Results 1 to 6 of 6

Thread: my brother's situation with bad pressure sores

  1. #1
    Junior Member
    Join Date
    Jan 2019
    Location
    Asheville, NC
    Posts
    9

    my brother's situation with bad pressure sores

    Hi all--

    My bro (MS para) is in a long-term care facility since September. He developed an ischial pressure wound that got large, down to the bone, infected with vre. Ended up hospitalized and debreded and treated with abx for at least three weeks. Had a wound vac until recently. He's since developed less severe but still serious areas on his coccyx and early concerns on his other ischium. Would care nurse calls me a couple times a week to keep me updated. This morning she tells me that they feel the wound is infected again and have cultured and started him on a cephalosporin (don't know the name) and bactrim until the C&S is back.

    He lost a good deal of weight since his hospitalization. His appetite is less but he drinks ensure supplements. He has a foley but is incontinent of stool. He's asked for PT and they have started but this means he gets up in his chair for a couple hours a day. When he is in bed the CNA's keep him turned Q2. The facility is very good, the nursing and CNA staff and docs and therapy--especially would care are all giving his very good care but this seems scary and insurmountable to me.

    I guess Im just looking for advice? wisdom? How to do best by my brother?

    thank you all...
    sib

  2. #2
    Senior Member
    Join Date
    Apr 2016
    Location
    Cincinnati, Ohio, USA
    Posts
    2,624
    If he's in a facility but getting sores then, I'm sorry, the facility is not very good. He should be on an air-fluidized bed and they should be changing his position every 2 hours.
    Does he have any issues with rash from diapers? If so, that's another sign of inattention.
    Atrophy will make it worse, but fat doesn't help. Only lean tissue can provide the blood flow needed to avoid and/or heal pressure sores. That means FES for paralyzed muscles and exercise for the non-paralyzed muscles.
    T3 complete since Sept 2015.

  3. #3
    What kind of mattress is he on? He should not be sitting at all, not for PT or anything else, either in a wheelchair or in bed.

    Is he not on a bowel program for management of his bowels as appropriate for someone with a SCI/D?

    Has he been seen by an outside wound care physician; ideally by an infectious disease physician (for his osteomyelitis), and a good experienced plastic surgeon who does a lot of pressure injury care?

    What is his insurance?

    How old is he?

    How much protein is he getting daily? He should be getting at least 100 gm. daily.

    Has he had blood work done for a CRP level? Sed rate? Pre-albumin and albumin levels?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    Junior Member
    Join Date
    Jan 2019
    Location
    Asheville, NC
    Posts
    9
    He's on an air overlay mattress. I will let the care team and PT know to cancel OOB activity.

    He was doing his own bowel program until his hospitalization. He's not able to do it himself in bed. He gets daily miralax and dig stim by nursing staff. But that is on hold as his bowels have been pretty loose with the abx.

    Yes he is being seen by an outside wound care MD as well as ID. His last visit with ID was last week when they removed his PICC. He's not seen the wound care MD since his hospitalization but the wound care RN sees him daily and takes pics and communicates directly with the doc. He has not been seen by a plastic surgeon.

    He is on Medicare/Medicaid

    He is 67 years old.

    He gets the ensure supplements TID--not sure of the protein gms. The wound care nurse has been working with him to increase his protein intake.

    Pre and albumin levels are slightly lower than normal. Not sure of any recent CRP or Sed.

    ---sib

  5. #5
    The mattress overlay is insufficient pressure reduction for him, or he would not have developed new pressure ulcers, if he is actually being turned every 2 hours. He should be on at least a good quality low air loss (LAL) mattress. Air fluidized is generally reserved for post-flap surgery.

    What care is being done on his wound right now? Was he in this nursing home before he developed the ischial pressure ulcer?

    3 weeks of IV antibiotics is rarely sufficient to treat osteomyelitis. 6-8 weeks is much more common.

    Has he been tested for c. diff? That can be the cause of his loose stools. He may need a diverting colostomy to keep the stool off his wounds.

    Rarely will a stage IV pressure ulcer heal with conservative wound treatment such as VAC, various dressings, etc. He most likely needs a flap surgery, but that cannot be done if his osteomyelitis is not fully treated.

    I assume he is not smoking or using other tobacco or nicotine products.

    Is a dietician part of his team? Getting in 100 mg. of protein daily is not easy. Can you get him on a different supplement than Ensure? Premier (which you can get at Costco and some Walmarts) has nearly 2X the protein of Ensure, and is a lot better tasting too. He should also be on a Stress Tab type multivitamin.

    I would also recommend getting his zinc levels tested, and if low, get him on a zinc supplement. Zinc is important for wound healing, and you loose a lot in wound drainage. It should only be supplemented if low though, as excessive zinc supplement can cause copper deficiency otherwise.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  6. #6
    Junior Member
    Join Date
    Jan 2019
    Location
    Asheville, NC
    Posts
    9
    Thank you KLD.

    I will ask for a LAL mattress.

    he had a wound vac but that was removed yesterday or Friday due to little to no drainage. They are packing it with dakins solution and changing dsg BID.

    He would get superficial skin redness/excoriation on these areas prior to admission that got angry looking w incontinence but totally cleared w desitin. He has some executive function and memory issues so in the care facility he forgot or declined to get OOB or do pressure relief or get turned or was even aware his linen needed to be changed. Staff learned his quirks after a couple weeks but by then we had the decubitus brewing. I wish he had the means for one on one care. I could not keep it up after 6 years. I have plenty of guilt.

    he was tested for c diff a month ago—that was neg. I wondered about a colostomy.

    will try to talk directly with docs and ask about cultures, rx of infection and eventual flap.

    no he’s never used tobacco products.

    I will ask for dietician consult.

    will look for the higher protein supplements, stress tab and zinc levels.

    I’ll keep you posted

    —sib
    Last edited by sibpair; 01-07-2020 at 09:51 PM. Reason: Typo

Similar Threads

  1. Replies: 2
    Last Post: 03-11-2018, 10:10 PM
  2. Pressure Sores
    By darty in forum Care
    Replies: 3
    Last Post: 05-28-2010, 09:01 AM
  3. Pressure Sores
    By rickhemi in forum Caregiving
    Replies: 1
    Last Post: 12-04-2004, 05:17 AM
  4. Pressure sores
    By Bryans Mom in forum Care
    Replies: 17
    Last Post: 09-18-2004, 10:07 AM
  5. Blood Pressure problems brother-in-law
    By Sister in forum Care
    Replies: 1
    Last Post: 01-28-2003, 10:35 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •