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Thread: My Father's New Injury-Have ?s

  1. #31
    You and your family are going to have to decide if there is enough family support to keep him at home of if you need a nursing home to help with his care. The VA (I work at one) won't just kick him out, they will work you you and your family to formulate the best plan for all of you. He may still recover from the stroke as well as from the SCI. But it takes time, and (unfortunately) patience.

    RAB

  2. #32
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    Hi again- Just wanted to ask opinion of an SCI nurse. My Dad has a stage II pressure ulcer and shearing on his sacrum. Right now at the VA they are turning him approximately every 4 hours and much of the time they leave him flat on his back. They told me flat on his back is okay but not sitting up in bed so much due to the location of the breakdown. At his last two hospitals they turned him religiously every two hours and never flat on his back. What's the deal? I haven't had a chance to see the sacrum area for awhile. They change the dressing nightly and are using a type of ointment with chlorophyll.

  3. #33
    Who are you talking to about his turn schedule and wound care? Have you spoken to his case manager or the SCI unit clinical nurse specialist (CNS), or just to the staff nurse or aide? I would suggest you make contact with the clinical nurse specialist and express your concerns, and also request that you be allowed to see the condition of the wound either directly or through digital photos at least twice weekly.

    Turning every 2 hours is a standard of care (see the Clinical Practice Guideline on Pressure Ulcer Management from the Consortium for Spinal Cord Medicine about this) and is not just for skin, but also for lungs, range of motion and other problems of immobility. I assume he is on a low air loss mattress, but even with this our standard would be to keep him off his back as sacral pressure is the highest in this position, and turn side-to-side only as much as possible.

    Talk to the CNS.

    (KLD)

  4. #34
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    I've only asked the staff nurses. Honestly, after I read about the specialized pressure ulcer program on PAVAHSC's website, I figured they knew what they were doing. You would think in a SCI unit, this would be standard practice. I will look into asking others about it. I have a good rapport with the case manager at this point, so she'd be a good resource. Also, KLD, I don't think they have the specialized call buttons you mentioned for a quad.

  5. #35
    Turn at least every two hours. Keep pressure entirely off the pressure ulcer until it is healed.
    Shearing friction is from dragging him or him shifting in bed. They need to pick him up to clear the bed just a bit and not drag him.Iff they keep doing this, the area will become worse or never heal.

    Even if he is on a special mattress- this needs to be done.


    CWO

  6. #36
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    Exclamation

    That's what I thought. Even the head Dr. at the VA (and the case manager) said the mattress is "doing the job" and seemed very irritated that we were second guessing her judgement on this. What more can we do? One of Dad's nurses told us that it appears the ulcer may be as bad as a stage 4 now (it was maybe a stage II when he arrived at the VA.) She said to me, "Don't tell anyone you heard this from me." What?! They performed surgery on it-without notifying us ahead of time-the day after we started really complaining. And they have been very hesitant to let us look at it directly. Am I imagining things or does this sound like a bit of a cover up?

  7. #37
    Even with a low air loss bed, you should never be directly positioned on a pressure ulcer. A turning mattress is a poor substitute for manual turning with a sacral ulcer as the sacrum is never unweighted. Manual turning side to side ONLY is required. If he needed surgery for debridement, it is at least a stage III.

    You need to talk to the following people about your dissatisfaction with his care:

    The SCI clinical nurse specialist (who should be able to get his nursing care straightened out)
    His case manager (who is supposed to be his advocate)
    The VA hospital patient advocate (you should have been given this person's contact information on admission)
    Your PVA NSO, who should be visiting your father on a regular basis

    Don't take know for an answer. Stand up for what you know is the appropriate care. You may be unpopular with his team....but so what? I am sad that he does not appear to be getting the care that he needs. You will have to push hard and often.

    I would also recommend you start legal steps to have you or another family member made your father's guardian and obtain power of attorney for health care (unless he has already given this to someone) since it appears he is currently not in a condition to make decisions for himself and does not appear to be competent to consent to surgical procedures (due to his stroke).

    (KLD)

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