New ulcer

Unknown

This patient was admitted with a failing fem/pop bypass graft with a nonhealing heel ulcer. Underwent redo resection with PTA x 2.
2 days postop now has new 2 cm lat malleolous ulcer with black base.

Does anyone have any ideas on how to query or if even to query? I am unsure that in two days the ulcer would appear and be black?

Due to pts severe PVD, BKA is planned.



Charlene

mannb1

There's nothing in the nurses' notes that indicates an ulcer/or something was there @ admission? Also, it sounds unstageable by wound care if the base is black...I think a query for whether or not it was POA - and maybe go back through the documentation to be sure there isn't something referencing it initially - ED, transfer form, somewhere?

Becky Mann, RN, CDS

Unknown

Unfortunately the nurses notes do not mention anything.
The progress notes state po day 2 this ulcer is new.

In reality it is not a decub but an arterial (ischemic) one.

I probably do not have anything to query for.

Charlene

dog

It really is amazing how quickly some ulcers can progress to unstageable...it is possible in two days because I have seen it.

I would review the physical assessment in the H/P to see what the physician said about the skin condition on admission, and I would probably query to verify that it is arterial vs decubitus, and community acquired vs hospital acquired.

Renee

Linda Renee Brown, RN, CCRN, CCDS
Clinical Documentation Specialist
Arizona Heart Hospital

sillygirl22

I would make sure the physician documents the ulcer is due to PAD.

Karen Beal, RN, BSN, CCRN
Clinical Documentation Improvement Specialist
Huntington Hospital
100 W. California Blvd.
Pasadena, CA 91109
626-397-2024
Fax 626-397-2904
karen.beal@huntingtonhospital.com

lspryszak

Well, first the physician has to name the type. It sounds like it's ischemic, but it can't correctly be coded unless the physician tells us what kind it is. If it's anything other than a decubitus it wouldn't be staged - only pressure/decubitus ulcers are stages. All other ulcers are described. Ischemic ulcers are not HACs, so if it's an ischemic ulcer I don't think POA applies.

Your query opportunities here are 1) type of ulcer, 2) POA (since the MD has to document the correct POA astatus whether any condition is POA or not)

The fact that this ulcer turned black so quickly tends to point to ischemia as the etiology, although a patient with a severely compromised peripheral vascular status wouldn't rule out a decub, if it's over a lower extremity bony prominence.