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The doctor was willing to discharge my dad back home and without any nurse support nor instructions which was shocking to me. He simply said "He is an old guy"....meaning ? Let his wounds become infected?

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Pressure sores kill. I am an RN and know how easily and quickly they do so. I am quite shocked at the advice from this doctor, and am wondering just how old a guy he is. This should be "wound care management" which is now a specialty and very precise. These are impossible to handle and become necrotic, and down to the bone. I am so sorry you had such bad advise and recommend you call and raise some "Hades" with this doctor. This is negligent treatment.
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I am an RN. Here are the general principles of pressure wounds:

Healthy skin needs all these components:
good oxygenation = good circulatory and good respiratory system functions
good nutrition = balanced diet and if there are wounds, a little more protein and probably vitamin pill
good hygiene = mild soap and water and mild rubbing on healthy skin to remove bacterial load
good mobility = moving self or help repositioning every 2 hours , if there are wounds, keep bodyweight off that area
good hydration = enough water so person urinates every 3-4 hours and pee is clear to straw in color

As for wound care. The adage is, "If it is dry, make it wet. If it is wet, make it dry."

Wet/Oozing wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, place non-stick pads over all of wound, pad with gauze to absorb fluids, and wrap with rolled gauze or elastic bandage(ACE) and secure in place.

Dry wounds - clean with liquid soap like Hibiclens in water, rinse with clear water, allow to air dry, coat with triple antibiotic ointment, place nonstick pad over wound, wrap in rolled gauze or elastic bandage (ACE), and secure in place.

Change dressings daily and keep a record of the size, depth (use a Qtip), drainage, colors. Let doctor know if wound is getting bigger, deeper, or changing colors or drainage. Doctors can prescribe antibiotic ointments or oral medications. Doctors can also prescribe visits from a wound care specialist.

In some older folks, wounds do not heal well or easily since they usually have problems with circulation, nutrition, mobility and/or oxygenation. So, do not get discouraged if your efforts do not yield speedy results.
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renoir May 2020
Thank you! This will be helpful for many.
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Superhawk, to me this is unacceptable treatment and behavior on behalf of the doctor. Was he a primary care doctor?

I would call him back and ask for a script for home care, for a nurse to assess and provide in home wound care. Start researching and contacting home care agencies to decide on one to choose, as it is your choice, not the doctor's.

If he won't do that, try to find a wound care specialist or wound care clinic. In my area, large hospitals sometimes have special wound care clinics.

To infer that he's old and not provide care is to me irresponsible. Even if he's old, wound care would make his life safer.
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Medicare will pay for a wound care nurse to visit your dad and help you learn how to treat the wounds, as well as, recommend products to alleviate the wound.

it also sounds like you need a different doctor.
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Call the physician and request that home care is ordered. Your dad needs to have the wound care provided by a registered nurse. The physician needs to write an order and if he doesn't, he needs to be reported. Saying your dad is an old guy is unacceptable. The nurse will evaluate, treat, and monitor the wound. I would tell the hospital social worker as well. The social worker is responsible for safe discharges.
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I’m confused. How does anyone know it’s unstageable without performing an assessment?
Diagnosing this would mean they’ve done some sort of evaluation.

Is it unstageable because it is not an open wound? Usually unstageable pressure ulcers are open wounds or can’t be measured for depth/width/length. Stage 1 is redness around an area With no open areas (yet). In order to be classified as unstageable the wound needs to be evaluated by a MD as they measure depth/length/width. When I was a HC RN we measured the wound weekly to assess for healing.

Did a wound specialist see the pressure ulcer while dad was in the hospital?
If it’s unstageable and no one has seen it, how could someone write woundcare orders?

Now dad will have to see a woundcare specialist to determine treatment. Then homecare will get ordered for woundcare if needed.

A physician needs to write homecare orders & specify woundcare to be completed and homecare orders the supplies designated by the doctor. Nurses can assess the wound but not write woundcare orders (unless they are PA’s or NP’s).

I can’t believe that doctor just discharged him with no instructions. Usually a nurse will come and explain discharge orders to a patient, not the doctor. Did anyone discuss this with nursing on dad’s discharge?

Change his position every two hours. Get an order for an alternating air mattress for his bed while he is sleeping.
Make sure he gets protein in him to promote tissue healing.

What does his wound look like now? As a nurse I am curious.
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SuperHawk May 2020
Thanks for taking the time, your concern and knowledge. Sorry if I repeat myself or fail to be more coherent I am new at forums. We are in California. Dad is still hospitalized. Just yesterday found out sacral wound is 10 to 15 cms. And there are 9 pressure areas of concern. Sacral an thigh being highest and the others just surface redness. No mention of stage. Is a wound care specialist a nurse? I was told he has been seen. I am really in the dark. I don't think he is being repositioned every 2 nor 4 hours. They do check dressings in two different shifts I think.
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Are you and your dad in the US?

Discharged from a US hospital? Call the patient advocate tomorrow and report this.


AFTER you get the doc to prescribe home care services, of course.
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SuperHawk May 2020
I am being careful not to be incendiary before getting help for My father. I was able to suspend his discharge. We are in California. The other disturbing fact is that any moment doctor can call for same day discharge. So no time to look for alternatives ....they do this on purpose. To catch the vulnerable caregiver by surprise.
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SuperHawk, Being wiser usually comes from experience. If your dad said something about his regrets, you can learn from those experiences and lead a "happier, more targeted life." "A Purpose Driven Life," I believe a certain book calls it, one that I have not read yet.

I know that growing up under a filthy rock as I did and absorbing the world view of a mentally ill person put me at great disadvantage as far as "emotional quotients" and knowing how to get along with people (not to mention not knowing how to do laundry or eat right). I've searched for answers and found that great book of ancient wisdom, the Bible, to apply to more situations that I could have imagined when I started reading it (I'm sure there are other ancient books of wisdom but I have not read others). I think everyone has regrets and our efforts to pass those down to the next generations are very valuable.

I'm glad you all has this existential conversation. Perhaps that is the budding of new growth on the rosebush. <3
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surprise, that is nothing but the truth! The Bible is the instruction manual for a healthy, happy, fulfilling life.

Thank you!
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I would call the hospital and find out how you can get wound care at home and how you report the derelict doctor.

I would write a report stating specifically what happened and send it to the hospital, the AMA and the states governing body for doctors, this doctor needs to go mop floors.
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SuperHawk May 2020
You have perceived perfectly this doctor's mindset. But THIS doctor at least "suggested" immediate discharge.....not ordered it last Monday he tried again..... if it were one of the other 2 doctors that I know work at this hospital under that medical group......they WOULD have hung up the phone on me after telling me TODAY IS DISCHARGE. TAKE HIM HOME. Probably without a good bye.
You say I ought to call the hospital but for me the hospital belongs to this medical group. I don't think there is a hospital manager.
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Make sure you rotate dad so he is not on the same spot. clean area. Calmosepetin I think helps. A & D ointment. air.. It. Bedsores come on quickly, usually due to some poor handling of your dad.. It took my MIL 2 days to get one in hospital, and months to get rid of it.
Make sure your dad gets extra protein.. Ensure, lots of protein, for some reason someone told me that it helps because the body needs protein to heal...??

If dad got it in hospital,,the doctor knew it and knew you didn't know how fast and bad these things get..
rotate every 3 hours. keep him off that spot.. clean bandages.
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SuperHawk May 2020
Thanks Mayday. Someone should have alerted me a long time ago about this danger with my dad. To avoid at all cost any pressure sore. Suggested buying a matress after the Rehab or during his post rehab at home. Every day counts .....so I hope someone is making my dad's days count.
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