Wound care advice please!!!

[Mandy LVN]

I need some advice! I have an 80 yr old chair-bound patient with what was reported to me as a Stage 2 pressure ulcer. I arrived at the home and found the wound to be more of a severe excoriation due to probably sitting in feces for too long. There are multiple open areas under the scrotum, on the buttocks and around the orifice. Most are small, less than .25 inch in diameter, but are red, oozing serosanguanous (sp?). What kind of dressing can I place on this? My thoughts are multiple small duoderms. My concern is possibly tearing the skin around the wounds. I will be placing a foley on my next visit (tomorrow) and will probably cover them with duoderm until I can figure out something else to help these heal. I am also going to educate the family to clean him AT LEAST every hour, if he has any feces thne clean him immediately. Any ideas as to what else I can use? All suggestions will be greatly appreciated! Thanks

[KateRN1]

See here for wound staging descriptions, sounds like a stage 2 to me. I like hydrocolloid dressings (duoderm or duoderm thin) for stage 2s but let it stay for 3-5 days before removal. I would probably do a large sacral size instead of multiple small pieces if the peri-wound skin is inflamed. If you have access to Medihoney's products, they do a great job of healing wounds if you can keep the pressure off. Don't forget to instruct the patient/family on nutrition interventions, fluid requirements, etc. Can the patient stay off his bottom for a few days to facilitate healing?

[tabster224]

It is possible that the wounds could be a IAD (incontinence associated dermatitis), I am not saying they aren't stage 2's PU but I did have a patient that when she sat in urine and/or feces she would get these small areas that had serosangeous to bloody drainage. We kept skin protectant (it was like a paste, called sensi-care I think) on her that had zinc oxide in it and it would take care of the areas. No matter how many times we would instruct her about keeping clean, she would claim her family kept her clean, but myself or the other nurse would end up changing soaking wet or feces covered depends almost every visit (she did have bad bladder spasms and had leakage with her catheter, and we also think she was tugging on catheter or rather family was when transferring her, but could never prove it). Anyway, as Kate said it could very well be Stage 2 PU, just another thought of what it could possibly be. Other than the skin protectant we did use Hydrocolloid too. And I agree don't use the small pieces and keep on 5-7 days before removing, sooner removal will cause more open areas. Good luck!

[Isabelle49]

Unless the wounds are over bony prominences, you are probably right that they are not P.U.'s. I would suggest scrupulous hygiene, every hour as you suggested and applying a protectant such as AloeVesta, very thick petrolatum based product. Using any type of hydrocolloid dressing could aggravate the problem as they often wrinkle and bunch up causing worse pressure than normal sitting does. Another product used in the NICU for severe excoriation is Preparation H, as it contains whale oil and does one hell of a great job. We used the Preparation H that did not contain the vasoconstrictor on babies who had a colostomy reversal and severe breakdown to the buttocks area when stooling - I guess their skin never toughened up over time because of the early placement of the colostomy.

[Mandy LVN]

Thank you for all the ideas/suggestions! I will keep these in mind for when the patient is discharged from the hospital. He went in on Thursday for unrelated issues. Not sure if or when he will return home. I almost think he would be better off going to LTAC.

[Merced]

If the area is bright red, consider anti-fungal powder to keep the area dry.