Just wondering if this is the norm..

Specialties Geriatric

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I'm a student and had my first clinical day yesterday at a nearby LTC facility. (Wonderful day. Could not have asked for kinder or more accommadating patients. :) )

There was one lol who had a wound on each of her heels (not sure of the nature of the wounds, we were never told.) Both of the dressings were soaked through. One of the students asked the CNA about it, and asked if she wanted her to go get the nurse so the dressings could be changed. The CNA responded with, "Oh, they only change them every 3 days." Huh???!!!

I found this a bit odd. Clearly these dressings needed changing badly. Now while I do still have that 'student twinkle' in my eye, I am not ignorant to the fact that how things are done in the 'real world' of nursing is not always what we are taught. I know that alot of these facilities are understaffed and alot of the nurses and cnas are overworked. I know that most of them truly do the best they can with what time they have. And I know this is not the most pressing of issues related to nursing a patient.

BUT...every 3 days?? To change oozing wound dressings?

Anyway, just wanting input from you more experienced gals/guys out there.

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Specializes in LTC, MDS.

Even if the order states Change every 3 days, they should be changed as needed, also, especially if they are soiled or soaked through. Leaving dressings on that are soaked through is not the norm. I know where I work, we automatically put a change PRN for soiled or loose dressing order for every treatment. Even if it's not written, it should be understood. Unless you have an order that states "do not take this dressing off!" Then I would call the doc and ask if we can change it and what we should put on, and descibe that it is soaked through or coming off or something.

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Need more information on the patient to make a decision on this. Could have been a wet-to-dry dressing, specific surgeon's order, or the CNA just simply made a mistake telling you that and did not know. As a student nurse, why did you not look in the the chart and investigate the wound orders?

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Specializes in Cardiology.

I agree with asystole RN. Some specific wound dressings are made for oozing wounds and work best when left on for that period of time. but I would have to see the wound to make a proper judgement as a sopping wound is just not good. Anyways you should use this as a opportunity to investigate wounds further as you may not get a chance like this again..

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Specializes in LTC, MDS.
Need more information on the patient to make a decision on this. Could have been a wet-to-dry dressing, specific surgeon's order, or the CNA just simply made a mistake telling you that and did not know. As a student nurse, why did you not look in the the chart and investigate the wound orders?

Even a wet to dry shouldn't be soaked through. But yes, it would definitely need to be followed up on if you felt there was a mistake. If you look through the chart and everything and it does say "change q3 days and not a moment sooner" I would ask someone who is familiar with the resident why it shouldn't be changed sooner if it's soiled. Or again, call the doc and get clarification. Everything I've learned says if it's soaking through, the wound is too wet and will cause further damage to the wound. We are the eyes of the doctor, so it's up to us to tell them when a treatment isn't effective. And if they come back and tell you that's what they want, then document, document, document!

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Need more information on the patient to make a decision on this. Could have been a wet-to-dry dressing, specific surgeon's order, or the CNA just simply made a mistake telling you that and did not know. As a student nurse, why did you not look in the the chart and investigate the wound orders?

We were not allowed to. :( Advised the instructor she said nothing we could do.

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I'm a student and had my first clinical day yesterday at a nearby LTC facility. (Wonderful day. Could not have asked for kinder or more accommadating patients. :) )

There was one lol who had a wound on each of her heels (not sure of the nature of the wounds, we were never told.) Both of the dressings were soaked through. One of the students asked the CNA about it, and asked if she wanted her to go get the nurse so the dressings could be changed. The CNA responded with, "Oh, they only change them every 3 days." Huh???!!!

You should have gone to the nurse. The CNA is not the appropriate staff member to go to regarding dressing changes, as the CNA isn't doing the dressing changes or reading the chart or treatment cardex. She might have heard from the nurses that it's a q 3 day dressing change but she doesn't know the details. The order might very well be to change every three days, however, there is always a PRN if soiled etc.

If I were you I would have also checked the TAR and the order in the chart to see exactly what the order stated before assuming that the CNA had all the correct information.

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I agree with asystole RN. Some specific wound dressings are made for oozing wounds and work best when left on for that period of time. but I would have to see the wound to make a proper judgement as a sopping wound is just not good. Anyways you should use this as a opportunity to investigate wounds further as you may not get a chance like this again..

Yea not really enough info I know. I have a lot to learn about wounds. Still a baby student. We go back to this facility next week. Anxious to see this pt again and ask more questions.

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Even a wet to dry shouldn't be soaked through. But yes, it would definitely need to be followed up on if you felt there was a mistake. If you look through the chart and everything and it does say "change q3 days and not a moment sooner" I would ask someone who is familiar with the resident why it shouldn't be changed sooner if it's soiled. Or again, call the doc and get clarification. Everything I've learned says if it's soaking through, the wound is too wet and will cause further damage to the wound. We are the eyes of the doctor, so it's up to us to tell them when a treatment isn't effective. And if they come back and tell you that's what they want, then document, document, document!

This!!

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Specializes in LTC.

There are some ding-dong nurses at my facility, who will say the exact same thing about a grimy, unravelled dressing dragging along the floor. "Oh, I don't have to change it because it's q3D!"

I'm not sure if they are lazy, or really just that stupid.

I would change a dressing that looked like that. It's not doing any good anyway.

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Specializes in LTC.

I'll agree..should have asked the nurse...the CNA could have totally been wrong about how often they are supposed to change it...

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If the wounds were on the heels and the patient was immobile they could be DTI's, I don't know why but in school I had tunnel vision and thought pressure ulcers only occurred on the coccyx. What you could do is make sure the heels are properly floated and that could be one of your interventions.

The only dressings that I was told Not to change would be fresh venticulostomy dressings, and once I had a post op burn patient with the dressing stapled to the neck with a not clearly said do not change. Ask the nurse is you and your instructor could change the dressing, its definitely an infection control issue having a saturated dressing applied for long term.

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