Stage 3 with undermining

[coco3299]

Hey guys, thanks for any help in advance... I am a home health nurse and while I was in orientation I was seeing a patient who is very pleasant and concerned about the wound. It has gotten to a certain point, like 4x2.5 and undermining and stopped healing. THe patient is only 80 lbs. Iodoform has been used with mesalt for quite some time. It was SLOWLY closing last I saw her but I had to change areas because her regular nurse was back off leave. SHe was none too pleased to have that nurse back and I am finding this nurse may not be as into such patients as this one (and one other wound pt) as she should. Recently at team meeting she said the wound was in DECLINE again. Ugh. What can be done for this lady to see what the problem is, she lives a sedentary lifestyle but will stay off the sacrum if requested, she says she doesnt know and does not know why this year old wound is not healing.

When a wound is anemic, what does that mean exactly and how can you know for sure?

Does silver nitrate have usually good results?

When is mesalt used?

How long should one dressing be used?

[mommy.19, MSN, RN, APRN]

Hi Coco,

Many things could be preventing the wound from healing including low protein levels, is the pt diabetic or on any immune suppressants? Does the pt smoke? Offloading the area is the number 1 priority with a decubitus, then pinpointing any aggravating factors. Is it infected? How often is the dressing being changed?

*Mesalt is generally used for enzymatic debridement and is not sparing to viable periwound tissue, i.e. if the mesalt touches viable tissue it will chew it up just as it would do to slough or fibrin.

*If the wound is not progressing after about a month I'd probably change product or try to find any underlying problems aforementioned such as infection, low protein levels, something from the pt's H&P.

*Silver nitrate is used to treat hypergranulation and sometimes used in place of surgical or mechanical debridement for "chronic granulation tissue" or the pinkish, slick looking (for lack of a better description) tissue around a chronic wound. I find that this is handy when the patient is not having serial debridements by a physician to mechanically remove the nonviable tissue, but ensure that the Silver Nitrate is deactivated by NS after it is applied or it will continue to cauterize the tissue.

Hope this helps a little! :)