leaving patient in bed with wound

BluntForceTrauma · May 16, 2008

EXCUSE! The pt will be on his coccyx whether in bed or in the chair, so I odn't see why he can't get OOB to chair.

Ms.RN · May 16, 2008

excuse! the pt will be on his coccyx whether in bed or in the chair, so i odn't see why he can't get oob to chair.

he has a biwave mattress to prevent any more wound, so i dont know if this is a good idea or not

asoonernurse · May 16, 2008

that depends on a variety of factors, gn.

i am going to make the assumption that you are not a cws or wcc-certified specialist (or you wouldn't be asking this question.)

1. have you spoken to the facility's wound care nurse about this? what are his/her thoughts on this particular patient' progress? is there anything listed in the mar in reference to the doctor's preferences for this patient?

2. have you spoken to the patient about this? is it his/her wish that she/he be up for feedings or in bed? which causes the patient more discomfort (pain?) will getting the patient up and down cause more damage to the wound?

3. you've given me no information on the actual wound itself. are we speaking of a stage i decub or a stage iv decub. is there tunneling present? what is the state of the slough in the wound? what do the edges of the wound look like? is there much eschar present? so forth and so on. these are all very important things to know.

the state of the wound itself (and how much pain it causes the patient) all play an important part in a nurse's overall care plan and implementation.

i've worked with cna's who have done things because it made their job easier, rather than made their patient's life easier or were important to their recovery, and i have worked with cna's who were more on the ball about the above than some charge nurses. which one is your cna?

you may need to elaborate a little more on the patient, cna and type and care of the wound if you want more nurses on this board to give you an opinion.

good luck, :nuke:

michael

one of the cena asked me if she can leave a patient in bed and feed him in bed because he has wound to his coccyx. do you think is a good rational or do you think its just an excuse?

asoonernurse · May 16, 2008

Hi BFT,

How can you make this determination? GN has given us absolutely no history on this patient. Would you make a diagnosis on a patient without ever having met, seen, or questioned him?

Good Luck, :nuke:

Michael

EXCUSE! The pt will be on his coccyx whether in bed or in the chair, so I odn't see why he can't get OOB to chair.

asoonernurse · May 16, 2008

okay, now we are getting somewhere. patients who have been ordered biwave mattresses usually:

1. have been singled out in a care conference to observe and chart the care of a high-risk wound. do you know if this patient is on friday rounds? might be a good thing to inquire about.

2. have a high-risk or developing wound of some advanced level. in this case then, offhand i would say, yes, keep him in bed but make sure your cna's are "correctly" repositioning q2h.

3. the physician is concerned (and you should be as well.) once again, check the charts for orders. oftentimes the physician will leave very specific orders in regards to care of the wound. (unfortunately, not all physicians will do this!)

4. do a quick check with your co-workers. how have they cared for this patient in the past? also, again, your wound care nurse is the one who will have all the answers for you...

good luck :nuke:

michael

he has a biwave mattress to prevent any more wound, so i dont know if this is a good idea or not

CapeCodMermaid, RN · May 17, 2008

Not all facilities have wound care nurses so you might be on your own. We have residents who were admitted with stage four wounds on their coccyx or buttocks. We have an in and out of bed schedule and of course a lovely cushion on the chair when they do get up. Every patient is different and every wound is different.

And, as an aside, if you have patients with wounds and your docs haven't written specific orders it's time to call the medical director.

asoonernurse · May 17, 2008

CCM makes several valid points that I failed to address. :yeah:

Many facilities do NOT have an in-house wound care nurse.

However, as I mentioned in an earlier post, a quick consult with your co-workers will, at the very least, give you some valid input and opinions to help you assess the situation and come to an informed decision.

Good Luck,

Michael

Not all facilities have wound care nurses so you might be on your own. We have residents who were admitted with stage four wounds on their coccyx or buttocks. We have an in and out of bed schedule and of course a lovely cushion on the chair when they do get up. Every patient is different and every wound is different.
And, as an aside, if you have patients with wounds and your docs haven't written specific orders it's time to call the medical director.

noc4senuf · May 17, 2008

You do NOT automatically say turn Q2 hours anymore, that logic is gone. A tissue tolerance test is completed and you guide your staff to turn and repositionaccording to those results. If the wound is on the coccyx, then they must be turned side-to-side. There are cushions for the charis called an isch-dish; these have coccyx cut-outs. Rarely would i leave someone in bed d/t a wound as other issues settle in such as respiratiry problems and decreased range of motion.

Ms.RN · May 17, 2008

patient has stage 2 wound in perineal area, no tunneling, i would say about 20% slough. edges are firm. very hard to treat this wound because every time he has a bowel movement, dressing has to be changed, and he is diabetic with poor food intake. the unit manager wanted us to sit him in chair no more than 2 hours at a time, so that means right after he has eaten his meal he is to go back to bed. he is a total care and very difficult to take care of. aides have to use a hoyer lift to transfer him and sometimes he tries to fight. cenas are saying he eats better when he is in bed but my worry is he is on pureed diet and honey thick liquid and he has difficulty with swallowing food and his intake is very poor and i'm worried hes going to choke.

Ms.RN · May 17, 2008

patient has stage 2 wound in perineal area,
correction, stage 3

marjoriemac, LPN · May 17, 2008

We've had patients with real bad wounds on sacrum etc, we would normally alternate between sitting up (with appropriate pressure cushion) and being in bed with regular positional changes.