How To Write A Pressure Ulcer Case Study

2. ensure the agreed care plan has been checked prior to undertaking the pressure area care

The aim of this reflection is to describe my personal experience in wound care and its management. Gibbs (1988) reflective cycle has been adapted in order to provide structure to the reflection process.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

PAST MEDICAL/SURGICAL HISTORY: As above. SOCIAL HISTORY: Status post heavy smoking, 50+-pack-year history. He quit 10 years ago. Status post alcohol abuse, quit 3 or 4 years ago. He lives by himself and no longer drives but has 2 daughters here in Miami who take him where he needs to go. FAMILY HISTORY: Patient’s wife died 14 years ago of COPD due to lifelong smoking. Brother has diabetes mellitus. Unremarkable family history otherwise. REVIEW OF SYSTEMS: No fever, no nausea, no vomiting. Patient has incontinence of bowel. No shortness of breath, no chest pain, no palpitations. PHYSICAL EXAMINATION: Well-developed, well-nourished white male who is alert and oriented x3. Wears bilateral hearing aids. Afebrile with blood pressure 130/70. NECK: No carotid bruits. LUNGS: Clear to auscultation bilaterally. HEART: S1, S2 normal. No murmur. No S3 or S4. ABDOMEN: Soft, nontender. No arterial bruits. No masses, no organomegaly. EXTREMITIES: No edema. No pulses present in the lower extremities. The right great toe is absent. The left great toe shows a 2 x 1 cm deep ulcer with redness around the toe with pus extruding. PLAN 1. Get consult with Dr. Beth Brian, Infectious Disease. 2. Follow up with Dr. Hirsch, Orthopedics. (Continued)

Review of the medical record indicates that he had a MVA in 1977 with C4-5 injury that resulted in him been a Quadriplegic. Due to his bedbound and immobility status he has had multiple pressure ulcers over the years that have resulted in hospital admission and rehab stays. Other medical history include, HTN, hyperlipidemia, Sacral pressure ulcer, Right hip pressure ulcer, Constipation, depression. Bilateral arm contractures, bladder cancer, prostate cancer, urostomy and colostomy, aspiration pneumonia, neuropathy and MRSA.

The skin is the largest organ of the body and it acts as a waterproof protector for all of the internal organs, it is comprised of several layers including the Epidermis which is the outer layer and is a protective multi-layered self renewing structure which varies in thickness depending on which part of the body it covers. Under this is the Dermis, this is a layer of connective tissue which provides the skins elasticity and strength, it also contains sensory nerve endings, blood and lymph vessels, sebaceous and sweat glands. Under this layer is the Subcutaneous fat layer, this layer separates the skin from the underlying bone and muscle with a rich blood supply it also serves as an insulator and energy store. Pressure ulcers develop

An 80 year old female patient with admitting diagnosis of Congestive Heart Failure was refusing care. She presented with unremarkable vital signs, shortness of breath on exertion, decreased air entry right lower field, heart sound 1 muffled, heart sound 2 regular. She had oedematous legs bilaterally. Due to excessive oedema, she had ecchymosis to dorsal left foot, her dorsalis pedis were not palpable and experienced foot pain exacerbated with passive range of motion. She also had a small open coccyx wound. Again, patient was non-compliant with care, refused to be repositioned and refused administration of all medication.

The presence of a pressure ulcer constitutes a geriatric dilemma, the cause of which is multifactorial. Some of the problems leading up to this condition are immobility, nutritional deficiency

Pressure ulcers remain a major health problem for many years. However, pressure ulcers have received minimal attention when we talk about patient safety issues. It is no doubt a patient safety issue as it can lead to serious damage such as life-threatening infections (Robyn). On a med/surge unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on maximizing regaining activities of daily living and assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO). What we fail to realize is that every patient who is at risk needs to be assessed and educated regarding pressure ulcers and the harm it can cause. During the hospital stay, patients may have limited movement and the pressure ulcers can extend into the muscle, tendon, and bone (RNAO). In many cases, patients do not notice the formation of an ulcer and as it may be in areas that are not as visible such as the coccyx. On a unit where there is short staffing, it is more vital to remember to assess for pressure ulcers and prevent the formation of an ulcer. Often, patients are admitted with the presence of a stage one or two pressure ulcer, whether it was from home or long-term care. In that case, patient education need to take place and teachings should be reinforced regarding the prevention of new pressure ulcers forming. Clients should also receive education regarding how to prevent

The patient is 33-year-old gentleman who comes in complaining of dialysis shunt problem. The patient has a AV graft in the left biceps. He had bleeding at this site is. He is normally dialyzed Mondays, Wednesdays and Fridays and he receives full dialysis session and postdialysis bleeding was noted to come thru the bandage and he was therefore sent to the ED. In the ED figure-of-eight suture was used to control the bleeding. The patient is admitted inpatient. His medical history is significant for end-stage renal disease. He had a seizure disorder, bipolar disorder, insulin-dependent diabetes mellitus, is legally blind, and as previoulsly stated he has t long-standing depression hypothyroidism and end-stage renal disease on dialysis.

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.

Based on the physical assessment of the wound described, it is difficult to determine (we don’t know if it was a sudden onset, we don’t know the shape and border – some of the characteristics specific to KTU presentation), if the suspected DTI can be concluded into a Kennedy Terminal Ulcer as a clinical indication of skin failure. Regardless the case, one of the most important aspect, is formulating and implementing an effective end-of-life care plan on how to proceed with the patient’s care. Discussing and educating the patient including the caregiver and other family members, also, in collaboration with the rest of the care team members (as part of the hospice at home program), has a crucial impact on the quality of care the patient receives.

This is a very complex patient because there are many problems to management in this patient. Care management of this patient can be divided in two goals: a short term a long term goal. The first goal which the short term is to manage the high blood pressure and to alleviate the pain. Addressing the issue of the blood pressure can prevent certain high blood pressure complications such as cerebral vascular accident (CVA), renal failure, and in certain cases heart failure. the reason that it is important to address the patient is to make the patient to feel comfortable. When a person is in pain, the pain may adversely affect the body’s endocrine, cardiovascular, immune, neurologic and musculoskeletal systems and require aggressive treatment of

The patient is home bound related to her inability to leave home without the assitance of one or more person and the usage of a modality such as a Walker , the patient respirations are even and unlabored, the patient has tub grips in place to bbel, the patient also has legs elevated is recliner chair, the patient stated that she has occassional pounding of her chest and elevated blood pressure, the pateint caregiver stated that the patient. Blood pressure systolic was over 210 on last night, the patient blood pressure elevated at this time , the skilled nurse. Called Dr. Druhva and spoke with Levon ad informed her of the Patient elevated blood pressure for several days and the patient elevated

Management of Listerosis in pregnant women first begins with avoidance of contaminated or high risk foods. Foods that are considered high risk includes, hot dogs, lunch meats, cold cuts, refrigerated seafood and meat spreads, unpasteurized dairy products, and unwashed produce. In M.L.’s case since she’s symptomatic and febrile, she will need testing via blood cultures and begin IV therapy with IV ampicillin. If blood cultures are negative, the physician has the choice whether to continue with IV treatment. In the case that the blood cultures are positive for listerosis, M.L. will receive 6g of ampicillin daily for two weeks. In case of an allergy to ampicillin, Bactrim may be given as a substitute. Another way of confirming a diagnosis of listerosis