Wounds in LTC

[Isitpossible, LPN, LVN]

please help... i have several pts in a long term care facility who are obese, and a myriad of other health problems MS, HTN, renal failure, A-fib ect.... they lay in bed literally all day... and have the stage four ulcers in the sacrum and heel area. aside for the reposition q2, and doing dressing changes, what else can I do to help them heal & PREVENT new wounds from forming...they are on plexi mattresses, but as a new nurse, I really dont know what the BEST treatments are for wounds.. i feel very busy at that med cart all day, but i know i will get a routine to be faster and efficient... i really want to help prevent and treat these wounds though..

[amoLucia]

please help... i have several pts in a long term care facility who are obese, and a myriad of other health problems MS, HTN, renal failure, A-fib ect.... they lay in bed literally all day... and have the stage four ulcers in the sacrum and heel area. aside for the reposition q2, and doing dressing changes, what else can I do to help them heal & PREVENT new wounds from forming...they are on plexi mattresses, but as a new nurse, I really dont know what the BEST treatments are for wounds.. i feel very busy at that med cart all day, but i know i will get a routine to be faster and efficient... i really want to help prevent and treat these wounds though..

As part of our care plans in LTC, we include dietary consult for adequate calories & protein defiency (obese pts are freq protein deficient) and wounds usually require extra cals for healing. We use zinc, vit C and multivits.

Monitor for anemia and wound infection (culture as approp). Good hydration. Use of a foley for moisture control is dependent on MD and facility choice (there's controversey re: foley use but it depends...). Just a couple simple things to keep in mind but there are more interventions out there.

[CapeCodMermaid, RN]

Some stage four wounds will only heal with a wound vac or a skin flap. Do you have a wound consultant or a wound center near by? Ask for a prealbumin to determine if they are nutritionally sound.Good luck.

[CoffeeRTC, BSN, RN]

Yep, just because they are obese doesn't mean they are getting good nutrition. What about activities or therapy to get them moving a bit more? Second the wound consult too. At that point they might need the surgical interventions then wound vac etc.

[luvmy2angels]

I agree with dietary consult, does your facility have a wound Dr or wound team?? If not and this is something you are interested in you can always get more education in wounds and start a wound team at your job. Once they got a routine wound Dr and wound team into our facility the wounds healed a lot faster and we now have very few wounds to deal with. Just a thought.