Candogal

I did Webwoc for the convenience but if I was new I would definitely go to Emory.

A DTI stands for deep tissue injury which sounds like this is the case. I'll fitting shoes pressed along the bunion would cause it. The patient needs to throw the shoes out or alter the shoes to prevent pressure to the site.

I did webwoc. From speaking to others Emory seems to be more informative but I did not want to travel and spend the mandatory week in Atlanta. Since I had experience all I needed was to complete the classes and take a test, all online for Webwoc

It would depend on the policy at the center. Due to so many abnormally shaped wounds we tend to measure the longest and widest areas (head to toe, should to shoulder instead of exactly the 12 to 6, 3 to 9). Feet are funky because the toes are actually at the 6 o'clock position and the heel is at the 12 o'clock position just like a ballerina or a skeleton the toes would be closest to the ground. It is important when you need to document undermining which is common in foot wound due to the shearing forces and tunneling which tends to occur along suture lines.

A deep coccyx pressure ulcer of an incontinent pt. definitely needs to be covered, leaving it open would put it at risk for an e coli infection.

I have worked at 2 wound center with a NP in each and both were very good and seemed to enjoy their job.

You do not need to be certified for an outpatient wound RN position. I began 2 outpatient wound jobs without my certification and finally became certified but quite a few of the RNs working in wounds are not.

I think you did fine, the old alginate just like any dressing should not be left in the wound for too long. Whoever wrote the order should have specified to re-pack the wound and then filled the remainder of the cavity with the vashe moistened gauze.

I can only give you an outpatient view as I have only worked a 2 out-patient clinics. You see the same patients over and over again most seem like a weekly basis which means that you have time to educate and see the wounds progress. It's usually an 8-4ish job- no weekends, no major holidays. The majority of the patients are stable. You are never alone-there will always be another nurse or doctor-it's a real team environment (again this is just my experience). It's pretty low stress. Of course you stand all day and it's busy at times. The main doctors tend to be podiatrists as there are a lot of below the knee wounds. You pretty much always get a full half hour lunch break.

Sorry, I'm a bit late but yeah to simplify if it's arterial then it already has a decreased blood flow so compression would only make it worse. Compression is good for venous ulcers because the veins don't work well so compression helps push the fluid out of the legs. There are many different types of compression dressings- however I would get a doctors order because you have to make sure there are no medical issues likea history of congestive heart failure and to make sure that the arterial brachial index is acceptable. The last thing you'd want is to compress someone and have them die because they now have all that extra fluid from their legs sent right back to their already overworked heart. Sorry the nurse wasn't helpful you were only trying to help your patient.

Since you said the wound is getting macerated avoid Telfa that would cause even more damage then the silicone foam dressing. First I would go back to whoever gave the orders and show them the wound for re-assessment. It probably just needs to be changed more frequently like every day or every other day. Other options to maybe consider are using a non-adhering dressing like mepitel or adaptic to allow the drainage to flow through onto the second layer and prevent any dressings sticking to the wound- if the dressings have a tendency to stick to the wounds and then plain gauze, aqaucel, drawtex, or even an abd pad.

I hope I can help, I have worked at 2 wound centers and very rarely do either place use tegaderm anymore-only for example when the patient is going to the beach and we don't want sand and water to get into the wound. The wound really needs to be assessed by a specialist- Santyl ointment will help loosen the slough but that needs to be put on everyday. Medipore tape is the strongest wound dressing tape that I'm aware of and the prior comment about the Allevyn Foam dressing cut into a diamond shape and then apply medipore tape would be a good option to try, just make sure to apply skin prep barrier wipe on the peri-wound to prevent irritation and breakdown.

See If you can get her treated at an out-patient wound center where the wound can be assessed by a doctor to determine if it needs debridement, wound vac, packing such as iodoform etc. If not Santyl (for the slough),dry gauze, plus a foam on top for padding to prevent further breakdown. I agree if it has slough than it's at least a stage 3. Definitely no skin prep to the wound bed, only to the peri-wound if needed. Make sure the patient has an adequate protein intake and vitamins. And off-loading, off-loading, off-loading. Sacral wounds take a long time because of location, that's for sure but it doesn't automatically mean going to a sub-acute as long as you can find a local wound center which are becoming more popular. We have many that come to our center who live at assisted living centers, they get assessed, treated and instructions on how to care for the wounds are provided until the next visit.

Ugh!! I worked as a brand new RN on the overnight shift at a sub-acute/ LTC for 13 long months. It was rough but I'm lucky that for the most part the night crew was a great bunch to work with. I hate to say this but there were occasions where I witnessed the long term LPNs give the newer grads a hard time. I don't know if it's because some might feel trapped at the place due to their degree (I even visited my old place today and talked to a few that are like help me get out!) and they know that you will basically get experience and move on (yes, that's what I did and it wasn't a day too soon-I feel like I aged a few years there) and leave them behind to train yet another higher degree RN or that they've been there for so long that they don't remember what it's like to be new. I get not wanting to risk your license, I felt the same way because of the stressful environment. Remember you are not alone I know of 3 RNs that cried or had a total breakdown during their first week but nursing will get easier. I love what I do now, no stress, Mon-Friday job I'm usually out by 4:30 and I get paid $10 more per hour than I did working LTC/subacute and that was only a year ago. Consider getting wound certified (WCC- approx. $3000)- I'm not (but defintely plan to go for my WOCN) because a wound center took a chance on me and trained me and now I work at 2 wound centers and I feel really blessed because I love what I do and can see myself sticking with it for many, many years.

Hi, I presently work at 2 outpatient wound centers- check a local hospital to see if they have a center. I would highly suggest the patient go to a wound center, which the staff will then instruct you on dressing treatments along with weekly visits to the wound center for debridments, follow-up care etc. Compression and Elevation are going to make the biggest improvements, your patient has to do their part by elevating to heart level as much as possible- they don't like to comply but it makes a huge difference!!! For more than light compression the patient will need to get ABIs (arterial-brachial index) done to make sure that compression will not cut off circulation. Unna boots are for patient's that are ambulatory because they're meant to work with the calf muscles, since you said your patient isn't right now than it's not an option. Stronger compression devices that most commonly used are Coban 2 lite, Coban 2 regular, Profore 3 layer and Profore 4 layers- but again ABIs are a must and it's a doctors order. Drawtex is more super absorbent than alginates. Silver dressings would probably be very beneficial for this patient such as Acticoat 3 or 7. Cauterization to help decrease wound drainage with silver nitrate applicators by the wound doctor might also be something they'd consider, it's used for heavy bleeding wounds after debridements but a podiatrist became a fan of it on a foot amputation patient who had excessive drainage. Once the wounds are healed and the edema has been controlled then they are an ideal candidate for specialty compression stockings or farrow wraps. But really, recommend the patient go to a wound center or at the very least a podiatrist, most of the staff at both places I work at are podiatrists because they deal with wounds from the knees down.