A Study On The Treatment Of A Patient On A Widowed 67 Year Old Caucasian Male Who Lives Alone

S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94%

John is in his early forties and has had Type 2 Diabetes for 8 years. When he was first diagnosed, he was offered a diet sheet and advice from his doctor to introduce physical exercise into his life. John is a manual worker and feels he doesn’t need to exercise as he keeps active most of the day. He gave up smoking and drinking alcohol, but after 3 months his blood glucose level was still above normal and was prescribed medication. Eight years later, he now uses insulin to control his blood glucose levels and is a non-smoker. He was admitted to hospital following a road traffic accident which resulted in an operation on his foot which had sustained multiple injuries. The wound was very slow healing and intravenous antibiotics were prescribed.

R/s Ms. Brenda Gasque is in a wheel chair, she is paralyzed from the waist down due to her having meningitis years ago. R/s Ms. Gasque suffers from high blood pressure, COPD, Congestive heart failure, and stage 2 pressure ulcer. R/s Ms. Gasque’s COPD is very severe she has to use a nebulizer. R/s Ms. Gasque wears a diaper and she has a suprapubic catheter. R/s Ms. Gasque needs assistance going to the bathroom and bathing. R/s Ms. Gasque can feed herself and she can use her hands. R/s it was reported that Ms. Gasque is being abused physically and verbally by her children. R/s Ms. Gasque is never happy because she lives at several different places with her children.

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

During the time of assessment the patient was watching television with his mother on his bedside. The patient report that another student gave him a razor off the floor and he wanted to make marks on him that looked like a cut that the patient reports appeared in his sleep. The patient appears guarded with a flat affect. The patient starts to talk in a low tone and only respond by head movements.

Patient incurred a T7 thoracic injury and has no lower extremity functional ability. At present the patient has a stage two sacral decubitus, urinary tract infection, and muscle spasms in his lower extremities. The sacral ulcer was caused from the lack of frequent position changes while in bed and improper seating in the wheelchair. The wound requires daily dressing changes and more frequent if soiled from urinary and fecal contamination. The urinary tract occurred from the patient intermittently cauterizing himself with a straight catheter every four hours. The patient has also been experiencing spontaneous uncontrolled spasticity in the lower extremities.

Sean has been diagnosed with Cerebral Palsy, Quadriplegic and legally blind. His vision is limited due to his peripheral view.

Foot ulceration is common, affecting up to 25% of patients with diabetes during their lifetime. Over 85% of lower limb amputations are preceded by foot ulcers and Diabetes remains a major cause of non-traumatic amputation across the world with rates being as much as 15 times higher than in the non-diabetic population. Prevention is the first step towards solving diabetic foot problems. Although it was estimated that an ankle is lost to diabetes somewhere in the world every 30 seconds, a more important fact is that up to 85% of all amputations in diabetes should be preventable. Strategies aimed at preventing foot ulcers are cost-effective and can even be cost-saving if increase education and effort are focused on those patients with recognized

Pupils equal and round, reactive to light. Wears glasses, had injury to eye in 2008 where traumatic Cataract removed and lens was implanted.

Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus [2]. Non-healing ulceration usually progress to amputation in spite of standard care. DFUs result from interaction of ;neuropathy, peripheral vascular disease and foot deformity. 80% of diabetic persons with foot ulcers present with peripheral neuropathy which is the greatest risk of foot ulceration [3]. Neuropathy in DM shows variable degrees of autonomic, sensory, and motor functions changes[4]. Motor neuropathy causes atrophy of the foot muscles resulting in clawing of the toes, sensory neuropathy results in repetitive trauma to the foot, and autonomic neuropathy changes skin consistency so accelerating ulcer formation [5] .40 to 50% of all patients show ischemic manifestations with the most having neuroischemic ulcers, and only few of them has purely ischemic

A diabetic foot ulcer is an infuriating condition that arises from the unmanageable progression of diabetes. Significantly, its occurrence can impact each patient physiological appearance and psychological state. The patients that are living with diabetic foot ulcers are faced with the possibility of encountering severe infections from the foot due to presenting multi-factors that initiate its development. Like many other foot conditions, foot ulcerations are in compliance with the evidence base practice of nursing as a whole. As a result of this practice, diabetic foot ulcers can be treated with the use of clinical expertise and scientific knowledge to provide the most safe and effective care to patients who are at risk for limb amputation. In short, this paper will discuss the pathophysiology, etiology, and risk factors of diabetic foot ulcers, while reviewing nurse’s perspectives on how valuable evidence based nursing is to their practice and to managing diabetic foot ulcers. The interventions listed, will be evaluated within the paper to ensure that they are appropriate in preventing the early onset of diabetic foot ulcers.

Impaired skin integrity related to limited mobility, impaired tissue perfusion, decreased cardiac output, altered nutritional and hydration status, increased moisture, decreased sensory perception and excess weight as evidenced by patient being bed reddened 95% of the day, +2-+3 peripheral edema, stage III- IV coccyx pressure ulcer, drainage from the coccyx ulcer, high blood pressure, decreased oxygen saturation between 85-95 % 2L NP, weak peripheral pulses, obesity, excessively dry skin, sores on both legs (blister-like), denial of pain regarding dressing changes, and excessive diaphoresis with movement secondary to CHF, hypertension, hyperlipidemia, and non-insulin dependent type II diabetes.

Mr. Trosack is a 72 year old man who fell down a long flight of stairs a month ago, underwent a total hip replacement and is in need of a discharge plan. He completed two weeks of rehabilitation in the hospital for his hip as well as diabetic teaching for his new onset of Diabetes. It was also discovered during this hospitalization that he needed to start taking medication for hypertension. Both he and his family are in denial about what it will take to get him home and deliver the care that is needed.

For the purpose of confidentiality, the patient will be identified by the initials A. S. A.S was a 52- year old African American woman who was admitted to the hospital when she started to experience severe urinary retention and shortness of breath. She has three adult children and eight grandchildren, but recently lost her husband of 25 years to diabetes. The patient appears to be very independent because she lives alone in her home and is aware of the disease process. She has a past medical history of acute renal

Patient also, has history of hypertension, GERD, morbid obesity, anemia, and depression. She reported that the past few months, she has been feeling very weak and overall generalized deconditioning. Her ability to care for herself including her activities of daily living (ADLs), and her basic physical needs (like bathing, grooming, ambulation, meal preparation, transportation, errands, and housekeeping), had decreased, and cannot consistently carry them out.