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Turtle in scrubs 6,421 Views

Joined: Mar 8, '07; Posts: 217 (43% Liked) ; Likes: 218

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  • Mar 9

    Triad works well for skin tears. Here is another trick I have learned that also works well with elderly skin.
    Cleanse wound as normal
    Re-approximate edges as well as possible, if skin is rolled up soak w/ NSaline use qtip to unroll
    Apply collagen powder ( I LOVE Stimulen powder) to wound bed
    Apply Skin prep to INTACT skin only
    Apply steri-strips (leave in place until they fall off)
    Protective padding as needed (silicone foam for drainage or contact layer for non draining) wrap to secure
    Change foam or contact Q 3-7 days ( per mfg recommendations) depending on infection control protocols, cover may be lifted to visualize wound and re-wrapped

    Thoughts ??

  • Mar 9

    Quote from Turtle in scrubs
    Yes, using foam dressing for cover dressing. Her skin is way too fragile to be left uncovered while it heals. And it was pretty exudative in the beginning. I've had her shower twice now with her dressing off, about a week between each dressing change, and it is going well. The flap I placed back was approx 70% viable and the other 30% went necrotic and is clearing away with cleaning. I didn't have much hope with the flap being viable in the beginning because it was so bruised, but I thought it was worth trying to save, and turns out it was a good choice. Interestingly, after her shower the triad was still on. It is a thin, scattered, layer, but still there. Of course she was instructed not to scrub it, only gently let warm soapy water flow over and sort of rub it in the direction the flap was going. So, I've stayed the course with the Triad, having her reapply another layer and cover with mepilex. I've not used Triad much, and never with a skin tear before, but so far I'm happy with it. I wanted something that I could dress and leave undisturbed for several days between dressing changes. The only drawback is wanting to completely clean the Triad off and not being able to. It just made it a bit tricky to assess the wound.
    Interesting, very cool! Have you thought to try a layer of adaptic or hydrogel to keep it moist under the mepilex? Sounds like you are getting good wound stability. I would think that if something bad were to happen to the flap it would have come off already? Or maybe it is acting as a barrier for new growth underneath? I would love to hear how progress is going on the tear! We have a large elderly population at our hospital and see many skin tears. I would love some new ideas to bring to the team!

  • Mar 9

    from what I understand triad is to be applied, gently cleaned and what is left on the skin remains and apply new layer over it. Have not used this a lot. polymem works well for skin tears, apply, check daily for break through drainage and change every 7 days, there are silicone contact layers also that work well,

  • Dec 3 '17

    I have never used Triad on a skin tear, but think it would be a good choice. As far as removing it, have you tried mineral oil? It should make removing the Triad much less traumatic, although leaving a thin layer after cleansing should cause no problems to the healing process.

  • Feb 19 '17

    So I started this thread originally and I wanted to give an update. I absolutely love being a WOCN but there are some downsides I think those considering the career should be aware of. First the pros: less stressful than working the floor, an opportunity to build close relationships with docs and other staff due to the high exposure, you really are the lifeline for patients that have anxiety over getting their first ostomy or healing a wound. Cons: salaried positions can really take advantage of your giving spirit, working 5 days a week isn't for everyone, and its easy to forget your other clinical skills when you're not working as a floor nurse anymore Also, I wanted to add beware of going into situations that seem too good to be true. I started off my original post by saying that I had been offered on the job training and certification as a WOCN. Turns out there was a reason for that. I ended up working for a WOCN Manager that is known for being very controlling and unprofessional. I did not know all of this at the time and this was her reason for wanting to "grow her own" WOCN. What ended up happening was that there was constant turnover in our dept, and I was bullied and gaslighted at every turn. I eventually couldn't tolerate it anymore and I had to leave. So I found out the hard way why they were willing to give me so much training, it was because experienced WOCN's didn't want to come to our facility to work because of managment. So if you live in the atlanta area and you are a brand new WOCN just be careful about what job opportunities you consider. You could end up in a situation that is not good at all for your professional development. Talk to other WOCN's who have been around and ask them about the jobs you are applying for. All in all though, becoming a WOCN has been great and I think I found my niche.

  • Feb 12 '17

    The hot water in a washing machine is not hot even to sanitize clothing, not even close. Supposedly from a clothing side of things warm water is supposed to set it protein based stains like blood.

    Until recently there were issues with detergents in that the surfactants used actually did work better in warm water. There have been some major changes in detergents in the last couple of years changing that.

    Keep in mind that the CDC states that there is no evidence for warm or hot water having an impact on handwashing and that warm water is associated with skin damage. The CDC recommend washing according to the manufacturer's guidelines but do recommend using a hot dryer to dry the clothes.

    Reference to washing clothes can be found here CDC - MRSA and the Workplace - NIOSH Workplace Safety and Health Topic

  • Feb 12 '17

    Quote from Turtle in scrubs
    I know exactly the position your in and posted pretty much the same question to this site before I jumped in. Strangely people don't talk too much about their educational/occupational journey here. I finally just took a risk and went for it. I did Emory's distance learning course. It required me to do the book work at home (so I could keep working full time), one week at Emory, and then clinicals back home at the hospital I work at. I'm now working part time at that hospital and hoping for full time some day. A couple of thoughts.

    I was only 1 of 3 people in the group of 40? at Emory who was not already working as a Wound/ostomy nurse of some kind. A lot of places take on people who are interested and then pay for them to go to school (or pay part of it). I would have done this if it were an option. I think it's the best way to go for a couple of reasons. First, you get it paid for. Secondly, having some experience in the field makes the course work easier and more importantly more productive. You know what questions to ask, etc. and just generally get more out of it. Also, if you get a facility to pay for you to go then they are invested and you are locked into a job. I paid out of pocket and just took a risk that I would find a job. Got super lucky b/c I really wanted to stay in the hosp I was working in (which was not willing to send me to school and didn't have an open position when I started going to school). If that hadn't worked out I would have probably gone into home health which was the only other open position in my area. I don't regret the route I took at all. Sometimes we just need to forge our own path, but if you can lock into a healthcare system I think that is ideal.

    If I had it to do differently I might have done clinicals at a different hospital than the one I work at. See different stuff, etc.

    Emory provided a solid program. I felt the wound and ostomy coursework were better structured and prepared me for exams much more than the continence coursework. The people at Emory were helpful and communication was good. The distance learning is not just a computer course, you will feel like you are part of a program once you have gone through it. Like anything, you get out of it what you put into it, and I asked a lot of questions along the way and had good interactions (via emails and phone calls) with instructors. I would have prefered to go there for the full onsite course but couldn't get a educational leave of absence from my employer, and it's a great option if you can't afford to stop working.

    Compared to staff nursing the demand for WOCN's is very limited, but of course the pool of WOCN's is quite limited. I'm guessing supply and demand is about the same but location of jobs is the real kicker. It can be harder to make that match. If you are willing to relocate you open your options up greatly. If you are not, I would recommend looking around at what openings there are in your area now. I doubt they will be considerably different when you complete the coursework.

    WOCNs seem to be an independent, self motivated, and creative group of people. Each person paves their own way and there is not one best way for everyone. You may want to work on "selling yourself" to facilities, make some cold calls, take them your resume, let them know you want to "make a deal". There is a lot of networking that goes on, so put yourself out there and take some risks if this is what you really want. Knowing what I know now, I would have been more assertive in this process. Every WOCN I've met seems to have a high level of job satisfaction, and that has been true for me thus far.

    Just a few thoughts for what they are worth. Whatever you decide, all the best!
    Thank you for your insight!! It was very helpful!!

  • Nov 12 '16

    Don't forget that the reason the ACA was imperfect was because Obama was blocked at nearly every turn by the Republicans! If they had been able to implement it properly it would have been much more successful.

  • Nov 12 '16

    Quote from smartassmommy
    I am conservative leaning, but after getting to research healthcare system around the world, I realized that systems like the NHS are really the way we need to go.

    Also, maybe we'll get lucky and Press-Gainey will no longer decide reimbursement!
    I'm originally from England and I worked in the NHS for 10 years before I came to America. While there are many good points about the NHS there are also many negatives. Going to an NHS style framework would mean much longer waits for patients...sometimes years for surgeries...much lower wages for nurses and literally zero choice for patients. Nurses wages in the UK are capped and formed into bands where you cannot earn beyond that unless you fulfill certain criteria. In England I earned 4 times less than I do here pound for dollar. There is much less ability to climb the professional ladder and less reward. There is so little money to go around that hospitals are old and groaning under the weight of patients. You cannot choose your doctor at all and you have to be referred to a specialist that takes months to get an appointment with. I am glad I don't work for the NHS anymore. However, the positives are that I never received a bill in my life for medical care there. My parents have medical care whenever they need it although they often have to wait a long time to get seen.

    The perfect system would be a hybrid. Funding from multiple areas...taxation and private insurance. Those who can afford should have the ability to buy a better insurance while those who cannot should have at least the safety net of basic, decent care free of charge. America has made things way too complicated with the whole ICD 9/10 thing. There is so much red tape and so many bureaucrats that it's out of control. ACA was a start in the right direction but it's not sustainable in the current model. Having said this, repealing it will be a huge mistake because it will leave us back where we were but now everything is more expensive. It's not like prices are going to go down!

    I too remember earning good money 10 years ago. Things weren't so tight and we could get travel reimbursement and bonuses and all that disappeared and the penny pinching started. For one side to gain the other side has to lose it seems. We need a system where everyone gains. I foresee caps on nurses wages if we're not careful. We cost too much money and they have to get that from somewhere. That's why I started accumulating degrees and certifications. Make yourself desirable.

  • Nov 12 '16

    I don't know about you, but years before the ACA went into full effect there was a multistep transition we had to go through. It changed our entire operation a bit. The first thing I learned as a nurse was "costs, costs, costs" and how area hospitals were going out of business because people just don't pay their bills. I was told to admit Medicare patients first because they paid the most. Every place I worked freaked out about us using extra pieces of gauze and cut corners to dangerous levels.

    All of these problems were the result of decades of financial healthcare disasters. If you remember the HMO movement in the 80's, that failed and led to the need for ACA. With the ACA, we can't be denied due to pre-existing conditions.

    My employer cancels our insurance if we go below 20/h a week for two weeks in a row. With my chronic illness child, she would have lost her insurance and I'd be bankrupt soon. I rely on the ACA to have insurance that doesn't cost 4 figures for the both of us.

    I haven't had to attend the "omg, stop using so many supplies" meetings in years nor have I been asked to go home as little as an hour early to save the facility money. Financially, the ACA is helping a lot. Keep in mind premiums have been going up long before the ACA, they aren't going up because of it. Please don't get rid of ACA because certain people are on a crusade to do it. My tiny girl needs her mama to not lose the house over her hospital bills.

  • Nov 12 '16

    I have concerns about this as well, not only for what it means for our patients, but as caregivers in the industry. I came across this article in my search to understand what might occur, but I'll need more time to digest it.

    Donald Trump's Proposed Healthcare Plan

    I do plan on writing my state representatives and voicing my concerns over many things. Mostly questions so I can clarify what to expect and how I can advocate for myself, my family, and the people we serve.

  • Nov 12 '16

    I have no idea what to expect, and honestly I am scared.

  • Aug 20 '16

    A&D ointment and/or hydrophor is regularly used in our clinic.

  • Aug 20 '16

    In our clinic we use Remedy lotion (a Medline product) to intact skin on the leg. We use a moisture barrier cream to the periwound. So far good results with no maceration.

    ETA: if they have really dry, scaly skin on the ankles and heels we also use Urea 5% cream.

  • Apr 23 '16

    Due to random drug tests and my children wanting to eat every single day, I can not smoke the reefer. But, I am counting down the years until I can retire.