Wound with no change, good or bad

Posted
by joyflnoyz joyflnoyz, LPN Member Nurse

Specializes in home health. Has 41 years experience.

I am a HH nurse . I have a client whom we've been caring for with a ST II wound to coccyx area. This is/will be chronic; she is WC bound, requires hoyer lift, hemiplegia. wound is clean, scant if any drainage, no infection. Base good color. , approx 1 cm x1cm with 0.25 cm depth

Wound is static- is not improving, is not deteriorating. Spends most of her day in wheel chair or recliner. Spouse wants her next to him as much as possible, and neither of them want her to be placed in bed to off load. Usually no dressing in place when we arrive for visit. We've tried everything from barrier ointments, medihoney, alginates, foam dressings and are currently packing with iodoform, covering with foam dessing. Looking for advice-- next step collagen powder?? How often to use? Cover with what? have been doing internet searches but not really finding anything other than ads for products. Not really a candidate for a wound clinic.. PCP looks to us to decide what to do with wounds.


Thanks for any suggestions or points to the right direction..

sign me, Stumped.

michksmith14, BSN, RN

Specializes in CEN. Has 8 years experience. 85 Posts

Is the WC electronic so that she can change angles? Does she have a custom chair cushion? The biggest thing will be offloading in order to get it to heal. As you know, even slight changes every hour can help. Without offloading, wound care doesn't matter too much aside from staving off infection.

No matter what you put into the wound, some type of foam dressing is best as it can help keep at least some pressure off the area. Collagen powder isn't a bad idea. It can be used with silver gel, which would provide some antimicrobial effect and a little moisture if the wound is dry. This can be purchased over the counter. Make sure they change the dressing if she is incontinent or if it gets soiled.

When doing any sort of packing, like iodoform, just make sure it is loosely tucked in there and not tightly packed, otherwise the new tissue cannot fill in against the packing.

anitalaff

anitalaff, BSN, RN

Specializes in Public health program evaluation. Has 6 years experience. 117 Posts

On 6/4/2019 at 9:18 PM, joyflnoyz said:

I am a HH nurse . I have a client whom we've been caring for with a ST II wound to coccyx area. This is/will be chronic; she is WC bound, requires hoyer lift, hemiplegia. wound is clean, scant if any drainage, no infection. Base good color. , approx 1 cm x1cm with 0.25 cm depth

Wound is static- is not improving, is not deteriorating. Spends most of her day in wheel chair or recliner. Spouse wants her next to him as much as possible, and neither of them want her to be placed in bed to off load. Usually no dressing in place when we arrive for visit. We've tried everything from barrier ointments, medihoney, alginates, foam dressings and are currently packing with iodoform, covering with foam dessing. Looking for advice-- next step collagen powder?? How often to use? Cover with what? have been doing internet searches but not really finding anything other than ads for products. Not really a candidate for a wound clinic.. PCP looks to us to decide what to do with wounds.


Thanks for any suggestions or points to the right direction..

sign me, Stumped.

Is this a stage II ulcer or stage III? How is packing appropriate for stage II? Maybe that's a typo.

I'm sure your hands are tied on this one, but it sounds like the main barrier to wound healing is the spouse. His needs are being met before hers are. I would work on him first. You can't work miracles with wound dressings when 24/7 something else is working against your goal.

If she doesn't already have a roho cushion, that would be a good start, but they cost $$.

Seeing as this is a fairly dry wound, I would stop all the iodine, which has a drying effect. Have you tried hydrocolloid dressings already? They are great for shallow wounds with low exudate, and a product like Tegasorb will stay on through showering and transfers. If you have already gone this route with no success, there is always the Nanova dressing- small vacuum assisted dressing (not the big VAC) to stimulate tissue growth.

Seeing intractable wounds like this is super frustrating and I feel for your situation, wanting to get a solution for your patient. I also feel strongly that the number one thing you can do is health teaching with the spouse until he is on board with getting this wound healed. He may be under the impression that how she spends her day is not important to wound healing. We know differently.

I hope this helps.

TAKOO01

TAKOO01, BSN

Has 6 years experience. 1 Article; 257 Posts

I agree with anitalaff. The patient has to spend some time off of the wound, laying on her stomach or side. Im assuming that if they are at home, and shes in the w/c right by his side, theyre probably just watching tv. Cant they watch tv in the bedroom while she lays down? Do they have a deep couch or pullout couch that she could lay on while he sits next to her in the living room?

Why is she not a candidate for a wound clinic?

What is her diet like? It needs to support the healing process.

It sounds like you are putting too much on yourself. You cant work miracles. The patient has to be a participant in her healing. Wound dressings are necessary, but useless without supporting activities.

Eagle2110

Eagle2110, ADN, BSN, CNM

Specializes in Wound Care. Has 5 years experience. 110 Posts

Hi!

All wounds are candidates for a wound clinic! At the very least, someone who specializes in wound care can give an educated and experienced opinion.

When healing a wound, one must identify what caused it in the first place, if pressure is still present, then it may still be the culprit.

Roho cushions are often covered by insurance , I order them all the time with no out of pocket expenses for my patients.

Hope this helps!!