Said nurse wrote only "skin redness not derma issue, it's pressure sore. Turn q2h while in bed and observe" in the doctors orders). After badgering and trying to get more info out of her she finally admitted that the Dr told her it was a combination of a vascular issue and pressure related (that's the jist of what I got from the nonsense she was spouting)

Anyways, some of our team are not convinced it's as diagnosed, seeing as we have actively been turning her in bed since it was first noted and it continues to worsen, especially the posterior thighs. Not to mention it looks more rash-like than anything.

Anyone have any thoughts? Or am I completely off base here?

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Why would anyone want to claim a pressure area, if there were any question?? Patient is probably in senescence. death is in the offing, just not the immediate. on the other hand, have there been any changes in laundry detergent? Skin care products? etc.

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Specializes in immunization, gerentology.

These are my thoughts exactly! I've brought up the whole change in products causing a reaction thing before and to my knowledge nothing has changed except the brand of briefs we're using on her but it wouldn't surprise me if that were exactly the case.

I get where the doctor was coming from with the vascular angle but it's just one of those gut feelings and I'm not alone in that so it makes me even more suspicious haha.

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Give up the "doctor" diagnosis. Fungal rash, easily treated.

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Specializes in ICU.

That could be mottling related to very serious metabolic derangements such as hypercarbia and acidosis.

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Could it be from personal care, like from fingertips grasping too tightly in an area with little subcutaneous tissue? Or just from normal handling but is bruising easily?

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Any recent labs?

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Specializes in immunization, gerentology.

I don't think so, she does bruise easily due to blood thinners. It covers a very large area, almost fully covering the back of her thighs and a large portion of her back now.

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Specializes in immunization, gerentology.

She only has INR done biweekly but the last complete work up would be when she was in hospital in the spring

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Specializes in immunization, gerentology.

Part of the problem is the mentioned nurses communication with the team. Apparently (at the same time as the pressure diagnosis was given) the doctor also said that this is a result of prolonged Coumadin use. I've never seen such a thing, have any of you?

After weeks of us being on the "head nurse"'s butt about this and the rashes steadily increasing. The doctor will be in to see her on Monday. I hope once he sees it, we get some real answers and hopefully the woman communicates what is said effectively so the rest of us can do our jobs!

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Also, make sure she has appropriate pressure relieving mattress in place. Does your team have a WOCN that could evaluate her? Just trying to help with ideas that may not have been tried.

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Specializes in immunization, gerentology.

She does have a partial air mattress and we've put in a request for her to be seen by OT. The doctor was in on Monday and saw the affected areas. The nurse who was here said he assessed her but all he said was he would consult her file and get back to us, haven't heard back yet

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