a "bad" wound

[bebop1]

Help! I have a patient that is dear to my heart. I am a home health nurse, and have a pt that was on the wound vac, doing great, but according to medicare guidelines the wound was not closeing the 10% the two cycles...so it stalled. even thought the undermining, and the tunnels ended up closing. so the took the wound vac away from my patient. so now here I am with out a wound vac on a huge coccyx wound. it was like 4x2x1...now it is 5.5x3x1.5. and the wound was so pretty we had been doing Arglaes powder, ca alginate dressing changes for the last three weeks. it has actully been doing well...and little aspects of the wound is closing. But within the last three days the wound has went from wonderful pink tissue to dark red, one area of black and a small area of bone. the patient has a "healed" wound stage III on his right hip that just broke down within the last three days with no real reason to break down.

words of wisdom? Md's at least gave me antibiotics, pt caregive is not wanting patient to pass away in hospital, will not agree to hospice. I have tried everthing for this couple. anything else out there I could try? or suggest? I am open!!!!! pretty much what I suggest to the dr they let me do....

if things get bad my DON said we have to report to APS. so I am not sure. I know this caregiver does everything to protect her husband. but the doctors are not helping too much, but yet the caregive will not bring her husband to the doctors. so I am the one caught in the middle!!!! help!!!!!!!!!!!!!!!

[cookie102]

how about getting MSW involved....does your agency have a hospice team that could just talk to the caregiver?

[managing just]

Have found Medicinal honey very effective in large wounds that are difficult to maintain. Twice daily application has worked best but once daily effective too. Have managed to heal large full thickness wounds with tunelling in elderly patients in the past. You might also like to look at the persons diet and intake if the other areas are deteriorating something else is going on within the body.Dietary suppliments with zinc in particular may be very helpful. The honey is both antibacterial and healing.:nuke:

[morte, LPN, LVN]

yeah, i was thinking diet....perhaps, it is just time.........

[XB9S, BSN, MSN, EdD, RN, APN]

My first thought went to nutrition as well, is there anyway of getting a dietician to do an assessment with recommendations?

[mrclpn]

I agree with the other posts about diet. Vitamin C and zinc are important. How much protein is he getting? If other health issues don't prevent it, you should see about increasing the amount of lean protein in his diet.

[ibtisamwm]

I was thinking if this pt is diabetic? becaused uncontroled diabetes will afect on wound healing

[KimT08]

Nutrition is important to consider. Could this be a kennedy terminal ulcer? They typically occur when a patient is getting near the end of life. If the wound is infected you could try using 1/4 strength Dakin's solution. I have tried this before when I had a wound that has traveled the same path you are describing with very good success. I would definately help the wife to understand if this patient does not have a good prognosis the wound may never heal.

[knorahs65]

curious as to what happened with this patient's wound. couple of things come to mind with considering reasons for a wound not progressing, nutrition one... having labs drawn to check an albumin level......this can give you a picture of the patient's protein status......before starting antibiotic therapy getting a culture of the wound and running a sensitivity to ensure the right drug is fighting the infection..........and if a patient is not turned and repositioned it only takes a short amount of time before pressure can cause a lot of damage.......