LPN-WCC

Is it a scab or eschar?

You may have a smoldering infection. Get an order for either CT or MRI to find out if she's pocketing. I would also get a CRP and ESR. Non- compliance is standard issue with wound pts. all you can do is document, document, document. Make sure you include education in that. Let a primary nurse switch one of my vacs. I would come *******' unglued. To me the KCI products are the gold standard, but expensive. I hate the S&N NPWT, they need ALOT of work. Watch this pt. close, she's got something going on. Are you doing the measurements yourself? What did your cultures show?

Hey, Sorry about your patient sound like a wee bit of a mess It depends on the patient as to what you would do. If his goal is healing then I would have ordered new vascular studies, TCOM, and labs that have to include albumin, pre-albumin, CRP, and ESR to start. It's pro active wound care initial assessment. When toes are black and hard, they usually require daily protective dressing until they declare themselves. When you have open areas and drainage, get cultures and treat empirically. The ideal dressing for this wound be Iodasorb with q2-3 day and PRN changes. If the patient is not wanting to treat aggresively, I would concentrate on pain managment, and still do the Iodasorb, with maybe some 4% LMX if needed. The labs etc. would be moot. I cannot tell you how many walls you're going hit with the primary nursing staff with wound issues. They have no clue what they're looking at, which is why you, as the wound care expert has to be proactive. Also you may have to have a care plan meeting with the family to find out in what direction they want to go. Wound care is expensive, and hard on your patient. Are they eating? Underlying med. hx.? Infectious process?? It goes on and on. Age and confusion are both huge barriers to healing, with any foot/toe wound you will usually write an order for non-wt. bearing, but with a confused patient..Good luck with that one. Anyway, I hope maybe this helps a little, and best of luck with your WOCN

Hi, We picture and measure all wounds on Mondays. We use a digital a digital camera which we download into our computer. We use labels which we preprint with patient initials, and site. We have our patients sign a consent to be photographed, which also includes permission to use the photos for education which we often do. There has been no privacy issues in the 10 plus years we have been using this system. Each patient has weekly documentation, for each individual wound. This system works very, very well, with state surveyers (not to brag) praising our program. Keep in mind that this will be an ongoing process, and you may have to insist on developing some of your own forms. We have found that most corporate wound care forms in no way shape or form are encompassing enough for the information we need to include