Kelly,

The easiest way is to just place a paper or plastic disposable ruler next to the wound, so it appears in the photo as a scale reference. You can go to more sophisticated computer technology where you place a standard guide in the photo, take a digital photo, outline the wound on the computer, and it calculates area. There is Polaroid grid film that shows things at half scale when you use it with the close-up lens and a standard distance. However, I find that the grid marks get in the way of the image.
Renee C, MSPT, MPH, CWS

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I would check into a Briggs catalogue for this item. There are close up lenses for poloroid cameras with grid film.
LPN,wound care

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If you watch those TV shows like CSI etc. you will see them put down rulers next to the object they are filming. This is the only way to do it.
A range finder on a camera would make it too big and too expensive.

unsigned

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Another alternative to grid film, is to place a measuring tool above or below the wound while taking the photo. This will show the dimensions of the wound. We date ours and place only the residents medical record # on
the meausring tool. This clearly shows the dimensions and a clear view of the wound bed.

Kim
LPN/Wound Nurse

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Wound Trakker software works VERY well. It measures your dimensions with use of a digital camera and tracks all your patient data.

Ellen

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There are "Polaroid" type cameras that utilize 'grid' paper. They are are made for the application you need. However, please keep in mind that wound pictures do not always show the real picture/healing/etc and the legal implications (if they are part of the permanent record) can be very huge. I work for a large corporation and we are NEVER allowed to photograph any wound. This directive stemmed from very ugly law suites that pictures were taken and utilized against the medical facility/provider.

Sandi,LPN, LTC
 

I commend you on your work, both hospice in general and your trip to India. If you talk to your vendors, they may be able to donate some supplies. Papaya (I don't know if they grow in India or not) helps debride. There has been a lot of work on aloe coming out of India.
While I don't have enough evidence yet to use it here in the States with what I have available, in a different setting I would definitely try it.
Renee C., MSPT, MPH, CWS

Joan

Hydrous lanolin works great. It's like marshmallow creme, and the infant can nurse without the mom having to remove the cream. I had a great experience with it.

Pam

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What about the plastic device used for mothers with inverted nipples?

Frankie

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Hi Gina,

Try worldwidewounds.com, you should find enough info there. I used several articles form there to setup protocols for my hospital.

Thanks,

Johnson DPT, MPH

FV

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Are there any signs of bone infection of the residual I°st metatarsal stump or of joint infection?


Bruno

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Have you used some algisite in the wound bed or maybe would an Alevyn work on this site? MM, LPN-wound care.

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I would try lightly packing with an alginate dressing and covering with a foam secondary dressing. Wrap with gauze/kling. additionally you might also
try to place an ABD pad between the alginate and the foam dressing. It sounds as though your patient is not able to elevate the foot during the day. Are you able to give the patient any secondary dressings to take home for use as re-enforcement before returning the next day? Good Luck with
wound care.

Kim
LPN/Wound Nurse

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HI Try Coloplast's new product "Contreet". It is a highly absorptive foam (like biatain) impregnated with silver. We had very good success with a foot wound that was exudating +++.

Donnie E. McIntosh
 

LJ,
You are correct, you cannot use a cream or ointment under a pouching system and acheive good "wear time". The affected skin needs to be treated by dusting with an antifungal powder such as Nystatin and then "sealing" the powder by blotting on top of it with a non-sting barrier wipe or spray such as 3Ms Cavilon Skin Barrier. Allow this to dry and then apply the pouching system. Of more concern is what is the cause of the leakage that has led to the fungal infection. Is it a poorly fitting pouch system or it is a lack of timely pouch changes with any leakage (since ileostomy effluent is immediately caustic to the peristomal skin). The patient needs to be evaluated by an ET or WOC nurse if there is one located near your area. This is critical to aid with the pt's control of the stomal output/pouching system and improve wear time as well as their social/psychological issues. Good luck!
Chris CWOCN

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Have you tried Diflucan or other systemic medication, or how about some yogurt with live cultures? Is there any way to cut the adhesive wafer to allow for healing with use of a topical remedy? Would you be able to heal even one section at a time?

Kim
LPN/Wound Nurse
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When I worked in the hospital, we used a light dusting of an anti-fungal powder like nystatin, then a skin protectant wipe before we applied the wafer. Skin protectants now come in sprays (Hollister, I believe makes one). You can use that instead of a wipe. We changed the wafer every 3 days instead of every 5 or 7. Another product that you might try is 3M's Cavilon cream. I use it on periwound skin to protect it when the wound requires frequent dressing changes because the tape sticks to it. I haven't tried it on ostomies. If you do and it works, let me know.

Nancy B. RN,CWCN

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How about oral antifungals, such as Diflucan? Also, using a barrier such as Stomahesive paste is a great way to protect the skin by creating a perfect seal around the ostomy site.
M. Larkins, LPN

Try Sween's product "criticaid". It can be removed easily with periwash and they also produce that product. I suspect the incontinent wipes are imprenated with a rinseless wash that should help to control the odor. If not, buy some Sween "Sproam" or Periwash 2 and ask the staff to try that. To protect blisters, use 3M cavilon - comes in wipes or spray - also very good for a denuded area in genital region.

Donnie E. McIntosh

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There is an excellent product on the market for just this problem. Xenaderm is an ointment that is used for skin denuding from incontience. The great thing about this product is you apply a layer and massage into skin. It will repell incontient material while healing and you can do incontient care up to 5 times before you would need to reapply the product. I have had excellent results with this product to get the skin healed and then once healed I follow up with Lanaseptic ointment to area BID and prn soiling to keep this from happening again. If your Mom is wearing diapers, you might consider converting her to adult pull ups as this allows for more air to reach the skin and release of body heat thus decreasing bacteria growth associated with incontience. Good Luck,
Janalene Eaton, LPN Wound Care Coordinator
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Hi-- I would suggest a regimen of good peri- hygiene first, because when the skin is in constant contact with urine it is bound to become excoriated and
prone to breakdown. I suggest gentle wipes for cleansing- soap and water on a constant basis can be harsh on the skin. There is a product made by
Coloplast called Baza Protect- there is also an antifungal variety. It can be effectively used to protect the skin from the effects of urine. It is also recommended that the product not be removed completely when cleansing unless the area is soiled with feces. Some patient's are allergic to zinc
products so before using protective creams that often have a zinc oxide base check for allergy. There are numerous products on the market that can be
used, but are overall in-effective if your aunt is not being cleaned often
enough.

Best Regards,

Jamie B. Pinnock, RN

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You do not disclose your country of origon so I do not know your resources but this is a problem of continence not wound care.
1. Make sure she does not have an active unine infection; treat any infection that may be present. Cranberry juice does work.
2. Have an ultrasound scan done to eliminate a retention problem. Chronic retention needs a catheter for 3 months then try retraining but with a dementia problem I would not expect much.
3. Commercially available continence pads properly applied to contain the urine with a good wash and dry and "oiling " the skin with a barrier cream. Continence Pads must be applied correctly to work but unfortunetly most carers do learn how to do this and put them in the general area.

I hope this helps.

Chris

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Heat lamps are really not a good idea, need to get the fungal problem cleared up, maybe a different cream? Also there are oral medications that would help. After it is cleared up they need to do peri cares a little more often and apply a good skin protectant-smith nephew has some. Not clear on the foley do they mean they would insert one if the area was clear? That doesn't make sense if using one would clear up the problem. wound care.

unsigned
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I would recommend against the heat lamp. It may slow healing, and could potentially burn her given her inability to notify someone of excessive heat. A good moisture barrier, probably one with an antifungal agent, should help. An antifungal without treating the cause
(moisture) won't solve it, but both may.
Renee C., MSPT, MPH, CWS
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Under the circumstances, I would expect the board home to give extra care throughout the day and in the evening. I would think the use of incontinent
pads and/or adult brief diapers would be appropriate, with the staff checking the pads/briefs for peak saturation every two to four hours, followed by cleansing and applying a light coat of a skin barrier cream i.e A&D, zinc based products. Has the mobile doctor recommended a systemic medication such as Diflucan? Can the home provide yogurt with live
cultures? Also it sounds like the urine may be concentrated. Is she drinking enough water/fluids? Even though she is dribbling "all day" she
may need more fluid. Or she could be currently experiencing a urinary tract infection. Also use of foley catheters can put users at a higher risk of obtaining a urinary tract infection, so this may not be the answer. Airing out the affected areas at night and if possible for an hour or so during the day would be beneficial. Good Luck

Kim
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I recently had a perineal rash. I’m a 56 year old quad with chronic wound problems (none now, thank goodness). I treated my rash with an anti-fungal powder (microstatin) but this had only partial success. My doctor put me on an oral anti-fungal pill (sorry, I don’t remember it) but that worked over 2 weeks. Ask her doctor. Good luck


Steven
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Debbie,

I'd first suggest that along with the antifungal cream that they give her a course of diflucan to treat the "white" blistery area which may be yeast due to her incontinence and obesity. I'd also suggest that maybe the staff have to assist with more perineal care and do more washing than once a day. I know that they get into a "routine" of doing things their way, and that works great if there are no problems...But your aunt has problems and needs more care. If the staff can not help meet her incontinent needs then I'd definately insist on a foley cath to prevent further skin breakdown in the future that can become more critical.

Rachael Nottingham, RN, BSN
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Would she lay down after meals so that her skin could be open to air? That would also help pressure areas from forming. Also, using a zinc-based cream similar to Desitin between cleanings would create a moistures barrier between her skin and the urine.

M. Larkins, LPN