Worries with family member's care

[petali]

Hello,

I'm a bsn nursing student (finished my 2nd year) and an 86yo family member is being hospitalized in a small hospital in the countryside of France. There are things that have happened during his hospitalization that I perceive as not good. He suffers from pad (peripheral artery disease) in his legs and had an above-the-knee amputation of one of them beginning of June. He has a stage 4 sacral ulcer, as well as 5 nerotic pressure ulcers on the remaining foot. I have some questions: I am a nursing student, so I know a bit about how to care for prensure ulcers, but I haven't worked in the "real world" so I don't know much what actually gets done in the hospital. Of course, since my family member is in a French hospital, things might be different. I could benefit from your experiences as nurses as well as with family in the hospital, and how to advocate for them if I'm right and he isn't being treated proverly.

1: pressure ulcer care

I learned that one of tge most important thing for pressure ulcers to heal is to relieve the pressure. Tim has a special pressure-relieving mattress. The nuses think that this means he doesn't need to be turned. When I asked them, they told me that you are not supposed to put pillows or foam wedges on the special mattresses. Is this true? Tim ends up spending all day on his sacrum, and so he never has any relief from the pressure. If the nurses won't do it, I was thinking of buying a foam wedge designed to get him off the pressure ulcer (it has a hole for the sacral area so that it doesn't come into contact). Would that be a good idea?

2: sleeping pills

During his hospital stay, Timy has been somnolent, and when conscious, would talk nonsense. He does not have a history of dementia, and does not have atherosclerosis in his cerebral arteries. A nurse recently told me that he had sleeping pills each afternoon, so that he would be calm during toileting. Is this common/safe practice?

3: pain control

We have seen that morphine makes my grandfather incredibly loopy- right now he is on ketadine and morphine to control his pain. Are there any alternatives you know of that relieve pain without somnolence in the elderlyrics?

4: debridement

I had a chance to observe the pressure ulcers on my grandfather's foot. They were necrotic (black), which I'm guessing means they haven't been debrided. From what I've learned, I thought that necrotic pressure ulcers should be debrided to promote wound healing. Why wouldn't they debride it?

Lastly, I would appreciate anybody's tips on having a family member in the hospital, and how to advocate for them without making the staff's lives any harder.

[meanmaryjean, DNP, RN]

It must be incredibly frustrating worrying about this going on in another country. But unfortunately, we cannot, per TOS, provide you with medical advice regarding your loved one.

[mrsboots87]

Most of what you are asking is in the realm of medical advice. However, to touch on the "pressure relieving matrss" there are actually some bed types that do not require much patient repositioning. A clinitron bed comes to mind (sand bed). It blows air into the sand so the lower back down is essentially floating with minimal pressure being applied. Putting a wedge in this type of bed could actually damage the bed as it would warm the sand part of the mattress and also refuse the airflow of the mattress in general. There are other types of pressure relieving mattresses that don't require as much repositioning as well.

Basically, don't bring anything to your family member to alter their care. As a new nursing student, you know just enough to get concerned about everything, but not enough to understand why things are done the way they are. Don't be afraid to ask questions and advocate for your family memeber. But don't do anything to alter their care or the medical items based on the minimal nursing knowledge you have at this point.

[petali]

Thank you for your responses:

I'm sorry, I didn't realize that I wasn't following TOS, thank you for letting me know!

Thanks mrsboots87 for clarifying that with some kinds of beds you do not want pillows/wedges being used. I looked up the manual for the specific mattress he has, and it's an automorpho from asklésanté. In the manual, it says that it functions by inflating and deflating 18 different cells with air. It also mentions that position should be changed frequently while using the mattress; at least every 2 or 3 hours. But it also mentions that there should not be objects between the mattress and the body such as pillows.

I don't think I would be this worried normally, but when he was first admitted to the hospital 6 weeks ago, there was only a stage 1 pressure ulcer on his sacrum (non-blancheable erythema). It has since progressed to stage 4 (bone and muscle visible), even though the whole time he has been on this kind of mattress.

If you had this kind of patient and this kind of mattress, would you be performing position changes?

[Lunah, MSN, RN]

Again, we really can't comment on the care of your loved one. I hope you find the answers you're seeking!