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Thread: Help!!! Need advise, dont know what to do???

  1. #1

    Help!!! Need advise, dont know what to do???

    Today while in the shower my husband felt a small rough patch on his left buttock. He scrached at it thinking it was just crust but I checked out his butt when he got out of the shower and we think he has a pressure sore.
    The area is right where his butt bone hits when he sits. It is about the size of a cookie. That area is redish purple bruised looking and the skin feels a little tough. He has a couple of small dry areas in the middle. They arent wet or weepy, seem to be extra dry.
    So it is the weekend and the doctor isnt in for him to have a check. We know he should STAY OFF HIS BUTT!!! But is there anything else we should do??? I read to put lotion on it to keep it from getting too dried out. Please advise us, this is our first time with anything like this!

  2. #2
    He needs to stay off it completely. What did his skin inspection look like last night and this AM before getting out of bed? If it was normal then, this is most likely an abraison from a poor transfer today, but an abraison can quickly turn into a pressure ulcer if any pressure is applied to it.

    Is the skin actually broken? If so, cover it with a dressing that will keep the wound moist but not wet and that will not stick to the wound. Telfa or Adaptic and Telfa are good choices, or Xeroform if you have any. Change this twice daily. No ointments are indicated at this time if the wound is not open AND dry. If it is, then some tri-antibiotic ointment like Neosporin would be fine (thin layer).

    No sitting at all...in bed, wheelchair, shower chair or commode. Turn side to side rather than laying on his back. What type of mattress is he sleeping on?

    Push hard on high protein foods and good intake of leafy green veggies and citrus. If he is not on a multivitamin, he needs one. He should also consider supplementing his protein intake with Boost or Ensure.

    Call his physician and insist on being seen by a wound care expert (home health nurse) ASAP on Monday so he does not need to sit to go to the doctor's office.

    (KLD)

  3. #3
    I did check his butt yesturday. I didnt notice anything then but think I missed it because it looks like it has been coming on for a little bit. We did just take a road trip last weekend and spent prob a total of 12 on the road. He admits to not doing his lifts as often as he should in fear of having a bowel accident but he is very worried right now and I think this will cure him of that.
    From looking on the internet at decub pics I think he is stage two. Very early stage two. If he stays off of it how long does something like this take to improve??? We are just trying to antisipate what kind of arangements we need to make with work, therapy etc?
    Having someone come to the house is a good idea but how will we trust they will know what they are talking about???
    Thanks for your help!

  4. #4
    He has an intelagel bed. I dont know what "skin broken" means exactly. It has a few different spots in the area. One looks like when a scab falls off, one looks like a mall scab adn one looks like a pimple.

  5. #5
    Your physician should know a good home health agency that has an RN that is a CWOCN. This is a wound, continence and ostomy expert. They would be an RN (sometimes an advanced practice nurse) who has special training and certification in wound care (as well as ostomy care). They would be the best wound care expert to see him.

    If there is any break in the top layer of the skin, including scabs or blisters, it is at least a stage II and "open" and could be deeper until the scab (called eschar) comes off.

    At his level of injury, he should be independent in self-skin inspection with mirrors and should have already learned to integrate this into his AM and bedtime routine when in rehab. It is critical that this not be skipped...as soon as undressing at night, and before getting out of bed in the AM. Early identification of problems and early action is always best.

    A true shallow stage II will take at least 2-3 weeks to heal sufficient to allow sitting again safely.

    (KLD)

  6. #6

    Questions for Nurse

    I started a thread yesturday regaurding my husband having a pressure sore. He has been in bed rotating side to side like you suggested. Yesturday 50 min after a cath while in bed he had a bladder accident. If he lays down his bladder always dumps. So after having to clean up a few times decide to put in a indwelling cath so he wouldnt be sitting in urine. He also had a bm in the bed. Was not a good first day.
    My questions are
    Would it be better to have a condom cath because then his bladder is still filling and emptying when full rather than staying empty, possibley causing him to loose bladder copasity???
    If so, where can I get a condom cath for him to use? Walgreens?
    Also he has a standing frame. We are wondering if it would be ok for him to get in his chair long enough to get in the standing frame for a change of senery and a new position???
    Thanks for your help!

  7. #7
    If he is in bed all the time, he won't be dumping urine like that. That occurs after being out of bed because he is mobilizing his dependent edema in his legs. He won't have that in bed. If he is leaking between every 4 hour caths, he is either drinking too much or should be taking more anticholenergic medications. Putting in a foley is a temporary measure, but I would try to get that out now. The longer it is in the higher is the risk for infections. I assume he is cathing himself and since he is in bed should not have a whole lot keeping him too busy to cath a little more often.

    If he wants to use an external condom catheter in addition to cathing, that is OK, but it should not be instead of cathing every 4-6 hours. This would require purchasing a significant number of external condom catheters as most cannot be reused.

    I don't know that any regular pharmacy carries external condom catheters. I certainly have never seen them there. You could call around, but it is much more likely you will have to wait for this until tomorrow and get them from a medical supply house. You can, in a pinch, make condom catheters out of regular non-lubricated condoms, but it would be difficult to teach you how to do this on-line, and you would also need skin adhesive and Elastoplast tape as well as latex tubing to do this.

    Most standing frames have a pad or strap that pushes on the butt right over the ischium, which is where his pressure ulcer is. If that is not the case for his, and he can sit for less than 5 minutes getting to and in the standing frame, then standing once daily would be OK, but he should not be doing a slide board transfer for this. He could do a lift transfer (with a sling) to avoid any shearing on the pressure ulcer.

    (KLD)

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