Pressure Sores

[LTC LPN 2006]

New to being a wound care nurse in LTC...

Since bunions and corns can be reddened, nonblanchable areas that are caused by pressure... are they considered pressure sores and do they have to be included in your pressure sore reports your facility or can you consider them other skin conditions?

[cougarnurse]

Thankfully, our podiatrist poked in today! Yes, they are pressure areas; main pressure areas are the hips, shoulders, heels, etc. I haven't really had any bunions lately, and haven't had to list them....yet!

'Cat'

[LTC LPN 2006]

We have residents with deformed toes that are never going to change and have bunions and/or corns on their toes. Its making our reports look bad just by the #s and my DON seems to be encouraging me to not consider those areas on our pressure sore report. I don't think those types of areas will ever heal, from what I read on the internet bunions can be treated with surgery which is not practical at this point. She doesn't appear to know what the technical answer is and if we knew for sure she would want me to follow the rules... but it sure would be nice if those didn't have to be included on that report every week!

By the way, what is the PC (politically correct) or technical term that should be used for wounds caused by pressure? I noticed you wrote pressure areas... which to me seems to downplay the reality of it... such as I heard they're changing STDs to STI - Sexually Transmitted Infection... to me the word Disease is more of a deterant to teenagers than if we start calling them infections they'll think its like a cold or the flu!

[bdeherr]

I believe acknowleging thier potential for pressure sores related to the bunions and corns in their plan of care and treatment/skin checks would be beneficial. Whether to count them as pressure sores depends on the success of the poc/treatment. If you have successfully prevented pressure on these areas and they remain stable with no skin breakdown, then I would not "count" them as pressure sores. If something changes and they become pressure sores at any stage, then they need to be "counted" however the point is to go back to your assessment and work on preventing the pressure in the first place! Let me know if this still does not make sense. :luck:

[LTC LPN 2006]

I asked the former wound care nurse, who is certified, about this on Friday. She said basically the same things. While they are caused by pressure, they are not a pressure ulcer. There is potential for them to become a pressure ulcer so monitoring them would be benificial and they could be on the "Skin Conditions" report as opposed to the "Pressure Ulcer" report. Thanks for the imputs! I have so much to learn about this area of nursing... but when I think of what I new just a month or two ago to what I know now, its amazing to see how far I've come!
BTW - Any advice on the topic of wound care would be GREATLY appreciated.
Also... the National Pressure Ulcer Advisory Panel just changed the staging of pressure ulcers recently and the new info is on their website. Ironically I was doing "homework" for my new job at home Thursday evening and stumbled upon this information on my own. The next day at work corporate put out a memo about it and it felt good to be already aware of the changes and to feel like I know a little bit about my job for a change!

[cougarnurse]

I am going to a seminar on Wednesday....will be sure to let you know any and all pertinant info. I learn.

'Cat'

[dianeskate]

I have been doing wound care as a staff RN for years but just took a position as a Wound Care RN in LTC (where I've worked per diem for quite awhile). One of the wounds is something like you've described - sort of a bunion, more like callused tissue that is hard and pale whitish/yellow. There is an open area on it and the exposed tissue is this same yellow/white. Not granulation, not epithelialization, not eschar. One nurse is calling it slough and it isn't. Its solid, hard tissue. The present tx is panafil so the dry edges are now greenish...its almost impossible to get all the panafil off. ITs painful for the resident. My question: Its a stage 2, that I have no problem with. But how do I describe the wound bed? I doubt this is going to heal. From my reading, calluses/bunions/corns are forms of keratosis, which is dead tissue. If dead, it sure won't heal. Ideas? I am thinking it either needs to be maintained, or surgically approached by podiatry. Thanks.

[cougarnurse]

Definately have Podiatry see the area. I know that some Wound Care nurses specialize in foot care, but I don't know of any personally Definately have Podiatrist see! Best to cover yourself AND the resident.