Need help with Tx ideas...

[LTC LPN 2006]

I'm the new wound care nurse for my facility. I've been working very hard to learn the wound care stuff, but I still have quite a few questions.

First off, I know that a stable heel wound should be kept dry and need not be debrided. Now if a resident develops blisters on the heels that are red/purple and those open up and begin draining, what is the best way to treat? Do you want to try to dry up the area? Do you debride it if necrotic tissue present? Or do you maintain a moist environment as you would for wounds in other areas?

I also have a couple wounds that seem to be getting worse because of staff failure to keep pressure off these areas (specifically a bunion area, lateral ball of the foot, and a knee). Because of the contracted state these residents are in, positioning is very difficult and I'm looking for a way to relieve pressure even if the other staff fail to do so. I've read that a dressing such as Elastogel/Dermagel (a hydrogel sheet) can provide cushioning and I would imagine using a foam dressing, though not quite its intended purpose, would also provide padding. I'm having trouble with dermagel because it is not on the approved formulary so the woman who orders supplies cannot order without approval from corporate. Any other suggestions??

And my last question is regarding diaper blisters. What kind of Tx would you recommend for a fluid filled blister? open blister?

Thanks for the help!