Stage 2 wound...

Couple of things, This is not a stage 2, stage 2's don't have slough meaning that this is either a stage 3 or stage 4. You can't really tell because the slough is covering, you dont know if its just skin or if there is bone under there. Wet to dry dressing: if you are doing them right it could work, you need to wet the gauze, put on the wound, let it dry then rip it off that way, if it works it will take slough with it, i have often seen people re wet the dressing before removal which defeats the purpose. Aqualcel AG is not needed. This dressing would be for a high drainage wound, it would absorb the drainage which is not a problem here. Wetting the aqual is not correct, again this is to absorb drainage so wetting it defeats the purpose. The AG part of the dressing would be antimicrobial, if there is a "high bio burdern" meaning there is too much bacteria in the wound. Not infected, just too much bacteria which would make the wound look dusty and pale. Not needed here. Start with Santyl which debrids the wound taking out the slough and cover with an foam silicone dressing, we use meplix. That will absorb the scant drainage without drying it out. Use Santyl as directed, if no reduction in slough within a week or 2, it will need a surgical debridement. Remember she stills needs to be turned every 2 hours and stay off that pressure point for it to heal and not get worse. Hope this helps.

Wet to dry dressing: if you are doing them right it could work, you need to wet the gauze, put on the wound, let it dry then rip it off that way, if it works it will take slough with it, i have often seen people re wet the dressing before removal which defeats the purpose.

Please do not do wet-to dry. Please do not "rip it off". How about consulting a WOCN?

I agree that it is beyond stage II.

You need to get an order either for Santyl or Hydrofera Blue. I prefer the latter but it must be applied correctly.

Thank you all! Will work on my staging.

Gonna try the Santyl.

rip it off .

DO NOT EVER rip off a dressing on an elderly patient!!! Did you fall asleep during the part of your education that dealt with Aged Care and the frailty of their skin?? *facepalm*

Wet-to-dry NS+ gauze dressings have been thoroughly debunked in the wound care business. (The fact that your wound looked worse after using them is a clue...) I know some MDs still prescribe them but bad, bad, bad.

Has anybody looked at her serum proteins? Inadequate alb and prealb -> no healing. Also need Vit C and perhaps anabolic steroids for new tissue.

You want a WOCN consult stat. There's a wound care forum under Specialties (check yellow band at top of page)-- people there have been very helpful to me in the past.

My facility has had good results from placing an alginate (sp?) or aquacel dressing cut to size in the wound bed, covering it with a 4x4 and a transparent cover like a tegaderm.

Our doctor explained to me once that these sorts of dressings actually secrete some sort of gel that maitains a moist healing environment. Plus, these dressings are changed once a day or qod. Old school wet to drys needed to be changed multiple times a day. So it's a labor saver.

I haven't seen a wet to dry dressing since nursing school.

I am a registered nurse of nearly 5 years. I am looking to expand my current scope of practice and am interested in wound care. I am just getting my feet wet, however, I would like to know what is the best wound, ostomy and continence text to buy that covers the different types of wounds, perhaps pathophysiology and type of products used for wounds. Also, any other information you feel that will be valuable!

Thanks in advance!

Get a wound specialist consult stat-best way is probably to get patient to a wound clinic for bedside sharps debridement (if patient is not hospice)

Turn to relieve pressure as others have suggested

Consider nutritional consult as others have suggested (wound clinic will probably do this)

No specific dressing will magically heal this wound, must address etiology and the dead tissue that is preventing the wound from healing

Hope this helps!

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Sounds like an unstageable to me because of slough covering wound bed you need santyl to wound bed with vaseline gauze covering the santyl it helps activate it and keeps wound bed moist, skin prep peri area and cove with foam dsg air mattress and offloading are a must also hope this helps ...I love wound care

Ca Alginates do not "secrete" a gel. They become gel-like after they get wet.