Nurse Advice

[LCoulter]

I have someone in my home, an adult, that had surgery about 3 weeks ago. A nurse (actually over the 3 weeks, it has been about 5-6 different nurses) comes in the home to change and check the dressing. At first it was twice a day that a nurse would come in but then I was shown what to do and watch for so then the nurse only came once a day. She comes in the morning while I’m at work.

So during these three weeks, I have been slowly watching this incision closing up and healing. All of the nurses have said it looks good so there has but no infections.

My concern is about one nurse in particular, who is the only one of the many nurses that uses a long que-tip like stick to push the saline soaked bandage into the wound. She actually keeps breaking open the wound as it heals and I don’t understand why. It closes up, looks good, and then she comes and breaks it open. The patient is far too nice because I would have pulled the stick from her hand and told her “enough”. She is the only nurse that uses this less than gentle care. Should I be concerned? I’m not a nurse so maybe this is an acceptable thing to do?

 

[Cinderella94]

I have someone in my home, an adult, that had surgery about 3 weeks ago. A nurse (actually over the 3 weeks, it has been about 5-6 different nurses) comes in the home to change and check the dressing. At first it was twice a day that a nurse would come in but then I was shown what to do and watch for so then the nurse only came once a day. She comes in the morning while I’m at work.

So during these three weeks, I have been slowly watching this incision closing up and healing. All of the nurses have said it looks good so there has but no infections.

My concern is about one nurse in particular, who is the only one of the many nurses that uses a long que-tip like stick to push the saline soaked bandage into the wound. She actually keeps breaking open the wound as it heals and I don’t understand why. It closes up, looks good, and then she comes and breaks it open. The patient is far too nice because I would have pulled the stick from her hand and told her “enough”. She is the only nurse that uses this less than gentle care. Should I be concerned? I’m not a nurse so maybe this is an acceptable thing to do?

When I was in the hospital after abdominal surgery, they used something like that when my wound wasn't healing on it's own. But once it was, they stopped using that. Just my $.02.

The fact that she's the only nurse doing it also makes me skeptical.

 

[happygirl]

If it was me I would ask one of the other nurses about it

 

[GigglyFigment]

Get her name and ask the other nurse about it. If they are skeptical, call and request that she no longer come to the house and state why.

 

[LCoulter]

If it was me I would ask one of the other nurses about it

Good thinking...I don't know why we didn't think of that.

 

[SandrA9810]

.

 

[Jen77]

I agree with the asking the other nurses what's going on.

 

[scrapquitler]

I have someone in my home, an adult, that had surgery about 3 weeks ago. A nurse (actually over the 3 weeks, it has been about 5-6 different nurses) comes in the home to change and check the dressing. At first it was twice a day that a nurse would come in but then I was shown what to do and watch for so then the nurse only came once a day. She comes in the morning while I’m at work.

So during these three weeks, I have been slowly watching this incision closing up and healing. All of the nurses have said it looks good so there has but no infections.

My concern is about one nurse in particular, who is the only one of the many nurses that uses a long que-tip like stick to push the saline soaked bandage into the wound. She actually keeps breaking open the wound as it heals and I don’t understand why. It closes up, looks good, and then she comes and breaks it open. The patient is far too nice because I would have pulled the stick from her hand and told her “enough”. She is the only nurse that uses this less than gentle care. Should I be concerned? I’m not a nurse so maybe this is an acceptable thing to do?

Well if I were in this situation, the first time this nurse was poking at the would and opening it back up I would have said "Hey, wait a minute, WHY are you doing that?" And then I would have known why she was doing it and I would have either googled or asked someone else if I thought her explanation was weird. And then when the next nurse came and Didn't do that, I'd ask THAT nurse "Hey, the nurse yesterday did xyz, why are you not doing it?" And I'd go from there.

It'a always better to ask right then and there why or why not something isn't being done, then there's no guessing what someones motivations may or may not have been.

 

[JessicaR]

I have someone in my home, an adult, that had surgery about 3 weeks ago. A nurse (actually over the 3 weeks, it has been about 5-6 different nurses) comes in the home to change and check the dressing. At first it was twice a day that a nurse would come in but then I was shown what to do and watch for so then the nurse only came once a day. She comes in the morning while I’m at work.

So during these three weeks, I have been slowly watching this incision closing up and healing. All of the nurses have said it looks good so there has but no infections.

My concern is about one nurse in particular, who is the only one of the many nurses that uses a long que-tip like stick to push the saline soaked bandage into the wound. She actually keeps breaking open the wound as it heals and I don’t understand why. It closes up, looks good, and then she comes and breaks it open. The patient is far too nice because I would have pulled the stick from her hand and told her “enough”. She is the only nurse that uses this less than gentle care. Should I be concerned? I’m not a nurse so maybe this is an acceptable thing to do?

Call the doctor and ask. Is there a re-check soon? Sometimes incisions that are sutured form fluid pockets (pus, old blood, infection) and maybe that nurse was preventing the wound from healing around one. Wounds heal from the inside out. Sounds like she is packing the wound but the others aren't.

In any case I would just call to be sure and also ask the nurse to explain it.

 

[ksjayhawks]

Don't ask the other nurses. Call the home health provider, express your concerns, and ask that this nurse not come again.

 

[DLgal]

Is this a deep wound? If so, the nurse that is packing it is doing it properly and the other nurses are not.

I had abdominal surgery (laprascopic) a couple yeas ago. The main incision formed a hematoma and had to be opened up and drained. I had to pack the wound for three weeks at home until it healed.

The protocol is to keep packing it until it heals from the INSIDE out. If the outer incision closes up too soon, it will close over a pocket of air and that can be very dangerous (could cause infection, gangrene, etc.). I had to repeatedly break open the incision so that I could pack it with saline soaked gauze. It was the most painful three weeks of my life. My doctor advised me to use a little less gauze each time as the wound healed. Worked great, just took a long time.

I would be more concerned about the other nurses at this point.

 

[rndmr2]

Is this a deep wound? If so, the nurse that is packing it is doing it properly and the other nurses are not.

I had abdominal surgery (laprascopic) a couple yeas ago. The main incision formed a hematoma and had to be opened up and drained. I had to pack the wound for three weeks at home until it healed.

The protocol is to keep packing it until it heals from the INSIDE out. If the outer incision closes up too soon, it will close over a pocket of air and that can be very dangerous (could cause infection, gangrene, etc.). I had to repeatedly break open the incision so that I could pack it with saline soaked gauze. It was the most painful three weeks of my life. My doctor advised me to use a little less gauze each time as the wound healed. Worked great, just took a long time.

I would be more concerned about the other nurses at this point.

This. I am a Home Care RN and that is how you have to do it with these kinds of wounds. You donLt want the outside to heal first.


Posted from Disboards.com App for Android

 

[LCoulter]

Is this a deep wound? If so, the nurse that is packing it is doing it properly and the other nurses are not.

I had abdominal surgery (laprascopic) a couple yeas ago. The main incision formed a hematoma and had to be opened up and drained. I had to pack the wound for three weeks at home until it healed.

The protocol is to keep packing it until it heals from the INSIDE out. If the outer incision closes up too soon, it will close over a pocket of air and that can be very dangerous (could cause infection, gangrene, etc.). I had to repeatedly break open the incision so that I could pack it with saline soaked gauze. It was the most painful three weeks of my life. My doctor advised me to use a little less gauze each time as the wound healed. Worked great, just took a long time.

I would be more concerned about the other nurses at this point.

Thanks, this has been very helpful. I'm guessing that each nurse has a different opinion on how deep it is. It's deep but not that deep where it actually needs to be "packed". The one nurse just pushes down into every little crevice and into the belly button too. The others just lay it down and push a little into the belly button. The less gentle nurse even started rubbing the inside of the incision which really iritated it for a few days. MIL is a tough cookie because I would be crying while she worked on me.

 

[Kellydelly]

Thanks, this has been very helpful. I'm guessing that each nurse has a different opinion on how deep it is. It's deep but not that deep where it actually needs to be "packed". The one nurse just pushes down into every little crevice and into the belly button too. The others just lay it down and push a little into the belly button. The less gentle nurse even started rubbing the inside of the incision which really iritated it for a few days. MIL is a tough cookie because I would be crying while she worked on me.

I am a nurse on a surgical unit. I will tell you that if you have 5 people dressing a wound, there will be a good 3-5 ways that it is done . Everyone will probably do it a little different. If there is an order from the doctor to pack the wound then only one nurse seems to be doing it right. There is no reason to be rough with your MIL, however. If you don't like the way this nurse handles her, request she not come back. Not everyone has a kind and gentle touch .

 

[bittybabygrower]

It depends on the wound type and what the order reads. You want wounds to heal from the bottom up and sometimes just laying the strip in there isn't enough. I'd ask her what she is doing and why. Good luck to your MIL.

 

[lsyorke]

Thanks, this has been very helpful. I'm guessing that each nurse has a different opinion on how deep it is. It's deep but not that deep where it actually needs to be "packed". The one nurse just pushes down into every little crevice and into the belly button too. The others just lay it down and push a little into the belly button. The less gentle nurse even started rubbing the inside of the incision which really iritated it for a few days. MIL is a tough cookie because I would be crying while she worked on me.

Time to see the surgeon to determine if this wound needs to be packed at all. Wound care nurse here...not packing deep enough(if the wound requires it) is not a good thing. "laying it down" over the wound does nothing.

Bring her to the surgeon to determine what the wound care should be, it will change over a very short period of time on a surgical wound.

 

[Disney Doll]

Is this a deep wound? If so, the nurse that is packing it is doing it properly and the other nurses are not.

I had abdominal surgery (laprascopic) a couple yeas ago. The main incision formed a hematoma and had to be opened up and drained. I had to pack the wound for three weeks at home until it healed.

The protocol is to keep packing it until it heals from the INSIDE out. If the outer incision closes up too soon, it will close over a pocket of air and that can be very dangerous (could cause infection, gangrene, etc.). I had to repeatedly break open the incision so that I could pack it with saline soaked gauze. It was the most painful three weeks of my life. My doctor advised me to use a little less gauze each time as the wound healed. Worked great, just took a long time.

I would be more concerned about the other nurses at this point.

I have been a nurse for 30 years and agree with this based on the information you are providing.

It sounds like the wound may have a "pocket" in it of some sort. What packing it does is allow the cells to migrate across the packing and the wound slowly heals. It's called healing by secondary intention.

Now, that being said, there is no harm in calling the visiting nurse agency that is providing the services and asking them. Explain to them that you do the dressing change once a day and the nurses do it the other time every day and you have noticed that one nurse does it differently.

You never know...the one you think is doing it wrong may be the only one doing it right.


This link gives a pretty good description of wound healing without too many gross pictures.
http://medical-dictionary.thefreedictionary.com/healing+by+second+intention