Hot Spots - Wound Care

Rob's Daughter

Hello everyone -

Question…. Both my Mom and Dad are under Hospice care, both are in Broda Chairs or in bed, unable to walk or stand. Hospice is treating both of them for wounds.

My dad has "mushy heels" I am told, they are putting plates on the bottom of his feet and elevating his feet in his Broda chair as well as using a wedge while he is sleeping to elevate his feet so they do not touch the bed.

My mom, has "wounds" on her hip and butt, which they are treating.

Question… is this "normal" progression…. I know they reposition them throughout the day and night… I am told that skin just breaks down due to nutrition and age… etc. Anyone else dealing with this?

Also, they put a fall mat by both my parents beds (separate beds - provided by hospice)… can they not or do they not have bars to protect them? I honestly do not think she has the strength to roll out of bed, but just wondering if there is anything else I can do.

My Dad was recently switched to a pureed diet and is doing well… my mom is having on and off days. Today was another off day - she refused to get out of bed…. sleeps a lot, refused to take meds or drink. She was like this last week, Hospice calls, the next day and said she is up and doing better, ate, etc.

Thank you for reading….

SDianeL

a bed alarm is an option that would alert the caregiver. I would ask hospice about bed rails but:

• Not a restraint: Bed rails should never be used as a restraint to keep a person in bed. Using them as a restraint can increase the risk of falls and injury.

towhee

Pressure sores can occur when there are certain conditions such as lack of movement, not soft enough surfaces, and yes age and either lack of correct nutrients or inability of the body to use those nutrients and vitamins due to age and illness. I think they usually try for a certain amount of protein, vitamin C and zinc in the diet. They usually try to reposition people in bed every two hours with pillows to prop them in different weight bearing positions. I do not know how often they try to reposition in a broda chair. You can get special mattresses that will inflate and deflate in a pattern so as to shift weight bearing, or gel mattresses. Sometimes with special mattresses it cuts down on the number of times the patient needs to be repositioned.

Bedrails can be a safety issue. Patients have literally gotten stuck between them and died. I have seen something like a pool noodle tucked on the edge of beds for preventing rolling out.

Heels are a common place for pressure sores to appear, I have never heard the term "mushy heels" but I suspect he either has current pressure sores or they suspect incipient pressure sores. I am a little puzzled by foot plates, I wonder if they are referring to padding part of the Broda chair? To heal pressure sores you have to keep the affected area from pressure, so elevating the heels in some way is part of treatment. What worked best for my LO was a foam boot with a heel cutout.

Part of the reason my LO wound up with pressure sore on the heels was the way they were pulling her up in the bed. People naturally slide down in hospital beds and have to be pulled up toward the head of the bed in order for the head of the bed to be raised to eat. Some patients literally "dig their heels in" while this is being done, so watch for that.

The pattern of eating/not eating is pretty common.