Skin Fluid Seeping Case Study

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

Around 3am in the morning during the hourly rounds to check the patients, Mrs. Keller was found by two carers on her bed doubly incontinent. When asked by the carers if they could wash and dress her in clean nightclothes, Mrs. Keller refused and started to be agitated but the care workers insisted. Mrs. Keller was uncooperative and very aggressive during personal care, she showed superfluous challenging behavior during care, but the carers did not listen to Mrs. Keller and yet stay composed, while focusing on their duties of care. Mrs. Keller remained in an agitated state but feels more comfortable and appeased as shown in her behavior after the care was given.

Pt's appearance is consistent with that stated by dispatch and pt appears to be in moderate distress due to abdominal pain. With assistance, pt is able to ambulate to gurney from the residence. Pt tracks EMS personnel as they move around him and pt is found to be alert and oriented to person, place, time, and event. Pt's airway is found to be open and pt and he is able to communicate with EMS personnel in full sentences. Pt answers all questions asked by EMS personnel appropriately. Pt's pupils are found to be PERL and no secretions are noted upon inspection of the pt's ears, nose, or mouth. Pt's trachea is found to be midline and no JVD is noted. Equal chest rise and fall are noted upon inspiration and expiration. All four abdominal quadrants are soft and tender upon palpation. A strong radial pulse is able to be palpated by EMS personnel and the pt's skin is found to be warm, pink, and dry. Pt is able to move and has sensations in all four

CCIB LPA Perryman-French received a call from Ramie. Ramie was reporting the following: On 05/26/15, Ramie's father C.J. Simmons (DOB 09/21/30) sustained on injury on his left arm (a gash, swollen hand and swollen wrist) from an unknown cause. This wound was healing. C.J. has had a dermal ulcer on his buttocks, which was healing as staff were repositioning him every two hours. The family stated to notice that the ulcer were no longer healing. So the family started to visit, and stay with him daily, between noon and 8 30 pm. On June 29th, 2015 the family arrived to discover that the wound on the buttocks is now open and oozing. He has an open gash on the left side of his head and a gash (now opened, on the same spot where the 05/26/15 wound

Mr. J.’s daughter noticed a red mark on her father who then reported this to the nursing assistant and her concerns were immediately dismissed. If the nursing assistant was properly trained in the use of restraints and had knowledge of patient outcomes, this patient would not have developed a pressure ulcer. The nursing assistant should have immediately informed the nurse and measurements should have been taken to prevent further breakdown of the patient’s skin which was not done. It is evident in reading this case that Mr. J developed a Stage I pressure ulcer from being retrained in one position with no assessment or release for an undetermined amount of time.

a-What is the cause of the edema and what teaching is necessary to help Mrs. Kiner?

Rachel was observed at 2030 on 2/22/17 to have soiled herself. Rachel was given a bed bath and changed by Melanie Laub, RN, Johanna E., RN, and Shatalya Sharp, BHT. They also assisted her with ambulation. Later in the evening, the night nurse, Linda Pickens found medications and some food in the back of Rachel's mouth. This morning Lacy Garth, RN, Nicole Dabbs, BHT, and Sheila Braxton, program coordinator, assisted Rachel to the restroom. She was entirely unable to ambulate and was primarily supported through staff support. She was assisted in drinking water and ensure. Sherri Martin, NP was informed of her medical concerns and total care requirements and determined she needed medical evaluation. PMT was called and arrived at 1200. Report was

Patient is an African-American male, in his mid to late twenties, with a diagnosis of Hidradenitis Suppurativa, which has been ongoing for the last three years, according to the patient. His wounds are post-operative, with about 20-30ml of serous sanguineous fluid discharge on the dressing, and packed with 2.5 inches of iodoform.

L.F, age 91, diagnosed with hypertension, dementia, and hx of falls. The clients general skin pigmentation had no deviations or abnormals from normal skin color, expect for on the clients left buttock. The area on the buttock was red, but still blanchable. The skin was warm to palpate in all areas of body expect for her hands. The clients hands were cold to touch but no problems or complaints noted from the patient. Skin turgor tested on clients sternum and top of hand. Skin turgor was loose and returned to normal baseline within one second. The clients skin was soft to touch, with only small area of dryness located on the clients buttock. Client had many winkles all over body. There was no odor detected on client. Deodorant was used during

CCIB received an Emergency Response Referral (0894-5505-1608-6072737) stating her mother Charleen has had several UTI’s due to a visiting nurse is only at the facility one a month to do urine test if necessary. RP went on to say that the facility would always puthe water bottles across the room which Charleen couldn’t get to due to she was bedridden. Also the RP mentioned 9/17/2017 that resident Maria (94) who is somewhat ambulatory was begging for water. RP reported that Charleen’s legs are severely bruised and she keeps getting open cuts on her legs. LPA Abram contacted the RP on 2/28/2018 and she stated that the bruising was explained by the facility that her mom was banging her legs on the bed rails. In addition, the per call stated that

The reporting party (RP) stated on 10/29/16 at 8:30AM when she visited her patient, resident Doris Wallstrom age 89 DOB: 8/15/27 she observed injuries to the resident's hands and wrists. According to the RP, exceptionally dark bruising and skin tears were observed on the resident's hands and wrists. Consequently the RP questioned both caregivers (their names were not provided) regarding the injuries and neither had an explanation on how the injuries occurred. The resident was described a predominantly nonverbal and unable to explain what

This is a 81 year old female admitted to Derby health rehab. She has a history of bilateral leg cellulitis. She has history of diabetic neuropathy. She normally wears support hose Patients reported numbness on her BLE and decreased sensation. It was worse with movement, relieved by rest. She could not bear weight on them. This morning pt seem to be weak and poor in her balance and reported numbness to her BLE and decreased in her

Mr. Barta said he was working on a roofing job. This required frequent repetitive hammering. He started to have pain in his shoulder and by the end of the day when he dumped trash in a bin it became worse. He did not report this to his employer until the next day. He had attempted to make an appointment with his PCP Dr. Batton but was not able to make an appointment. He then went to the U O M urgent care clinic and was seen by PA Wesley Fischer.

Patient is a 55-year old male who was diagnosed as a Quadriplegia. The reason the patient is quadriplegia due to uncontrolled hypertension. The patient is under the care of Hallmark Home Healthcare. According to the Hallmark Home Healthcare policy, the staff must turn every changing a patient's position in bed every 2 hours helps keep blood flowing. This helps the skin stay healthy and prevents bedsores. According the patient’s chart the patient was turn every 2 hour and the staff change the patient incontinence pads. On March 15, 2015, Skye Moore the patient daughter, report her father had a skin is worn away and underlying muscles, tendons, and bones are exposed on the patient sacrum and heel. The patient was rush to Wing of Mercy’s

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.