Wound question,

[Finallydidit]

Work in LTC, Last night nurse from other unit ask me to come and look at a heel of a Resident that was admitted 16 days ago. (Not my Resident, so I don't know any Dx, or history)

Residents heel was Black and hard from the back of his heel all the way to the beginning of his arch.

He has had (or not) 3 skin assessments, since being admitted. Initial assessment when admitted 16 days ago, one sched weekly 5 days after being admitted, and one sched weekly 7 days later. (4 days ago) Also he gets a shower every other day, (last one 1 day ago) Res. also wears TED Hose, that are put on and taken off daily. His skin assessments are sched during 11-7 shift, showers are during 7-3 shift, and TEDs are taken off during 3-11 shift. Therefore, no less then 5-6 nurses and countless aids have provided care for this gentleman, without ever mentioning, or documenting an issue.

My question is how long does it take for a wound to go from nothing to unstagable? Did the admitting RN most likely miss this with the initial skin assessment 16 days ago? Did the shower team really not see anything the day before and it just showed up last night?

I know heel wounds are different, but I have not had any experience with them, if I see redness, or fell that it is soft, I apply skin prep and order a heelz-up cushion and that resolves the issue.

Im just really curious as to How fast can they change?

Thanks for any enlightment...

[wound warrier]

Seems to me that this was missed on numerous occasions. There could be an arterial component to the wound, and that would speed the progression of the wound. It did not happen overnight, has been there for while.

[Finallydidit]

Seems to me that this was missed on numerous occasions. It did not happen overnight, has been there for while.

Thats what I thought too, and it just burns me up!!

What I don't get is how can a person, if they are doing their job at all miss something like that.

[leslie :-D]

Seems to me that this was missed on numerous occasions. It did not happen overnight, has been there for while.

Thats what I thought too, and it just burns me up!!

What I don't get is how can a person, if they are doing their job at all miss something like that.

because they're not doing their job, that's why.

sadly, you will find example after example of txs being charted as done, when it is clear they haven't been.

i've seen all types of neglect and it sickens me.

this thread reminds me of times i've been on interviews, and the interviewer asks me my weakest quality.

i always answer: "i get extremely upset when others do not live up to my high standards."

when they ask me my strongest quality?

"my high standards of care".

it's a win/win every time.

back to the question:

wounds deteriorating to eschar will be hastened by circulatory problems (dm, pvd), malnutrition, immunocompromised, etc.

not knowing the pt's past and current medical condition, there still would have been a stage 1-2 on admission.

i'm not going to blame the aides who give the showers.

even when washing their feet, it's easy to overlook the heels.

it should have definitely been caught on admission.

a thorough skin check is important to do, and it wasn't done.

bottom line.

leslie

[retiredlady]

Ted stockings can cause heel ulcers in patients with pheripheral artery disease quickly and they shouldn't be used with them. I think is says that on the package. It's a shame that it got to that. It sounds like thorough checks were not being done.

[mskate]

sounds like some false documentation to me and people taking short cuts to me.... saying you assessed something and that the assessment is xyz - and it CLEARLY was not. thats a major, major problem.

[carolmaccas66, BSN, RN]

Was the person a diabetic? Most in LTC are.

Wound can go necrotic/infected whatever really quite fast, especially if the person has many co-mobidities, and the blood flow is occluded for some reason. And TED stockings should only be used intermittently, in some patients, not at all.

Not documenting anything is serious too - was there no wound chart started? If not something should get now documented. He

I would tell the other nurses he needs to be re-assessed by a physician, fast. He might need some sort of vascular scan done.

[CoffeeRTC, BSN, RN]

The wound could have gotten dark and soft, but not hard and necrotic looking in just a day or so. Srlsy...this person wasn't getting skin assessments and the CNAs were negligent.