SeCond guessing this one

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Specializes in LTC.

i had a pt today who bumped her shin in something and it was 5cm long x 0.5cm wide. she's on coumadin and aricept. the edges couldn't be approximated and it looked more flat vs having depth to it and was crescent moon shaped. well later on i noticed it had bled thru the dsg so i redid it. i got another nurse to come look at it with me because i was iffy on whether or not it needed stiches and after we reassessed it we both concluded there be no way it could be stitched so to make the final decision i called the md and asked for a wound consult and a different dsg order than what our protocol is ours is for hydrogel dsg change q 3 days and prn i felt like it should be done daily bid minimum so he gave me orders to monitor bleeding q shift hold the coumadin if any inc bleeding and to do a bactroban dsg q shift so i did all this but i'm second guessing myself and wondering if i shouldve just sent her on over to the er. i think there is less chance of infection by it being poked at q shift vs 3 days. i even told the md i didn't think it was stitchable but i wasn't 100 percent sure yet. what if another nurse decides to send her out? ughh. she's diabetic and she has always been known to ge cuts and scrapes but they usually heal up. i'll feel pretty stupid if she gets sent out i'm afraid it will seem like i didn't do enough. she said it didn't hurt . it just worries me. i'm off the next day but i'm tempted to go in and redo the dsg just to see if it looks any better. i'm so paranoid and haven't been this unsure in a long time. it was a stressful shift anyhow we were short a nurse and had 2 extra halls to medicate chart on and do treatments on that's 40 residents for 2 nurses wirh all kinds of residents from demented to skilled to tube feeders and 2 picc lines and we had new orders to write an iv to get started plus tons of blood sugars and insulins to do.

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Specializes in LTC.

FYI that's not 40 residents between us . That's 40 residents per nurse on 2 nd shift. Way too many I think but just wanted to clarify that. Sorry the spelling is a little weird I use my phone for the net.

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Specializes in LTC, AL, Corrections, Home health.

well, I always hate making that call... to send out, not to send out... And I usually try to be fairly conservative with my decision (though I have felt silly a time or two when the pt was completely fine), but you had another nurse there to back you up. I would just be sure it got crossed over to the next shift to check the site for bleeding.

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wow thats a lot of pt for 2 nurses. I have second guessed myself as well i think we all do. Having someone else to take a look is the right thing to do if you second guess yourself. Always nice to have back up. As long as you chart that you had someone else look

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Specializes in LTC, MED-SURG.

ok well first all i can say is dont second guess your self. to me it sounds like you did it right. you called the doctor with what happened, he/she made the orders, you followed the orders. yes it may get infected, but even if it was a tiny scratch that you might not even think to put a bandaid on could get infected. just remember if you think that something would work good for a treatment ask the doctor for that, (ex, may we have an order for such and such dressing, and to be changed twice a day?) if you ask them before they verbalize an order in my experience they will often do that order, and if not your off the hook anyway as long as you follow the order.

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Specializes in LTC.

I feel better now. It's actually looking much better now. No more bleeding and no drainage. It's not even bruised like I thought it would become. The tx seems to be working so far. I'm glad I got a second opinion that night. I just hate it when I second guess myself like that.

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Specializes in LTC, Memory loss, PDN.

Hydrogel drsgs are not suited for draining wounds due to their limited absorbency, as you found out. Furthermore, the patient is a diabetic and the wound needs to be looked at more often than q 72 hrs. Steri strips were not an option (couldn't approximate) and it was a superficial wound. Sounds to me like you took very good care of the patient and got an order for an appropriate dressing.

P.S.

A good LTC nurse knows when to send a patient to the ER.

A great one knows when not to. ;)

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