dsharrison

Hi all, I am running into a lot of trouble with differing opinions about how to approach wound infections (or possible infections.) I am a home care nurse and work with many different physicians who all believe their way is the only way. So, in the case of a possible infection, what do you think about wound cultures? Both to superficial and deep wounds? Necessary or no? Beneficial or not? In treating wound infections, are PO abx only good for cellulitis type infections, and in that case, topical abx (bacitracin, etc.) for other wound infections? In many difficult situations such as this, I've been fortunate in that Medihoney seems to clear up many infected or possibly infected wounds. How about identifying infections? Sometimes it's really hard when the periwound is kind of a darker pink and could either maybe be infection, or maybe healing?? I tend to think infection, but some of the physicians I work with think not...

Curious what happened with this patient. For wounds 1 and 2 I wonder why they are being packed with calcium alginate if they are hardly draining? Usually calcium alginate is for moderate to heavy draining wounds. Is the alginate moist when it's being removed? Might be better to pack with something else. For wounds 3 and 4, I would culture to rule out infection. Switching to medihoney alginate (which is what the impregnated guaze is) was a good plan. Skin prep should be used on surrounding good skin to protect from maceration. Covering with more alginate, then try foam. If foam isn't lasting two days, or becoming oversaturated then daily dressing changes but with abd pads, guaze, wraps, etc. I would be highly suspicious of infection however if that is the case. Also, does patient have edema contributing to this drainage? If so, edema has to be resolved before wound healing will occur.

If it's already moist I would steer clear of any cream or ointment. It will only contribute to the moisture problem. I have had patients use guaze or soft washcloths to help separate skin folds with success (and continue Nystatin powder). Using the blow dryer sounds like a good idea!

I pee when I have to pee. If it's in a patients house, and I feel comfortable, I'll ask. If I have to go bad enough and it's dirty, I hover...very carefully as to not make a mess. If I'm in the middle of nowhere, it's a gravel road for me. I never held it in the hospital either. I'm sorry, but even in the ICU a patient can wait for 3 minutes while I pee so I can focus again!

There is no way this is legal. New grad or not, every nurse new to a company should be checked off on competencies. In order to be checked off, you would have to go out with another nurse. I believe new grads can make great home health nurses, but only with proper orientation. If this company is trying to send you out on visits with no shadowing, not only should you run, but you should report them. If this is how they operate, I would hope someone reports them! Think of the poor patients they serve! How unsafe!

Yesterday I did 2 SOC and 3 RV. I am still working on the paperwork! I think 3 SOC per day with no RV. Otherwise 2 SOC, 2 RV is a fair day! If a company expects more, I personally would be looking elsewhere. Take it as a sign...it's shady to expect that much of anyone, new or experienced!