My father is in a rehabilitation facility due to a fractured hip from a fall. He has developed a bedsore on his backside, which he says it's very painful. They come and turn him every 2 hours so he is not always lying on it. He also has a recliner.
wouldn't it help if some air got to the wound? I thought if he was lying on his left side for example, and even if someone made a little hole in the back of the depends where the sore it, that might help. if he has an accident the urine won't go to the back will it?
any help is appreciated. thanks!!!
Unfortunately, bedsores for someone who is stuck in a wheelchair, doesn't ambulate and goes from wheelchair to bed and back again are a part of life. They require constant, vigilant care. We persisted and persisted and persisted and persisted, even to the point of calling the corporate headquarters of the NH to get this attention to mom and it's true: the wheel that squeaks gets the oil.
Also: hard but true: patients who get regular visitors are going to get more care. For awhile I would pop in at different times of the day so no one could say for certain if or when I would be there; miraculously mom's care improved.
I didn't say I was nurse for 30 years. I didn't say how long I was a nurse because in my book being anything for a longer time than anyone else does not give one greater authority or knowledge,
There's no need to 'trump' anyone or do a triumph dance for all to see. If you want to be the chief, then go ahead and flap your feathers. I am, not in a competition with you or anyone else. I am, here to share what I know and hope it is of benefit to some. If it is not beneficial to you, because of your greater knowledge, then so be it. But I do wonder why you feel the need to be the top dog all the time. How does the heklp anyone except yourself?
This is not a game. For those with pressure sores it is deadly serious and can be the difference between life and death.
I trust that we can all remember that.
Farewell.
About 10 years ago my dad developed a tiny little bedsore. His physician wasn't even positive it could be called a stage 1...it was more like a stage 0.5, I guess. Whichever it was, as I recall it took close to a YEAR to heal at home, even with the cream treatment recommended by the physician. Why did it take so long? Maybe because all we were doing was treating the bedsore, not also addressing the problem that had led to the bedsore. (Fortunately, back then my dad was a bit more mobile than he is now.)
Whereas about a year and a half ago (during a period of time when Dad was no longer physically able to attend the day care he'd been attending in recent years, where he'd get up and move around often throughout the day), a watchful home agency caregiver with a nursing background alerted us that Dad's skin appeared to be nearing a NEW breakdown. (For my dad's particular case, the main issues appeared to be the length of time he was spending in chairs during the day vs walking and the fact that he doesn't shift his weight while he's sitting. Whereas...for another patient the main issue might be something else, such as urine touching skin for too long a time.)
First, we confirmed the seriousness of the problem by taking Dad for an exam with his dermatologist. Next, we made some changes at home. Thankfully, my dad's skin went back to normal-looking skin in a short period of time without a new bedsore ever developing. And according to the physician, the skin had been near a breakdown, just as the caregiver had advised. What worked in my dad's particular case was 1) For daytime, an alternating air cushion, which he sits on while he's in his wheelchair or recliner during the day and 2) for overnight, a ROHO overlay for his mattress that I found online. Note that me just turning him during the night was not helping sufficiently, as confirmed by physician exam. (Note that this is just what worked for my dad with his particular medical circumstances and another patient might need an entirely different approach.)
We were SO fortunate.
Don't let any facility tell you there's nothing that can be done to prevent a bedsore or that they're doing all they can if they really aren't. Seek out medical professionals who have solid expertise and success in preventing and treating pressure sores and get yourself seriously educated on this topic.
Then, keep fighting until you get your loved one's skin protected. It's 2014. There is more knowledge now and solutions that simply weren't available 10 or 20 years ago. But not everyone's up to speed. You have to be.
I suggest that you align yourself with a person at the facility that can employ all these different ideas. Have a champion for the cause. A person who would not be afraid to suggest these different approaches to the clinical team and management team at your loved ones facility. That person needs to have the "command of authority" and ask why these remedies may not have be tried and the physical why it didn't work if it was tried.. Then move on to the next suggested remedy. Don't give up or give in. The unfortunate thing is this takes time and will not correct itself over night. Yo have to find the mechanical cause of the problem and fix that first.
By the way good luck finding that third party I spoke about. "It may be you!" Don't hesitate to conact me if you need a pointer or two.
Aren't you also posting as RonnieBray? Why the dual personas?
Never be sorry for asking questions. Even though I was part of your discouragement ( which I again apologize for, I am not trying to ruin it for anybody) there are lots of great answers here.
We all have similar yet different situations. Glad they have gotten your dad up! So often this caregiving gig is a roller coaster ride. I too come here for tips, ideas, advice, to laugh and to cry. It is a sounding board, sometimes we just need to vent....
I want to add also when she had a persistent ulcer from a shoe rubbing her years ago the podiatrist prescribed zinc and vitamin c oral suppliments to promote healing ...I cant remember if the zinc was Rx or OTC but vit c was OTC, 1000mg daily I believe.
Bedsores can be due to neglect/abuse BUT more often it is the lack of information/training of the caregiver.
Here is am imaginary scenario. Mom and Dad are a devoted , raised a couple of kids, do lots of volunteer work in the community but at 62 mom has a devastating stroke. Dad is a huge bear of a man and can physically manage to lift mom in and out of bed to wheelchair , shower etc. and is determined never to place her in a nursing home. Mom can only move one arm, can't speak or swallow. Dad agrees to a feeding tube and learns how to use that and takes Mom home. Dad has some minimal professional help during the day and mom sleeps a lot of the time.
Dad how ever is worried about the nights he fears she could choke during night and he would not hear her because he takes his hearing aides out at night. So he asks their unmarried daughter who only lives 25 miles away and works in an office close by if she will just spend the nights so he can sleep worry free. No problem says daughter and moves back into her old room for the weekday nights. This is a fine arrangement because daughter can still do all her social activities and continue to go to school two nights a week but she will be the ears for dad at night.
Mom usually sleeps peacefully all night and has a catheter so no bed changing needed plus Dad says she needs her sleep because he does a lot of physical therapy during the day with her and the therapist comes once a week. They are doing everything right, Mom is not being abused or neglected but the visiting nurse comes by on her weekly visit and Dad is anxious to show her how he stands Mom up and pushes her feet forward so he thinks she is getting better. The nurse agrees and Dad manages very well which the nurse was confident he would and does not try and disillusion Dad about Mom's prognosis. When mom is stood on her feet her gown falls apart at the back and to her horrror the nurse notices a stage two ulcer on Mom's tail bone. Dad cheerfully acknowleges that it has been there for a week and he has been applying some aloe gel he found in the bathroom but it just seems to be getting worse. NOW how was this allowed to happen?
LACK OF INSTRUCTION IS THE ANSWER not neglect criminal or otherwise.
I have never seen classes offered for caregivers to learn basic nursing skills. The hospitals give instructions on discharge sometimes better than others and visiting aides often really don't know any better frequently hired to just be bath aides. Visiting RNs may be few and far between. If the patient is eligible for hospice even if the caregiver does not want to admit it they will provide so much help. As other psoters have noted you don't have to tell the patient it is hospice. Visiting nurse and bath aid is sufficient and the social worker is no problem as is the chaplain whoose services you are free to refuse. so once again it comes down to educate yourself before you take on the caregiving roll and even then if you are doing your best don't beat yourself up if something bad happens
When we had hospice come in for Mom we took her into the facility to see the hospice doctor. We showed him the giant pear shaped "blisters" on her hips. He said he had no idea what they were, in fact had never seen anything like it before. We continued to have Mom sleep on alternating sides and her back. We placed pillows under her knees and under ankles. We got and air mattress for her to sleep on, I made her high protein shakes........we did everything we could physically do and still.........
There was no neglect, perhaps a lack of training. It is as you say, the hospital nor any other group gave instructions on how to do things differently than we were doing. I do not beat myself up over this. My Mother was happy, laughing, playing with the dog, sitting outside on the patio, etc. up until two weeks before she passed on to her Glory.
but first....my home health service was very thorough and gave us RN who warned us to rotate and watch for but not how to react once one is present. until of course we got the first one since her immobility issues. anyway 2 things stated to me as the one she was addressing I immediately took her to PC office when I found it and the DR's dressed it improperly which probably irritated it a little more and by the time home heatlh made it out to dress it properly was 10 days....well she clearly stated DR's are not well experienced with this type of wound care and also that they can just show up overnight and like stated before.....
Now for the other disturbing fact....several years ago we lived with a chronic blistering butt that started out as a request from her PC again for help, in the beginning of my care role.,... about what I should do i have seen some "diaper rash now and then" He prescribed silvadene cream to be applied after changing... well i guess years of that use actually was causing this awful chronic blistering of her bottom....she is even so scarred up....but home health ordered me to stop silvadene and use just a good barrier cream i use max strength desinex now and she is free and clear since!!! So the DR actually caused the thing i could be accused of being neglectful of....by following his direction!!! sorry rambling but it upsets me!!!!
so thru experience, trial and error I am learning how to manage at my loved ones expense