Just wondering if this is the norm..

[SeeTheMoon]

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.

[DixieRedHead, ASN, RN]

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.

Agree, agree, agree. A nasty dressing is just that, nasty. And if it's nasty is should be changed. This kind of stuff freaks me out. I think any nurse worth her cap would change it.:angthts:

[kanzi monkey]

Check the orders and learn what's under the dressing from the chart or from the nurse. Often a dressing over a skin graft is left on as a bolster for 5 days or so--if it's oozy it may need to be reinforced. If it's a donor site, it may be really oozy. General principle--keep it clean. If it's serosanguinous fluid on a bolster, reinforce. If it's frank blood or the drainage appears infected, you'll want the doctor to assess. If you remove a bolster dressing from a recently placed skin graft, you can damage the graft and you really don't want to do that!

[ktwlpn, LPN]

We were using tegaderm absorbable on a leg ulcer a few months ago-a nurse documented the entire area as " large fluid filled sac" Yes-she thought the dressing was a blister...and put another dressing over it.Boneheads are everywhere.A quick look at the treatment record may have clued her in to what was going on with that leg.

[SeeTheMoon]

Thanks to all, I really appreciate the responses. Like I said, we were really limited in what we had access to in the charts. (matter of fact,we were not allowed to request the charts at all. Could only ask for info from the chart. :\) I have a long way to go, and alot to learn. Helps to hear your perspectives.

[CoffeeRTC, BSN, RN]

What are DTIs? I've been in LTC for years...never seen this...is is Due to injury?

I'm willing to be they are pressure sores if they are on heels.

Are you just doing vitals and ADL or CNA work? That's probably why you don't have more access.

I'm willing to explain a few things. First off...the CNA could be wrong. Most often they are not privy to the dressing orders. They are the best sorce of info about the residents though and a good CNA is the eyes and ears for the nurses!

Dressing can be changed once a day, twice a day, every shift, every other day or a few times a week. It all depends on the order. Wound healing is best when moiste so a wet wound/ dressing isn't always bad. It probably needed a better outer dressing or could have just needed changed. That said, I would have just asked the nurse. Maybe the treatment wasn't working and needed changed by the doctor.

As far as the nurse changing the dressing. Just because you told me it needed changed..don't expect the nurse to drop everything right then and there.

Good observation on your part. LTCs have a ton of learning opportunities!

[yooperPN]

The only dressings at my LTC facility that isn't "PRN" would be the ones wound care specialists come in and do, and that's rare.

I'm willing to bet the CNA gave you the wrong information, and maybe in the future you should direct your questions directly to your nurse or your instructor.