wocnnurse

Our ET Nurse retired with 1.5M but our hospital is state-subsidized with huge retirement contribution. They stopped the program when I joined so I am not one of them! I gave up bedside nursing 3 years ago and am now in business, still in healthcare. After my first year, my gross income was 1.3M and now with 3 companies running I hope to increase the figures. Business has a different kind of stress and pressures than bedside nursing, but as a near retiree, the physical demands are a lot less plus I am now working for my family, not for some corporate giants. It gives me a higher level of job satisfaction, I am still dealing with patients but in an indirect way. I remember telling myself one day after a hard night shift, "I wil retire from nursing at 55 before I become disabled from lifting those heavy patients of post spine surgery!" I reached that goal earlier, I left nursing at 50 this year I will be 53 and working on retiring, meaning free from all financial responsibilities at 55. Wish me luck!

Yes, I had worked with a plastic surgeon who used these live necrotic agents to prevent swelling on certain facial surgeries. He believed that wound healing is hastened by the maggots' movements stimulating the capillaries and thus improving circulation to the wound. They are flown in sterile from a supplier and we would do occlusive dressing so they won't wander off to other areas. Likewise hungry maggots eat up dead tissues so they keep the wound sterile as well. This practice has been more popular in Europe.

Vac's on a fistula? I agree with Mike, we usually use an ostomy appliance on fistulas. I remember one case we used a urostomy bag and had to connect it to a foley cath bag becuse of the large amount of drainage it was putting out. And when the patient was up, we connected it to a leg bag. Drainage from the small intestine is very irritating to the skin, stomahesive paste around the appliance and duoderm on the surrounding skin usually helps.

Wound appearance changes everyday, that is why in your daily assessment, you recommend a treatment according to the kind of wound you have. NS wet to dry in my experience is very good in slow debridement of deep sloughy areas. When I see some granulation going, I then switch to a wound gel. And when you say "wet", it's not sloppy wet but the sponge is wringged out of extra NS so that it has the chance to absort the dead byproducts of wound healing. Goodluck!

Hi! I am both for steri strips and opsites depending on the type of skin tear. If it is a clean linear type, steri strips is best to approximate the edges and let the wound heal itself. Then you can use a protective dressing like a telfa and wrap it with kerlix so that the wound will stay clean. For scrapes and tears with irregular edges, I use opsite. After the first day one maybe amazed of the increased drainage accumulating there which forms a pouch. That is part of wound healing process, I usually change it since I don't want the periwound area get macerated by the drainage. Usually from the 2nd or 3rd changes daily, can I safely say I leave it for 3-4 days or until the wound heals. 3M has a product named "non- stick skin barrier" that I apply to the periwound before I place the opsite so that I can take it out easily. Then I still place a protective dressing as well to alert the other members of the team that there is a skin tear there and they should be careful in handling that part. I am not so much for any antibiotic ointment if I am not sure that the wound is infected. A clean wound should heal without it, most of the time it just increases the local bacterial count of a clean wound with its sticky consistency. Goodluck!:)