Mother's hand is bent down and she has a large skin wound below wrist? Any advice on what to do?

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My mother went from the hospital to a skill nursing facility. My mother stayed 9 days in the hospital. This was because her wound had some dead tissue and it needed to be cleaned out. She has a bone infection and previously been given 2 IV meds for 5 weeks and oral meds a little over a month. Her doctor said she has a new infection. Previously given Daptomycin - This time started with Daptomycin but when a skilled nursing facility was called they said it cost $700 a day and the insurance only pays $200. Therefore they can not lose $500. The the med was changed to Vancomycin 1 gram/200ml. She is now also given ampililin sulbactan every 6 hours. About 4 days before she left the hospital a few blisters appeared near the wound vac. One blister underneath and a few about one inch away from the vac. Now in the Skilled nursing facility within 2 days her right hand is bent and she screams in pain when touched. On the same arm just below the wrist the skin is torn about the size of a full inch and about a half of inch below that is a smaller tear in the skin. I have asked her roommate and nurses did she fall. They all said no. Mother is still retaining fluid in legs and stomach. This first happen in hospital when they put constant drip of saline solution. She swelled until the membrane sac in eyes hanging out of her eyes. I requested an xray and they say it is not broken. I now notice a couple more blisters appear on her skin. My mother has never blistered and her skin was clear before. I was told her muscle has contracted. Now 3 days with her hand bent down. I told them I think it needs to be in a brace and I know it will hurt to put it in one. They said nothing will be done until Monday. I am not sure why this has happened? I made the nursing assistant place pillows to hold her hand. I am thinking they will need to adjust it each day myself to try and straighten it. As the nurses just leave the wounds tears exposed and hand bent? Any advice on what to do? I have never met the doctor as only nurses can text him. He just texts them back.



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Tired, oh I’m so sorry she has shingles on top of her other issues. I hope you have had your shingles vaccine. My mom has had it twice on her face, and it was very painful.
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Reply to rocketjcat
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I would call Hospice for a consult. They treat wounds while taking care of the patient in the months before death. Even if you don't use hospice now, it would be worth talking to them.
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Reply to jjariz
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Tired123,
I am so sorry about what is happening to your Mom.  I can assure you that this type of situation does not happen in all of the nursing homes.  You need to investigate other nursing homes while your Mom is in the hospital as she needs much more care than what you can give her at home.

{The ****Comment section FROZE UP again!!!  and I LOST 2 paragraphs of my comments!!!}

I don't remember, have you taken care of your Mom in your home before?  In not, then you need to:
rent a hospital bed, a Hoyer or Easy Lift machine, a bedside commode;
buy a baby monitor so that you can monitor your Mom at all times;
arrange for Home Health nurses and CNAs and Wound Care Nurse or hire nurses from an agency;
be prepared to stay home 24 hours/7 days a week and to quit your job (if you are working).
This is just a small "To Do List".

You need to seriously think that having your Mom go to ANOTHER nursing home (even though the last nursing home was lousy) because I don't know that you can take care of your Mom adequately or properly unless you have an army of nursing/healthcare professionals  which could cost you as much as a nursing home.
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Reply to DeeAnna
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Tired123 Jul 25, 2018
I am not working, so I can take care of her. I glad I go her out and back into the hospital. They did not care about her swelling and I found out from the hospital fluid was building up in the thoracic area. They but a device to drain her slowly. I was told all the blister covering her back are shingles. The facility bent her hand and now PT will need to be done to fix it. Her wound needs to be changed 2 times a day and the facility was only doing it 1 time. The picc line was not attached to the heart, so the hospital took it out. I have talked to other nurses and they said she was not given proper wound care and skin care. I will be trying now to find a doctor who will come to the house. I will now only take her out using non-emergency transportation on a stricter. As the insurance covers it 100% - before did not know. I have asked the doctor to see about getting a bed and mattress for her to heal. The doctor is working on it.
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I just read your update - you are sooo stuck between that rock and hard place with no good options. I'm sorry that the people you entrusted to care for your mom didn't do their jobs. I'm sure that you can bring her a little physical comfort at home but how will you manage? Please don't forget to take care of yourself.
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Reply to cwillie
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Could you call an ambulance and have her transported from the SNF to the ER? I'd tell them she is in a lot of pain and that you are worried her infection is getting worse.

At the minimum, they need to reassess the situation and maybe give her a different antibiotic and something for pain. There's no reason why she should sit in pain while the SNF staff take their time getting answers.

I'm so sorry you and your mom are going through this.
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Tired123 Jul 23, 2018
I went back to see my mother and she had to go poop. I told her nurse and she said for her to go. She would later clean her up. My mother was laying on her back. They did not want to move her. She had diarrhea and it went all over her, one her wound bandage, and inside of her vagina. No one would come and 20 minutes went by. I asked another nurse from another area just to look at my mother. Afterwards the other nurse had one of her CNA come to clean her. I helped the CNA and when I went to look at my mother's back - she had her whole back with blisters. Blisters under her arm pits too. I talked to the CNA and he said just get her out and take her to ER. The nurse was saying she is stable and we could give her Benadryl . I told him about her hand. He said they know what happened they just not telling you. I am wondering if they caught her hand when lifting her out of bed with their lift. Anyways I took her out and back to the ER. The ER doctor took pictures and said she will be in the hospital for a few days. Doctor said her wound needs to be treated, the hand, he said their is a little fluid in lung and she has a infection. While at the Skill Nursing Facility one of the nurses said the wound needs to be changed once a day. I told them the doctor said twice a day. The last three days her wound was only changed twice. As one full day went by without anything. I could not talk to the nurse that was over all of them. Anyways once she gets out - I will be bring her back home to take care of her. I saw at that facility some CNA's working very hard and some of the nurses not doing much.
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Is your Mom on Medical Leave from her job?  Can your Mom call either Human Resources or Humana Employer PPO and check to see what has to be done so that she can get the correct antibiotic?  If she cannot call, are you the Financial and/or Medical POA for your Mom? 

Is a Wound Care Nurse visiting your Mom at the Skilled Nursing Home?  Even if a "Wet-to-Dry" dressing is being applied, a WCN still needs to be following the progress of the wound.  Where is the wound located--at her wrist?  EDIT: What did your Mom rub her wrist on that she got such a wound? 

Osteomyelitis infection is very "NASTY" and very hard to treat (although it is easy to get from a very deep skin scratch or puncture wound).  The antibiotic needs to "FIT" the infection organism/bacteria.  If the wrong antibiotic is given, then the infection is not going to get better. 

The bend in your Mom's wrist might be related to the osteomyelitis either because of the infection or because of pain.
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Reply to DeeAnna
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Tired123 Jul 21, 2018
My mother gets her insurance through my father who is retired. As their Union gives the wife health insurance. I am not sure, but I was told they had wound nurses. Since it is the weekend a different nurse is working. We brought up all issues and she said she needs to read up on my mother and history. They just changed the bandage at 3pm for the first time today. It was only changed once yesterday at 8pm. I know the bandage is to be changed twice a day. The new wound on her arm she got after being there for 3 days. As her hands were fine and when I come back it is bent and she cry in pain when touching it. It is just below the wrist and the other torn is just below it. It looks bad and I took pictures. First they say they did not know , then later say it was the tag around her arm that did it. I am not sure if I am to believe it. One nurse said she was picking at it. I do not think that happened. As watching her she does not touch it at all. I now also see a pink mark on her chest too. I am not sure if it is a burn? As she did not have it before. I am almost thinking did her roommate burn her with her curling iron. As I saw the lady curing her hair in her bed. Her roommate does not seem all there mentally. I just told the nurse I did not want my mother receiving ice-cream from her, as my mother is a diabetic. My main focus is the hand and changing of the wound. As I am thinking they are only doing it once a day. I will need to talk to the nurse who is over them all. The nurse today said to us, did you talk to your primary care doctor about this. I said not yet, as the office is closed Fri Sat & Sun. The nurse did not seem too upset and said she will need to look into it. I will not get an answer right away. One CNA said make sure the PT look at it Monday and request a brace, so it does not freeze.
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There are a couple of possibilities for the blisters:
A) The vancomycin is not controlling the growth of the infection/bacteria and it is getting worse and spreading to the skin;
B) your Mom is having a reaction to the vancomycin which is causing the blisters
C) the Wound Vac is MALFUNCTIONING and air is entering under the skin via the wound vac.   You need to DEMAND that the WOUND CARE NURSE who is following your Mom's wound care at the skilled nursing home to visit your Mom TODAY! 
If the facility states that they do not have a Wound Care Nurse, then you tell them that they MUST get a WOUND CARE NURSE to supervise your Mom's wound while she is at the facility.  Do not take "NO' for an answer. 
I know that Doctors "Hate" nursing homes and that is why your Mom's doctor will only receive and send Text Messages to the nursing home.  I knew a doctor who would only receive FAXES and would not take any phone calls from a nursing home.  More that once, I was faxing the doctor that we were sending a resident to the ER Dept. via ambulance as the resident was being wheeled out the door because the doctor would not take my phone call so that I could let him know that the resident was on their way to ER Dept.

I don't understand the statement made by the skilled nursing facility "that they would lose $500/day if your Mom received Daptomycin".  Does your Mom have Medicare Supplemental Insurance?  IF so, then the pharmacy that is supplying the antibiotic should be able to send a claim to your Mom's Medicare Supplemental Insurance company or to the Medicare Pharmacy Insurance and get paid a percentage for the remaining $500.00.  The other possibility is that YOU might HAVE TO PAY for a percentage of the Daptomycin antibiotic so that your Mom can receive it.  But I would think that it should be the Pharmacy that is losing the $500, not the nursing home.

It sounds like your Mom needs to be given the Daptomycin again as the vancomycin might not have any affect on the infection/bacteria/organism.  Take your Mom to the ER Dept. TODAY before her skin gets any worse.

You need to ask the doctor for the name of the specific bacteria organism that is causing your Mom's wound infection.

Good Luck.  Let us know what happens with your Mom.
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Tired123 Jul 21, 2018
My mother has Humana Employer PPO and the Humana took my mother's medicare too. I was told that Humana bills Medicare and what is not paid Humana pays the rest. Right now my mother does not have a wound vac on but she still got a few more blisters. Right now they are just doing wet t o dry bandage until it gets better.
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Perhaps, one of our posters with a nursing background will comment, but if you're concerned then get her sent to the ER before Monday
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Tired123 Jul 23, 2018
Yes she is back to the Hospital .
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HI .. I think you need to take her back to the hospital . asap . Im not sure if its a drug reaction or just the wrong Antibiotic , but she needs to be seen again . Something sounds like its happening to the muscles in her arm and it needs to be seen to now .. just my opinion
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