Should this situation be referred to a WOC nurse?

[erin3900]

I would like to ask a question about whether a referral to a WOC nurse may be appropriate in a particular situation. I am currently a second year nursing student; so while I do know something about wound care, my knowledge on this subject is not particularly specialized. My grandpa spent 4 weeks in a Cardiovascular ICU and was transferred to the Burn ICU here about two weeks ago. He has no burn injuries, but the cardiovascular ICU had to make room for additional surgical patients, so my grandpa was moved at that time. He has been suffering from a variety of conditions (seizures, pneumonia, etc.).

The burn unit nurse told my mom yesterday that my grandpa had developed pressure sores on his back, and the RN said that she was putting "cream" on the sores to treat them. The nurse is not putting a dressing on the sores, because (as she says, and perhaps rightfully so) my grandpa moves around in bed a lot (although he's not fully conscious) and his moving around would keep pulling the dressings off. (I have not seen the sores myself, and the nurse did not describe the sores in detail to my mom; however, I would assume that they are at least stage II ulcers if the nurse took the time to even mention them to my mom). When my mom described this to me, I told her that I thought it may be prudent to have a WOC nurse take a look at the sores in order to give an assessment about how best to treat them. So when my mom went in to the hospital today, she did ask the same nurse if it would be possible to have a WOC consult done. The burn unit nurse replied, "Well, we are the wound experts here. After all, this is a burn unit." The nurse seemed very put off that someone would even ask her such a thing.

Can you tell me what you think? I have a hard time believing that "cream" in and of itself will be enough to promote sufficient healing. Am I wrong to think this? In a home health position I used to have, when I used to help with dressing wounds for a quadriplegic, I used a variety of different wound dressing techniques and types.

My grandpa has been on an air mattress for the whole 6 weeks that he's been in the hospital, but I'm concerned that if these sores continue to get worse that his prognosis will continue to decline. My intent is not to upset the burn unit nurse by pursuing this further, but it does seem to me that we should be able to get a WOC consult if it is requested.

Any and all advice would be greatly appreciated.:bowingpur

[KimT08]

As a wound care nurse I can tell you that yes your grandpa should be seen by a wound care nurse. While the burn nurses are experienced with wounds resulting from burns they are probably not very experienced with other types of wounds. It sounds as if your grandpa's wounds are probably caused by friction and/or sheer from him moving about in the bed a lot. They could however be associated with something else also such as shingles (as his body has been through a lot of stress), a reaction from a medication, a reaction from heat, moisture, and/or incontinence. There are several factors that need to be evaluated and ruled out including his nutrional status. Simply putting a cream on it will probably not fix the problem. You must find the cause of the wounds, eliminate that cause, and treat the wound. The air mattress is probably a good start. I would make sure it is an alternating air mattress as their are many mattress. The alternating air mattress provides pressure relief. One thing that you and your family can do if your grandpa is stable enough is change the position of the head of the bed. Most hospital beds are set about 30-45 degree angles which is not good for people who slide down in bed because that makes friction and sheer. If your grandpa like to have his head elevated alternate between 20-25 degrees, then 30-45 degrees, then up to 90 degrees, etc. which will help to displace the pressure to different points. This will help if the wounds are caused from pressure. You could also try to get your grandpa to lay on his side if his condition allows it. These are just a few simple things that will get you started. If the burn nurses are offended when you ask for a wound care nurse just ask the doctor to write the consult or if you miss the doctor I would just explain to the burn nurses that while you have no doubt about their ability to care for wounds you would prefer to have a wound care nurse consult to ensure your grandpa can get the best possible wound care evaluation and treatment to prevent his hospital acquired pressure ulcers from getting worse. I hope this helps!

[erin3900]

Thank you so much -- that actually really does help!! I'm going to follow up on this then and see if we can have a WOC nurse do a wound consult on him. Even though I'm a nursing student and usually feel pretty confident in my assessments given certain situations, I always hesitate at the thought of "making waves" -- but there are times (such as this one) where I feel it really is in the patient's (in this case, my grandpa's) best interests to take this a step further to possibly prevent other complications.

Thanks again for your help!

[CoffeeRTC, BSN, RN]

Nope...I would ask too. I'd want to know exactly what type of wound it is too. I work LTC and see alot of wounds that came from in the hospital. The fact that he "moves around alot" doesn't mean they can't find a dressing that will stay on, but then again, he might not need a dressing per se.

Ask the doc to order a consult.