SuperHawk Asked May 2020
Any practical advice for a total novice on wound care for unstageable pressure sore management?
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The doctor was willing to discharge my dad back home and without any nurse support nor instructions which was shocking to me. He simply said "He is an old guy"....meaning ? Let his wounds become infected?
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i came home with the air mattress and I did pay a fee (but stage 4 would have qualified for it). I also learned you can buy the same one that DME rent you on amazon for like $200. Beat investment is an air mattress.
I also use daily a foam dressing (from amazon in her sacral area with a bandage over it) as added protection. U can cut these foam price to size - box of 10 for like $11.00 they last me a long time as I cut them up. Dynarex Foam dressing.
Home health can be set up with any drs orders. They will also set you up with supplies and wound care bandages (delivered to you).
I will try to look at more of this to see where else I could offer any help. About to set up for in home Skype therapy ;)! Best wishes and keep reaching out here.
Plus.....astronauts are not geriatric patients.
Who would dare think they are unable to stand up because they are over the hill!?
Or worse....because their time has come!?
Try to get wound consult immediately.
This has become my dad's reason for being enlisted in the list of full discharge from this world.
This pressure injuries.....were not due to a big bang.
Not spontaneous. Somewhere along the line while he was with 24/7 care.
I know that growing up under a filthy rock as I did and absorbing the world view of a mentally ill person put me at great disadvantage as far as "emotional quotients" and knowing how to get along with people (not to mention not knowing how to do laundry or eat right). I've searched for answers and found that great book of ancient wisdom, the Bible, to apply to more situations that I could have imagined when I started reading it (I'm sure there are other ancient books of wisdom but I have not read others). I think everyone has regrets and our efforts to pass those down to the next generations are very valuable.
I'm glad you all has this existential conversation. Perhaps that is the budding of new growth on the rosebush. <3
Thank you!
Dad instead, is a white dove run over. Thus makes me want to help him even more.
He is very stoic. While he was at hospital he told me "everything sooner or later breaks down". It was small talk. Turned existential.
I wish I were wiser now not 40 years from now .....would be a happier more targeted life.
I am sorry for your loss. Thanks for sharing your experience.
No I do not at all. But they can’t wave a magic wand and make the tissue heal, or restore dad to optimal nutrition, or make his bones create red blood cells. His body is in a state of inflammation which makes his other organs/body systems not work as they should. Please try to accept that It is very unlikely the wound will heal quickly IF AT ALL. I say this to you respectfully, your father is on hospice. That means no heroic efforts will be done if he should take a turn for the worse. The decubiti dressing changes are no doubt painful for him and stressful for you. He’s home but they want him to sit up....why? He’ll be sitting on the wound.
Consider your father’s quality of life going through all this as well.
Please Superhawk listen to his providers. It is very difficult when you know you are losing your dad. He is 91. He’s lived a long time. Reevaluate your expectations for his recovery. You are caught up in the blame game as well. Maybe you are not hearing what his doctors are saying.
My advice? Keep him as comfortable as possible and let nature take its course. Medicate him for pain before dressing changes so they are less painful.
You’ve never told us what your father wants nor if he has Advanced Directives for EOL planning. What does HE want?
I also want to say one more thing and hope you don’t take it the wrong way but throughout my career I have seen many families who continue to insist on every possible treatment to keep their loved one alive when in fact those treatments are futile. Keep this in mind going forward. He may be ready to go but you are not ready to let him go.
I don’t mean to hurt your feelings with not knowing exactly what ails him, my advice may be wrong.
Just know you are doing the best that you can.
And this has happened In the middle of a pandemic, which makes it worse! Every hospital has been effected by Covid 19 and doctors & their availability of the providers is stretched.
Hydrogel and medihoney is an appropriate dressing for that wound.
No one has told me he is terminally ill. Simply that he is old.
He has been old for sometime. He has never been sick in all his adult life. Not even with a cold. So I am assuming he has deteriorated by being in bed for so many weeks. He did not have this sacral wound ... when he arrived to hospital 4 weeks ago.
Nothing invasive will be done when the time comes. In the meantime no harm in trying to harness the decubitus. It will spare him lots of pain. No harm in trying. All humans deserve a chance at healing and having a better end.
Sometimes roses bloom from a dead branch. This surprises me and inspires me. This rosebush at home has a thick dried out trunk and blooms incredibly from that visually dead trunk.
Even the gardner who is an "expert system" told me he could replace it with a live plant.
I told him it still bloomed. He did not think so. Nature has a way. Even without watering it has bloomed. The gardner shakes his head now tells me it is dying. Maybe so but it still manages to bloom beautifully.
Nature thrives until it can no longer.
I am hoping for the best that my father can muster. Step by step. Helping his nature along. We will see.
https://www.coloplast.us/Global/US/Wound%20Care/Pressure%20Ulcers%20-%20Prevention%20and%20Treatment%20Quick%20Guide_M4006N.pdf
Coloplast is a manufacturer of products so I must declare their commercial interest but this link is to a very good, useful manual. It is also an extremely graphic manual, be warned.
Take a breath You can deal with the “why’s & “if only’s” later. Again, at 90 age does matter. We all get old. The staff there were providing realism and perhaps told you this to help you understand the challenges here.
What does dad want? I don’t think you’ve told us that.
SNF now have specified Covid 19 units & keep patients separated. The virus is out there so chances of anyone getting it is equal - doctors & nurses have become positive. 11 weeks into this pandemic management of cases in SNF’s have improved after what was learned the hard way in NY state.
Heartbreaking I know.
This is what it seems like. Anyone decent and without risk of self incrimination upon seeing what was accomplished after his 3 week +/-hospital stay, would wonder if he really was at "any" hospital and if that hospital was in the USA or in Timbuktu and if maybe he was destitute, thus unable to pay for medical dressings for his pressure injury.
I am still in disbelief myself. This has been so difficult and unfair for my dad. All odds have been against him. Upon seeing what became of his decubiti during hospital care. I dread the worse: he was not being properly cared for.
His life was so endangered there and whatever outcome, it would be documented as ninety year old with comorbidities appropriate to his age and expected prognosis "null". Discharge ASAP without further expense.
Dad is so happy to be home, so hungry and eager to watch films.
Lots of ensure and caloric intake .....new wound consult. Still in bed. Still weak. But better than 6 days ago.
Why?
They found placement in one of the SNF with the highest rate of deaths in the last month.
If when in hospital I was concerned for his survival. How to send him off to a worse place? No visits allowed in any setting. I only accepted him staying at hospital because I believed he would be better taken care of more so than anywhere else. Certainly better off than with me. Who knows. If they did their best they failed magnanimously. On top of that selecting a viral incubator SNF as his transition ?
Endangering him 100%.
I was a homecare RN and performed a lot of Woundcare. First a doctor must evaluate the wound and they order the Woundcare. If an agency has a certified Woundcare nurse they will be sent out to evaluate it and make recommendations to the doctor who may then agree or disagree with the nurses’ recommendations.
Woundcare supplies have come a long way and the materials used depend on the wound itself.
Usually my patients were seen by the MD every two weeks if not sooner depending on the severity of the wound. Often wounds need debridement to cut away the dead tissue to promote healing.
I believe the OP’s dad’s wound is not open, just reddened. An “egg crate” and frequent repositioning is the treatment and then daily observation to address any changes. If he needs an Alternating pressure mattress (recommended) Medicare may pay for that with proper medical necessity documented. Usually Medicare pays when a wound is open and requires frequent dressing changes.
Even if your dad is in a HMO they have resources outside of network they can refer you to but I am not sure about how and at what rate you will be charged.
Please don’t listen to suggestions about what to use to care for the wound. Dad needs evaluation and orders specific to his wound.
Again, if there is no open areas only redness it sounds like a Stage 1 PU. Make sure you turn him every two hours and add protein to his diet.
Today I saw the care they were putting on his wound site. He might as well been left alone in a jungle to have snakes dressing his wound.
No sign of any care done with a pair of hands.
It is huge. It is deep. It is open. It is flesh. There is no way this could have been there upon admission nor anywhere close to what I see now. Unfortunately again, but this time the experts are hospice, reminded me it is a sign of his old age. Go day by day they suggested.
They are unable to shock themselves they have seen it all.
No one cares to speak another truth independent of his age.
Negligence and not from neophytes but from paid experts.
It is so deep that it looks as if it is not part of his body.
Packing the cavity with gauze squirted with hydrogel and medihoney is the dressing he got today and second opinion wound nurse specialist will try to check agenda to see which day she can suggest course of action not without taking orientation from his "age".
May all the gods protect all of us when we approach 80 or 90. Best not to disclose one's age!!
Keep them guessing.
Re: gel mattresses -- in addition to turning the patient, don't forget to turn the mattress (or rotate, whichever the instructions recommend). My sister had one that Medicare provided and after a couple of years, it developed a sunken place right where my sister needed the most support. (She has since purchased a Purple mattress, with her wound care doc's approval. Not cheap or covered by insurance, but it is holding up well.)
Dressing it only hid it from view. This hospital has an outpatient wound care clinic and they boast they are among the best. Their specialty is non healing wounds.
So....if money could buy you better dressings....why doesn't anyone put that on the table? Then one decides what or how to gather the money.
I am wondering WHY they allowed dad's pressure injury to go "day by day" denying it was actually getting worse !
Healthy skin needs all these components:
good oxygenation = good circulatory and good respiratory system functions
good nutrition = balanced diet and if there are wounds, a little more protein and probably vitamin pill
good hygiene = mild soap and water and mild rubbing on healthy skin to remove bacterial load
good mobility = moving self or help repositioning every 2 hours , if there are wounds, keep bodyweight off that area
good hydration = enough water so person urinates every 3-4 hours and pee is clear to straw in color
As for wound care. The adage is, "If it is dry, make it wet. If it is wet, make it dry."
Wet/Oozing wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, place non-stick pads over all of wound, pad with gauze to absorb fluids, and wrap with rolled gauze or elastic bandage(ACE) and secure in place.
Dry wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, allow to air dry, coat with triple antibiotic ointment, place nonstick pad over wound, wrap in rolled gauze or elastic bandage (ACE), and secure in place.
Change dressings daily and keep a record of the size, depth (use a Qtip), drainage, colors. Let doctor know if wound is getting bigger, deeper, or changing colors or drainage. Doctors can prescribe antibiotic ointments or oral medications. Doctors can also prescribe visits from a wound care specialist.
In some older folks, wounds do not heal well or easily since they usually have problems with circulation, nutrition, mobility and/or oxygenation. So, do not get discouraged if your efforts do not yield speedy results.
it also sounds like you need a different doctor.
Answering your question here.
I have worked with RNs (as their secretary) and my daughter is one. They all know what a pressure sore is and how to treat it. Just some, like my daughter, are better trained. She runs a Woundcare unit and was a wound care nurse at a facility she worked for.
Someone mentioned they had been shown by a Nurse how to dress the wound. Thats OK but a nurse should be checking it regularly.
He is 90 so that number alerts hospice in preparation for the end. Currently he is bedridden. I almost lose hope upon looking at his wound for the first time today. Almost but I have a little left.
How could you muster courage to undertake stage 4 curettage? I will start on peanut butter breads tomorrow. And smile with my slice of hope left.
Thanks much for your success story. You did everything right.
Getting up moving around and changing positions is also key.
My mom never has pressure sores except when in the hospital or rehab. At home we use Desodine to prevent them.
Then within 1 hour a case manager called and said they had found a placement in a SNF. So they could discharge him tomorrow. I said I was already in conversation to have him back home on Monday. She said once there's a placement available and discharge in place patient needs to go. Or you could be hit with some fees for the extra days. So I had to rush decision and move dad's return home for tomorrow!
No time for mattress negotiating....I was assured by social worker he would get what he needed. Rest assured. So now I just realized that I will be 99% responsible for all his care. When I asked if nurse could also help with dad's stoma bag I was told if that day needed change. But that nurse was mostly wound support. Now I just realized that if mattress is not alternating pressure.....I will need even more to be on top of repositioning.
24 hours a day. Just not physically possible. Yet that is what they are leaving me with. So I will have wound, stoma and condom Cath care verification all day and night.
When will I sleep? May have to get a relative to caregive moonlight shift for some compensation.
I was so fixated on dad's wound care I had forgotten the package was much larger. This was a savvy entrapment. Feels very coordinated ....impossible to out maneuver the system. This will be my last good night sleep until I get plan B set in motion. Rotational mattress and/or shout out to a cousin to help during night time repositioning. Somehow they still manage to slide in the word team (working with me).