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'rotting' not for weak stomachs...

I work home health, and have a patient who is .....lets put it "rotting" away. I have tried multiple times to get her BLE amputated but the dr said not medically stable...and has sent her home to die. she is only on hydrocodone elixer TID. This last hospital stay....at some point someone 'broke' her ankle and now when you raise her right leg her ankle drops at a 90 degree angle. Let me say I am no wound care nurse, but plan to go to school for wound care/ostomy and these legs/smell make me sick to my stomach. As soon as you walk into the house you smell it. we only see the patient once a week dt it is a non healing wound...duh....and medicare will not allow us more....I don't want to see those legs more...the family does wound care daily....or at least they are supposed to. we clean with NS, and then do a W/D with NS and then also they apply hydrogel also...and wrap with kerlix. these wounds are from behind both knees to the tips of both toes. Black, unstageable, you can see bone dt at parts the flesh is now fallen off, and the muscle is hanging out of the leg. I think at any time the toes will fall off into our hands. What do we do for this patient? This patient pain would be gone if the legs were gone. but the dr does not want to operate, and the family at the same times does not want the operation......why you ask? the monthly check the patient gets...the family takes.

This patient is in the bed moaning at all times of the day and night, only getting hydrocodone TID, with a broken right ankle, and rotting lower extremities. She has been like this now for at least 4.5 months. Any suggestions? I know I won't heal her.....I want any either support, anyone I can talk to to help this lady. Or I guess I just really needed to hear what other nurses thought of this case. my heart goes out to this patient, and I wish I could make her pain go away!

NurseyBaby'05, BSN, RN

Specializes in Neuro/Med-Surg/Oncology.

I would contact the department of aging and report elder abuse ASAP. This is just wrong. Proper care is being withheld from her. :angryfire

I don't know what can help, maybe try calling adult protective services? Suggest hospice or pain management of some sort? How does the family seem to feel about her pain? It seems cruel to let her suffer. Please keep us updated..what an awful thing for a human being to endure.

Yes, definitely what the other two posters said. The thing that you can do immediately is talk to the doc about stronger pain meds; there is no way on earth that Vicodin (I think that's what you said your pt was getting) is going to touch that kind of pain; if the doc sent her home to die, then she should get morphine STAT. This situation is just heartbreaking; please take action by contacting the appropriate authorities immediately. :angryfire

those dressings aren't too hot, either.

suebird :o

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health.

Perhaps hospice could be brought in and then there would be access to more services and pain control? I am assuming she is in a terminal condition.

Thank you! I was wanting to see I was not crazy in thinking this. I have no clue why no one will help her. With all my "consultations" I am going to this dr....and I hope he will change her to hospice....or give her something else to control the pain. I never ever hope for a patient to die. But this patient of mine, I pray that the Lord will take her to stop her pain and suffering. I cry after each of my visits with her. I hate it. Her dr just does not care, and seems mad when I call about her. I hate that. This dr does not like our home health agency anyways dt he is the medical director of the other home health agency. So he gives us trouble. Which is not good, very 'childish' for him. It is not about him and money...it should be about his patients.....but it is not. And that is sad. But I am going to cont to try and a try to get my patient comfortable. and I will keep ya all updated as things happen.

Thanks for your support.

:uhoh21:

{{{{{{{{{{{{{HUGS}}}}}}}}}}}}} to you and your poor patient. Please continue to actively advocate for her in any way you can.

if he is with the "other" hha, why is his patient with another agency? makes me wonder.

suebird :p

the family does not like the other agency....the other agency is not good...we are better ....may I say so myself....we get a lot of the other agency patients because of how much the other HHA ..........'sucks'....hate to put it that way....but thats how the patients put it. I have put a call into the dr today. to either get this patient on hospice for a morphine pump, to get her a pain patch, to get her a implanted morphine pump....something besides hydrocodone. and of course no call back today. I called that dr 3 times, and I know I got him mad at me. i will once again make him mad at me tomorrow. I know he doesn't want me calling him on christmas!!!!!! Thank you for all your support!!!!!

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health.

Bebop 1,

I am really glad that you are being such a great advocate. I know it is not easy when people get mad at you (MD), but what you are doing for this patient is just hugely important, kind, and caring. Keep it up and don't let the jesrks get you down. This MD may have written her off in their mind because they just don't want or can't deal with this difficult situation. You are a wonderful person to keey advocating the way you are. Thank you for all your work on your patient's behalf.

crb613, BSN, RN

Specializes in Med Surg/Tele/ER.

Why wait for the MD to call....Why not just get social services involved now. This poor pt is in pain & if you have ever had horrible pain, a minute can seem like a lifetime. Better yet why not call 911, this pt needs help now. It would seem to me that the more people you have involved the harder it would be for this pt to be ignored. I am just a nsg student & don't know all the rules, but please don't let this go on any longer.:crying2:

How horrible! Keep documenting unrelieved pain and document MD phone calls. It's hospice time.

can the md be reported?

suebird :p

i like the idea of calling 911- and too bad if the family doesn't like it.

once she's transported to the hospital, you can be assured she will receive much more aggressive pain mgmt., as well as social services getting involved to ensure she receives the proper services at home.

bless you for being this lady's guardian angel.

let your heart be your guide.

and document everything....

leslie

All patients and family have a choice of homecare agencies. Certain social workers try to forget that rule, especially if a hospital has their own agency. Any Dr affiliated with a homecare agency such as having a relative own one can cause the Dr alot of hassle. I personally know one Dr who was reviewed by medicare and fined for how many of his patients had his brother inlaws homecare company( kickbacks common ). As for this patient, I would contact protective services. Once they are on the case, this physician will also have to become involved. He can literally let the patient go with a 30 day notice if he feels backed against the wall by the protective services. Hospice would be ideal for this patient . Pain mng and dying with comfort, support and dignity to say the least. Hospice can use their medical physician.

My Goodness!. I agree with the others. Social workers, Omsbudsman, Dept of Aging should be notified. How about a Duragesic patch with the Hydrocodone for breakthrough pain. The odor will also be a huge challenge. Might want to try a Charcoal type dressing. Hopefully these items will be covered. Can't this pt be sent to ER for an eval and possible admit to get these issues under control??? If they aren't septic now they will more than likely be soon. Sounds like you are a wonderful nurse! BTW I have used Vicks in MY nares to enable me to tolerate the horrible stench of decaying tissue.

Can't this pt be sent to ER for an eval and possible admit to get these issues under control??? If they aren't septic now they will more than likely be soon. Sounds like you are a wonderful nurse! BTW I have used Vicks in MY nares to enable me to tolerate the horrible stench of decaying tissue.

that's exactly why i think 911 should be called.

contacting these other agencies could take days, or even weeks.

time is critical now.

her doctor appears dismissive and she needs treatment NOW. this woman is suffering needlessly. someone has to do something now. once 911 is called and she's transported to the er, it might possibly open up a can of worms, including negligence, abandonment or even abuse. the hospital would treat her and also get the appropriate authorities involved. this is downright barbaric. i still maintain 911 is the way to go as this is an emergent situation and would be the fastest way to alleviate this poor soul's suffering.

leslie

wonder when the op will give us an update????

suebird :icon_razz

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