sillyang

You are definately not alone and sounds like you did everything right. The only difference is I think I was in a state of shock frome that sound and feeling because it didn't hit me until my drive home 2 hours later then I cried. I do remember being told that you will break ribs which didn't set in until I actually did.

It seems that teaching hospitals are more apt to hire new nurses. I had the same thing happen, the large area hospitals liked my resume, life experience, and job history and told me to get a years experience and reapply. I ended up with a position at a skilled nursing facility which gave me great experience. Now I work on the skilled/rehab wing of a rural hospital not much different than the skilled facility but I like the environment and care better. Lots to do, quite a bit of deversity in patients, Anyway it has given me experience and right now with this economy, job security. Many of our area hospitals have had layoffs in med-surg. Keep lookin, something will come along, mabey not your dream job but one to keep ya busy till then.

Information is from a WOCN accredited course text book, ment to add to the discussion. I'm not a physicain and don't pretend to be, like I have noticed other repliers. Personally I have enjoyed the feedback (hence my continued responses), I don't want anyone to tell me I'm correct with anything, I was venting, discussing, learning, and sharing. I haven't been a nurse long and I know I don't know everything, The above info is why I considered tegaderm, The patient needed protection. I haven't agreed with everyones post but I have learned that many people think I used the wrong dressing and that I want someone to say it's right. Thats not at all what I want. The dressing was approved by the pcp and the wound did make improvement for a few days.I don't know what happened on the days I wasn't there, I have seen good things come from butt paste and I have seen some raw butts from butt paste. This thread has made me question appropriate dressings and alternatives for this situation. So far I don't have the perfect answer other than to completely eliminate shear. Short of never allowing the patient out of bed I haven't come up with anything else. Amongst all the hostility this is a professional forum where profesionals discuss and debate. Advice is just that... ADVICE...it is not law and no one has to accept my advice. In the event that they don't except my advice I don't believe I'll stomp away from the thread like a child. The main context of my original post is lost (thats ok) I was asking how others would handle dealing with the other nurse who is continually a struggle for many co-workers. in turn the post turned me into a self rightous know it all who needs validation. It's kinda like playing the phone game. I don't see any reason to get upset though. :redpinkhe

Food for thought: Main wound management principles are to control causative factors (shear), prevent infection, maintain appropriate level of moisture, protect wound and periwound. Transparent film : function protection; indication partial thickness minimally draining or closed wounds; the adhesive is inactivated by moisture and will not adhere to a moist surface, such as the wound bed or periwound surface. The film dressing is semipermeable to gas, such as o2 and water vapor, allowing excessive amounts of moisture to escape when used over a wound. percautions contraindicated with infection, liquid skin barrier may be applied to periwound skin to prevent stripping. Moisture barrier paste : provide thick barrier over vulnerable skin; indications protect from moisture, wound exudate, urine, or feces, perianal, peri-rectal, or periwound denudent. precautions may be difficult to remove which can cause more skin damage due to friction used to remove product. The wound was not a facility aquired PU, patient is on a rehab wing of rural hospital r/t PU. Much education has been given to patient regarding prevention. I believe there is adequate documentation on this case, the state surveyors focused quite a bit on this patient with there recent visit and upper management seemed pleased with there visit. Bryant, R.A. & Ovington,L.G. (2007). Principles of Wound Management. In Bryant, R.A. & Nix, D.P. (Eds). Acute & Chronic Wounds: Current Management Concepts. St. Louis Missouri: Mosby inc. pp. 391-414

Not yet, haven't worked with her for few days, but I will. The patient is no longer mine since he has had a room change.

Great advice everyone, but I think I've been misunderstood. I don't wish to run over any co-worker and I don't need to feel speciall at work., I have a hard time letting go when the patients wound took a step backward. Although I have let go at work, I did my part, I didn't just change the order because she came up with it, the wound had increased in size. Many of us on the same shift with this nurse have tried to work with her. She makes it difficult and its hard to explain without sounding like i'm bashing her (not that this doesn't occur in the breakroom occassionally from us all). The DON has commented that she has had to reminded her to work within her scope of practice and this is from a situation that didn't involve me. I don't want to be a "shining star hero" of a nurse so I will take the advice.

I use to wonder if I could graduate and retire in the same year. Guess not! I hope I will have such a rough decision to make in 30 years:D.

sounds fishy to me!

Not a turf war, I actually care about the end results of my patient. I considered leaving her order the first time because I really try not to play a part in the catty part of nursing. The wound was obviously worse, I didn't make the call I left that for the physician, I asked what dressing he would suggest. It has been stated in this thread that the tegaderm was the wrong tx. I can accept feedback. Butt paste is a zinc paste which is hard to remove and makes the wound difficult to assess on a regular basis, doesn't provide protection either, the tegaderm did show effective results right or wrong, I'm just learning.

Patients daughter grabs my arm and states that her father would like to lay down now, I said Ok I will have the STNA's come down. The daughter growls and says why can't you do it. (200 lb 6' tall cva man vs. 5' tall 130 lb nurse) Without even thinking I say, " it will take two people, besides I don't recall seeing your name on my paycheck". Instant foot in mouth but the daughter smiled and said that was a good one...... whew, I thought that was gonna be bad.

Ms. frustrating is good buddies with the wound nurse yet she is not wound nurse. I did ask the wound nurse in general if she thought tegaderm was appropriate for an area of denuded skin with minimal exudate and she did agree that it was acceptable. The wound nurse is not highly regarded at work because she acts like she is a doc and talks down to everyone. I can't prove that Ms. frustrating is writing orders under the doc's name without a verbal order but i have witnessed stranger things.

It is the same doc. He is the house doc too. I'm not sure she is calling for the order.

I am frustrated at work. I have a co-worker that gives me the impression that she believes she knows everything, and is supperior to everyone else (I think she can even smell when a doctor is present). background info is she assists the wound nurse sometimes in the clinic. I have a patient that has a resolved by scar tissue stage III ischial tuberosity pressure wound. The patient has become weak through the long healing process. The patient has been working on transfers with PT (oh yea parapalegic) and the inadequate strength and shear has created one intact bullae and one that ruptured each 1cm diameter. I am not a wound nurse yet but I am currently in school for certification. I called and got an order to cover area with tegaderm, rational being it will keep a proper moist wound healing environment, provide protection/skin barrier and will be easy to visibly monitor. I applied dressing, had 2 days off and return to a patient with a 3 cm long 1.5 cm wide denuded area on the ischial PU scar. My frustrating co-worker had the order changed to butt paste. I was irritated because the patient has had a long road of healing and didn't need this set back. I called the doc explained the wound and asked what dressing he wanted. Once again I write an order for tegaderm. Over the next couple of days the wound made visible progress, smaller. The patient was then moved from my hall to make room for a new patient. The same day as the patients move my frustrating friend changed the order back to butt paste. I know I can be critical of Ms. Frustrating because there seems to be a personality conflict but come on. The second order for butt paste was written to be applied before patient is up in chair and leave wound OTA while in bed. That would just create a bigger wound from washing the butt paste off. I have seen Ms. Frustrating do similar things to other nurses. How do you deal with a person who needs to be so important? Or is it just me and I should shut up and just go to work.

I wonder how many patients could tell you what their nurse was wearing pre-op. I have a hard time believing very many, it's not like they have nothing better to worry about at this time. Shoot sometimes I can't tell you what I was wearing yesterday.

I had a patient who received IVP dilaudid follwed by IVP phenergan every 4 hour prn, the patient had a port a cath. The patient had been receiving it this way for a long time even at home ( the spouse was giving it). The policy at work has changed now and we hang it in 50cc NS. The patient has made a recent return visit and was not happy with the policy change. I think the patient liked the comatose effect.