Wound Care Plan

Pressure Injury – Leg (Unstageable) and sacrum (Stage 2)

Last Updated
19 May 2025
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Quick Overview

Reference ID Number: TWS-WCP-37

Categories

Pressure Injury

Scope of Practice (ScOP) Designation

Medical Officer,Registered Nurse (RN),Enrolled Nurse (EN)

Treatment Goals

To keep the patient at home as long as possible through stabilising her wounds so that her daughter can take care of her wounds.

Aim of Dressing

Dry out the eschar tissue so that it does not progress into we gangrene and cause sepsis. For the grade 2 pressure injury a protective moist wound environment will be created.

Frequency of Dressing Change

Everyday

References

Shopping List

Dressing Pack (Small),Normal Saline,Iodine (100ml) (AKA Betadine),Inadine (10cm x10cm),Mepilex Border Flex (15cm x 15cm)
Page Table of Contents

    Product Selection Disclaimer:

    The wound care products being currently used are a suggestion ONLY. They do not take into account your patient's individual needs which you must assess. No funding from medical companies has been provided and wound care products are chosen on their merit and what is available on the NSW Health State Wound Care Contract. Where an exact brand name product is not available we suggest you review the alternative tab or use another wound care product from its category eg. Hydrofibre

    Photo Gallery

    Care Plans

    Pressure injury

    The patient is a 92 year old woman who is bed bound and is being care for by her daughter.

     Swipe 
    Step 1

    Setup sterile field

    Setup your sterile field with all your sterile products
    Products Used
    Step 2

    Apply inadine

    Apply a double layer of inadine to the sacral wound
    Products Used
    Step 3

    Apply mepilex border

    If mepilex border is not available try and minimise the bulk of the dressing. Aim of better offloading rather than padding in a dressing.
    Products Used
    Step 4

    Paint Eschar tissue

    Paint any eshcar tissue with betadine mutliple times to dry out the tissue and stop wet gangrene forming
    Products Used
    Step 5

    Offload the area

    Using a specialised body wedge (prescribed by a occupation therapist or orthotist) offload the area to aid healing.
    Products Used