ceebeeRN

..hmm...second time this has happened so by now, I should known better lol. I posted a wound care issue in the wound care nursing section with no avail. Since I'm genuinely concerned and am seeking advice..I decided to repost here. I serve primarily as a wound care nurse on a rehab floor of a LTC facility and I have one resident who some how developed what was diagnosed as a decubitus on his scrotum/member (to me it actually looks more like a laceration from friction/force possibly from his foley cath). The resident is on quite obese and his stomach overhangs on his scrotum causing the wound environment to be really warm and humid and in turn quite smelly. Right now, the order is just for cleansing with normal saline, patting dry, and applying a dry dressing. The wound didn't get worse but it sure doesn't look like its getting better and the odor...phew! Any suggestion for a new treatment and/or some kind deodorizing cleanser since Dakins is probably out of the question due to the location? Ouch!

I serve primarily as a wound care nurse on my floor and I have one resident who some how developed a decubitus on his scrotum. The resident is on the obese side and his stomach overhangs on his scrotum causing the wound environment to be really warm and humid and in turn quite smelly. Right now, the order is just for cleansing with normal saline, patting dry, and applying a dry dressing. The wound didn't get worse but it sure doesn't look like its getting better and the odor...phew! Any suggestion for a new treatment and/or some kind deodorizing cleanser since Dakins is probably out of the question due to the location? Ouch!

I know dansko sizes are in European sizing (EU) but that's where my problem lies:for some reason, its always tricky for me to pinoint what my EU size is. According to most conversion charts, a US womens shoe size 10, which is my size, is supposed to be equivalent to EU 40. However, in the past when I've purchased shoes in EU sizes, 80% of the time, dependent on the style or brand, the size 40 is too small and I have to get a 41. I've never owned a pair of danskos, but from the reviews I've read, It seem that dansko clogs run a half to full size small. Is that pretty accurate? If it is, I'm thinking that a EU 40 is totally out the question for me ans that I should aim to buy a 41 or even a 42. I know the most ideal way to find my proper size in this brand is to find a store to try on the dansko clogs since I've never owned a pair, but as of now, Im planning on chancing it and buying Dansko clogs online following the input of the allnurses community of course lol. so my question for all you faithful dansko wearer is should I get the 41 or 42?

we may need an ostomy nurse consult after all. we have a wound doctor but honestly, he's not that effective when it comes to ostomies lol

just when i was about to try your hydrocollloid suggestion, i went back to work only to find that the resident out to the hospital because of how aggravated the area became. now that he;s back we're really trying to nip this issue in the bud, so what I did is used Duoderm instead of hydrocolloid (we are out of that at the moment). do you think that duoderm is a suitable temporary subsitute for the hydrocolloid? I've only used it a couple times and it seems to have helped to a degree. the leaking is minimized but since we are using the one piece pouches we have to be very diligent about changing the bags and keeping the area as dry as possible. Even with the lessened leaking, I can already see his skin getting a bit red but its not nearly as bad as before. Hopefully the added barrier of the hydrocolloid or duoderm keeps the leaking at a minimum. it would be wishful thinking to think it would stop it all together! =/

I've seen another nurse use the skin prep + nystatin powder method on a patient, however, that patient's site was no where as irritated as my resident's is. I actually tried using the skin prep once and he let out a scream so loud, I practically fell backwards, so I Know not to do that again. Oops! lol We have been leaving the site open to air from time to time, with just a towel against it to absorb the drainage, but the DNS was not so happy about that. I, however, do think my patient would benefit from having the pouch off for a bit and the application of some type of dressing.

I will try this tomorrow...I know we have hydrocolloid and we should have calmoseptine. If not, I'll put in an order for it. Thanks for the advice. For my patient's sake, I hope it works!

I originally posted in the wound/ostomy section to no avail...go figure! since I work in a post acute unit in a SNF, I figured I'd try my luck here. I am the treatment nurse on my unit on a pretty consistent basis and we recenty admitted a patient with both an ileostomy and a colostomy. The colostomy site and the skin around it is fine but its the product from th ileostomy site that leaks through the skin barrier and his skin is now as raw,red, and angry looking looking as this bird-->. The site is so irritated:arghh:, that one MD saw it and suggested maybe we send him back to the hospital or at least follow up with the doctor who did the surgery to see what can be done about resolving the irritation. we've tried multiple pouches and multiple skin barriers, including the presized 1 pieces and the 2 peices that need to be measured and cut to size. Nothing seems to be sticking...literally or figuratively! hence the leaking and further irritation. the rawer his skin gets, the less the skin barriers are adhering. the drainage from the stoma just breaks the seal of the skin barrier and the acidic drainage gets everywhere. To relieve a bit of the discomfort, the MD ordered mylanta to be applied to the irritation skin but it seeems like the mylanta further weakens the seal and once again, it doesn't really solve issue or provide a great amount of relief. I feel so bad for my patient!! any suggestions for what we should do to help?

I am the treatment nurse on my unit on a pretty consistent basis and in the last two months, we have had 2 patients with ileostomies. We were ill equipped and only had the premeasured 1-piece colostomy bag available for the first patient, which were way too big for his stoma. Needless to say, the drainage got under the seal of the colostomy bags and there was a lot of leaking and not before long his skin became irritated. Our wound doctor ordered zinc oxide for around the stoma but that made it even worse because the adhesive would barely stick and the leaking and subsequent irritation was just as present as ever. Before long, that patient was transfered to another floor and I was never sure if the irritation issue was resolved. Now we have another patient with both an ileostomy and colostomy and it looks like its just as bad, if not worst than the 1st patient. The site is so red, that one MD saw it and suggested maybe we send him back to the hospital or at least follow up with the doctor who did the surgery to see what can be done about resolving the irritation. The colostomy site seems to be fine but once again its the ileostomy site that leaks through the skin barrier and his skin is now as raw and red looking as a lobster. we've tried multiple pouches and multiple skin barriers, including the presized 1 pieces and the 2 peices that need to be measured and cut to size. Nothing seems to be sticking...literally or figuratively! hence the leaking and further irritation. the rawer his skin gets, the less the skin barriers are adhering. the drainage from the stoma just breaks the seal of the skin barrier and the acidic drainage gets everywhere. To relieve a bit of the discomfort, the MD ordered mylanta to be applied to the irritation skin but once again, it doesn't really solve issue or provide a great amount of relief. I feel so bad for my patient!! any suggestions for what we should do to help?

Yea..I always add negotiable.you're absolutely right about the experience pay scale...so i never understand why employers even ask about a salary requirement. just another thing for applicants to stress about I guess lol. Even though the company knows how much they are willing to offer, I don't want to appear as if I GROSSLY underestimate or underestimate the value of my work by putting down some inane number

Thanks for the great advice! This would be a change of pace for me so I am not extensively experienced in the area that I am applying for since I currently do home care as well as as Long term care, so I guess There was no formal application form..The office just asked for a resume along with a salary requirement. Some places go so far as to write sometime like: "applicants who do not include a salary requirement will not be considered" etc, so that's why I usually try to come up with some kind of reasonable figure.

I don't know about you, but I know always hate the salary requirement part because I don't want to shoot myself in the foot by either lowballing or highballing it. I don't want to be taken advantage of financially or appear uninformed if I put in a salary that is too low and I dont want to be overlooked if I put one that is too high. What I usually do is put a range and then I would also imply that I am flexible. So for example, I would write: $35-$40/hour but open to negotiation. In the NYC metropolitan area, what would be an acceptable range for a RN in a ambulatory care center? I know a regular office RN would make about $25 an hour, give or take, so I suppose a RN in an ambulatory care center would make more than that? maybe $30? I don't know. Also, I always wonder, what is the proper place to include your request? .Since I don't always include a cover letter, I usually put it at the very end of my resume for the jobs that ask for a salary requirement.

Yes, I know combining med pass is tricky. However when there is only one nurse to 40 patients, I don't know how 2 med passes can be done especially when new orders, new admissions, falls, etc are subject to happen at any time. I would hope facilities that use eMAR take into consideration their nurse to patient ratio.

No. You're reading way too much into it. If I were an LPN, I would've written the same thing. point being if you are any sort of licensed nurse, you have patients AND a license to protect, so I'm sure you would assess no matter what letters follow your name.

Please do not take offence, I was just stating my title. My facility does not really make a differentiation between LPNs and RNs, so I have no reason to make this a LPN vs RN thing.