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New Pressure Ulcer Staging Standards

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  • #16
    Wound on right heel

    Originally posted by lynnifer
    This is great thanks!

    I'm having a helluva time with one wound on my right heel - it's almost healed but the skin must be thinner than tissue paper. Even dousing the dressing in oxygenated water as I change it - pulling off the dressing re-opens it ... dammit. If I could just heal and be done with one ... but I get them to this stage and am so unfamiliar with what to do. The skin around is so flakey and dry. GRRR

    A wound care nurse is only available on Thursdays at one hospital and she is usually booked ... 8-4pm doesn't jive with my shift work schedule either. No home care nurse - deemed too independant.
    I am chipd's nurse. Try covering heel with Mepitel. Dressing is porous and wound can be cleansed right through without disturbing wound base with dressing change. leave Mepitel in place for 1 wk. then change. use reg dressing, gauze or foam over mepitel. lynn rn

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    • #17
      Picture Please?

      Originally posted by SCI-Nurse
      These have finally been approved by the National Pressure Ulcer Advisory Panel. The major change is the addition of Deep Tissue Injury (DTI) and "unstagable" categories.

      It will take a while for clinicians to learn these new standards, so you may want to print this out to share with your providers.

      If anyone would like example photos of some of these, post here and I will see what I can do.

      (KLD)
      wow..........
      Last edited by Jr.; 07-10-2007, 09:04 AM.
      Thanks: {Art}

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      • #18
        Stage 4 pressure sore with the butt and the theigh....omg it would take a year and they would have to cut your leg off to use the muscle for a flap......shit just shoot me if it gets that bad.....omg........Art
        Art

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        • #19
          My husband is an imcomplete quad with a three day life span that will be a year Oct 18. These pictures really helped as he has the worst of the worst pressure sores on his left calf and on both heels, I have found on this journey that everyone has something different to say about the pressure sores and the prognosis. the nursing home he is in works and debredes everyday and use the silvidine cream but I dont see much progress, they are taking the dead black tissue off his heals and they are really oozing and infected, the calf is now where you can see the total destruction it is about 6 inches long and about two inches deep and two inches wide. Since he has feeling but cant move I know these are so painful for him. I guess I am asking is there anything else we can do for him beside the lidocane patches and the 300 mcg of phyntenol he is on now, he is also on morphinie liquid every two hours as needed. thank you for letting me ramble

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          • #20
            Originally posted by kandycane View Post
            My husband is an imcomplete quad with a three day life span that will be a year Oct 18. These pictures really helped as he has the worst of the worst pressure sores on his left calf and on both heels, I have found on this journey that everyone has something different to say about the pressure sores and the prognosis. the nursing home he is in works and debredes everyday and use the silvidine cream but I dont see much progress, they are taking the dead black tissue off his heals and they are really oozing and infected, the calf is now where you can see the total destruction it is about 6 inches long and about two inches deep and two inches wide. Since he has feeling but cant move I know these are so painful for him. I guess I am asking is there anything else we can do for him beside the lidocane patches and the 300 mcg of phyntenol he is on now, he is also on morphinie liquid every two hours as needed. thank you for letting me ramble
            I DON'T KNOW the reason that dead tissue always wants to be removed from pressure(bed) sores with creams and medication pads EVEN when they keep getting worst. Don't get me wrong, they often work and have worked for me in the past. But, there should be a limit of how long to try different creams and pads before the doctor gives the OK get some sterilized scissors and cut the dead tissue. I was in the hospital the first time I had to deal with a pressure sore from not being able to being taken off my back for most of the day. It was right above my butt and finallaly got on my butt cheeks and no pads or creams were making the sore get better. You could actually smell dead rotten tissue badly in my room. One nurse that became very good friends with my family opted to tell us that the only way she knew to work. We would need to cut out all the dead tissue until you could only see red healthy tissue. We asked her to tell the doctor and she said for us to talk to him but not to mention her because she would get in trouble. We asked the head doctor and three other doctors that had attend me and they all said to trust the medications and keep me off of the sore for as much as possible. About 3 weeks later of trying the regular creams and pads and then the most expensive creams and pads and the sore getting worst the nurse talked to us again. She explain to my mom that she would cut of the dead tissue until she got to health red bleeding tissue but for us to buy the sterile pads, gloves, scissors and other sterile items she needed to remove the dead tissue. We asked her what she was going to charge and she charged NOTHING. She did it and a week later I had healthy tissue growing and 5 months later the wound that once looked like it could fit around my fist was only needing the outer skin. Moreover, more than two years later I didn't have proper help and when the fevers started again because of dead tissue in a NEW sore in the same place we started to look for that same nurse. We couldn't fine her and had a hardtime finding a doctor willing to cut off the dead tissue. We had to pay operation charges to a doctor that was willing to cut off the tissue but not before we signed off that we would not sue or make him responsible if things went bad. This time it took almost 2 years to completely heal but it healed. It only took like 7 months for the hole the sore had made to be covered in healthy tissue but it took over another year for the skin to cover it completely. We tried all kinds of creams and pads to help the skin cover faster but it seems that the skin takes forever back there after the wound is covered in healthy tissue. I hope this helps someone but still trust the pads and creams first.
            AstrO

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            • #21
              Thank you very much, was very helpful. Esp the pics, had trouble finding any.

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              • #22
                Wound Images

                SCI--Can I use your photos for an educational handout at my Home Health agency?

                Thanks.

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                • #23
                  use of photos

                  Originally posted by SCI-Nurse View Post
                  Here are some PDF example photos of both Unable to Stage and Deep Tissue Injury pressure ulcers, which are both new categories in the NPUAP standards. WARNING: these are graphic photos.

                  (KLD)

                  SCI- Nurse-- can I use your photos for an educational handout for our home health staff?

                  Thanks. JL

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                  • #24
                    Dolphin mattress( sub immersible mattress)

                    Has anyone used this mattress? I know several VA's have? I would like more info on use in rehab and use in acute care.
                    CWO
                    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.

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                    • #25
                      Any changes in buttocks implants over the past few years?

                      All of the threads that I've read referring to butt implants weredated between 2004 and 2009 which has me wondering if there's been any type material makeup that wouldn't cause as many issues as dated buttocks implants from years ago? The reason I ask is, in 2002 a surgeon who was debreeding a rather small pressure ulcer on my right buttocks made a rather drastic mistake, slicing into an artery that had me lose between six and eight units of blood and nearly bleeding to death had it not been for a very quick thinking physical therapist who was in the room as the surgeon turned and walked away, out of the room but that is done and over with and life goes on.

                      Afterwards, I became anemic which caused me to gain four other nasty pressure ulcers on both of my buttocks even though I wasn't sitting up in my chair at the time. I then had a number of surgeries, including a number of flaps which failed along with other surgeries in order to hold Humpty Dumpty back together again. Without any type of muscle tissue under my left buttocks to where it's just skin to bone contact with my wheelchair cushion which is extremely painful and has me sitting up for between two and six hours at a time before it's necessary for me to get out of my chair. With that said, I'm willing to go to whatever means necessary to get any type of cushioning back between my butt bone and the outer layer of skin but I don't know what, if anything can be done to replace the muscle mass which is no longer in that area and that brings up my question:

                      Has any type of technology evolved enough to where some sort of cushioning (butt implants per se) could be surgically inserted where my muscle mass once padded my buttocks or is everything still pretty much the same that I've read and posts three and four years old? I've never allowed anything to get me down (depressed) but the nicer the weather gets outdoors, the more I want to be outside as cabin fever is beginning to kick in, again!

                      If you like to see some extremely gross pictures, I can upload some images that'll have you either being more careful when it comes to your butt and/or checking the background history of a potential surgeon prior to allowing him or her to cut on you. Being hindsight is 2020, life goes on and I now check any type of doctor or physician backgrounds prior to seeing them.

                      Thank you very much your time and I'm open to any and all suggestions you might have. Like I said, I'm willing to go to whatever means necessary in order to get some sort of padding back where it counts, relieve some of the pain and extend my quality of life which is more important than anything else mention. I'm not complaining about my quality of life, it's just that I would like to extend it beyond six hours of sitting up because so much can be done to change one's life one hour at a time!

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                      • #26
                        Windstar, if the sores have been on your ischial tuberosities (butt bones), you might try a Ride cushion. They offload the weight onto your thighs and lower back, and your ischials get no pressure. That's how it works for me anyway.

                        Good luck, I don't believe there is any substance that is pumped into the buttocks for padding.
                        Please donate a dollar a day at http://justadollarplease.org.
                        Copy and paste this message to the bottom of your signature.

                        Thanks!

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                        • #27
                          I decided to try Manuka Honey for a Stage 4 Pressure Ulcer. I had a hard time deciding which honey to try and finally settled on one stating that it was "organic, raw and unheated," thinking that would make it better for healing. I've been on bed rest for 2 years and decided enough, so scheduled wound flap surgery. I got this honey 2 weeks prior - have been using it one week and my surgery is one week away, The sides of the sore are filling in, but not the deepest part at the bone (the biggest problem), I tasted the honey and thought it tasted like regular honey - it certainly didn't have a "flowery" taste. Did I get the wrong stuff? This is my last ditch effort before the surgery. I have a feeling I might not make it through this one, but can't live my life from bed anymore either.

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                          • #28
                            I have been nursing a self inflicted stage II pressure sore for a few weeks. After researching and taking advice from others I ended up cleaning the wound with 9% sodium chloride with a cotton ball, then spraying Vetericyn wound & skin care (from tractor supply) on it, then lightly taping gauze over it with Johnson & Johnson comfort cloth tape. Changing it out twice a day and most importantly staying off it. After 3 weeks it is pretty much healed and now I am putting Lantiseptic daily skin care on it to keep the skin healthy. Will probably use these Johnson & Johnson hydrocoiled tough pads as cushion for a while just to be safe.
                            Life's perceived journey in this PMR is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out, shouting "holy **** what a VR ride!"
                            Pete C6/'97

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                            • #29
                              Thanks KLD My sore was only stage 2, all is good.

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