Pseudomonas treatment

[jeepluv818]

I have a patient that has s/sx of pseudomonas infection to the venous ulcers on his lower extremities. Patient has lymphedema. He is very non-compliant, does not elevate his legs, does not follow dietary restriction, is non-compliant with his wound care and takes his dressings off often. Previous orders were for maxorb AG to the open areas cover with ABD pad, unna Boots, cast pad, Coban. They were doing the wound care twice a week. He has been saturating the dressing in less than 24 hours. He is starting to have macerstion to his surrounding skin including the base of his feet from the MASSIVE amount of drainage. He does not tolerate the dressing well. This was the first time I have seen this patient and immediately recognized the pseudomonas. The doctor has not ordered wound cultures but I'm going to call and ask for them. With the wounds being on his legs and in the home health setting, I thought I would get some pointers on suggestions for the wound care. Most Physicians, expecially VA Physicians, want wound care suggestions. The research Im seeing shows that acetic acid has used a lot for cleansing the wounds but I also saw that it is cytotoxic and delays healing. It also showed that patients need to be soaked for like 15 minutes twice a day and that's not optional in the home setting.

Ive used dakins on a patient in the past but again was in the hospital setting twice a day.

Primary goal is to keep patient at home but I'm wondering if he wouldn't be more appropriate in LTAC.

Any pointers appreciated.

Thanks

[Nurse SMS, MSN, RN]

Sounds like he needs cultures and probable admission to me. Pseudomonas progresses quickly and he probably needs IV antibiotics.

[Eagle2110, ADN, BSN, CNM]

Topical Gentamicin covers pseudomonas but he really needs to get his edema under control. If he cannot care for himself, then maybe it should be suggested that he goes somewhere with around the clock help. Also may need more compression than what the unna boot is giving. Hope this helps.

Edited to add..... Reread your post. If the goal is to keep him at home, is a sitter feasible?