amyann

Hi, I have been a nurse for two years now and I work on med-surg. We don't have a ton of patients with pressure ulcers, and the ones we do see we usually put a tegaderm on and they get discharged and we don't ever see the results of our treatment. Recently though I have had a couple of patients for a longer than normal stay (over a week) that have had stage III ulcers on the sacral area, and it was not until now that I have realized the debate/controversy over wound care/treatment. It does not help that there is no policy or wound care specialist at my hospital. It seems that every nurse has a different opinion and is very sure of themself. I have done research on this, and even went to a wound-care conference on this, and I still don't feel like I know what to put on these stage III sacral ulcers. For one thing, we don't have any cool treatments, all we have are thin and thick hydrocolloids and opsites. Many nurses I work with think open to air is the best policy, besides obviously turn Q2 and nutrition, but I lean towards the moist wound healing offered by opsite and the tegaderm. The only problem is the wrinkles that form when these are placed on the sacral area. I have tried every trick to get them on smooth and perfect but they always end up wrinkled. Also, how do you keep the intact skin around the wound from being macerated, and how do you know when the exudate that is supposed to be healthy for the wound bed is not so healthy any more? Any insight or tips at all wound be helpful. I even asked the doctor this morning and she didn't know- she said she is used to having a wound care nurse to ask... so it is in my hands at this point. Thanks a lot!

Hi, I work on a med-surg floor and somehow, in the last year, half of us have had a baby. So I usually work shifts where we all pump every few hours. Its not really a problem, you just try to fit it into your routine. I heard somewhere that its the law that you are aloud pumping breaks- not sure if that is state or federal. Besides, where I work, somehow smokers fit their breaks in no matter what.

Thanks for your insight, that is pretty much what I thought but the supervisor and charge nurse made me feel like an itiot when I questioned the idea of giving her Xopenex. I felt like we should get her back in bed from the commode and let her calm down a while and reassess before I called the doctor but they didn't. The doctor pretty much told me the same thing and then I was left feeling like an itiot on the phone to the doctor. I'm going to bring it up to them, that maybe we shouldn't just give Xopenex out to anyone with SOB, but I thought I'd better do some research first- Thanks!!

I pretty much clean up fesces/vomit or some other type of bodily discharge every time I go to work. Some shifts there is no CNA and us nurses do it all.

I am a new nurse and have a question about a patient I had- she got up to the commode and her heart rate jumped up to the 150's, blood pressure was slightly higher than baseline at 130/80 and RR was 20 and she stated she could feel her heart pounding and felt like she could not catch her breath- Sp02 was 95% on 2L. She has chronic A-fib and she usually does tach up when she gets up. The charge nurse gave her a breathing tx of Xopenex which I did not think was necessary since her SOB was not from bronchial constriction, just and increase in 02 demands. Also I know Xopenex is not supposed to have the cardiac side effects of albuterol, but I have heard the it can increase HR. Was she just being on the safe side? Should you just give Xopenex with any breathing problem? Any insight wold help, I have a lot to learn!:)