Wound Healing: A Case Study

Outline and discuss a clinical audit that you have undertook into one aspect of care delivery and reflect upon the experience using Driscoll’s model of structured reflection. Word Count (2197)

Dale Gordon has been a patient in the ICU for 6 days after developing complications after open heart surgery. He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him.

I can relate to one of the points in your discussion. I work in a small community hospital in the Wound Healing Clinic. We are an outpatient addition to the hospital. We have one nurse who has the primary responsibility of the acute admissions wound care. Last year we were bought by a large health systems. Recently, we were informed that we, the Wound Center, are held responsible if a patient has a hospital acquired pressure ulcer (HAPU). As part of this new directive we were also informed that prevalence rounds were to be done weekly. This is what you described your facility does once a month. These changes place responsibility for care which our staff does not even provide, moreover the changes were never discussed with our clinical coordinator.

Patient malnutrition is a very real and serious matter; it can lead to a worsening of the patient's

DOI: 1/14/2016. Patient is a 47 year old male senior information technology field services who sustained injury when his vehicle went off road. He had a transmetatarsal amputation of left foot with failed flap, status post further surgical excision debridement twice a week removing necrotic tissue.

Nutrition is an important aspect of health within all age groups. A nurse’s initial assessment is very important to a patient’s nutritional status because during an assessment, many findings can determine the nutritional status of an individual. For example, a simple examination of a patient’s overall appearance can determine whether the patient is malnourished, by evidence of decreased functional status, decreased bone mass, impaired muscle function, immune dysfunction, reduced cognitive function,

Implications of discharging patients who do not understand their wound care discharge instructions, and follow-up care can lead to several problems. The problems included: poor health outcomes, increased risk of infection, increased health care cost, decreased insurance reimbursement, low HCAHPS scores, non-compliance with health care recommendations, recurring hospitalizations, and increased morbidity. An example that involves several implications listed above would include a patient who is non-compliant with his diabetes care, does not understand his wound care instructions and how his diabetes effects wound care healing, does not have a follow-up appointment and the wound becomes severely infected requiring a long readmission stay in the

Shawna Garito BSN, RN, CWON is a nationally certified wound and ostomy specialist at Sacred Heart Hospital in Pensacola, Florida. She has been serving the Sacred Heart Ministry for 8 years in the cardiology, intensive care, and wound care capacity. She holds certifications in Advanced Cardiac Life Support (ACLS), Basic Life Support (BLS) and Diabetic Foot and Nail Care. Currently, she provides advanced wound healing modalities for patients with wounds originating from diabetic complications, venous and arterial disease as well post-operative dehiscence. She also provides pre and post-operative education and teaching to new colostomy, ileostomy and urostomy patients.

Further Infection due to the effects of age, location of the wound, malnourishment, and diabetes mellitus.

At 6 hours, the wound closure in the control (Fig. 1a), diabetic (Fig. 1c) and diabetic groups supplemented with whey protein (Fig. 1e) was not visible. In contrast, wound closure in the diabetic rats supplemented with whey protein at 4 days after the injury (Fig. 1f) was greater than the diabetic rats (Fig. 1d) and nearly similar to the control rats (Fig. 1f).

DOI: 3/10/2016. Patient is a 51-year-old female accounts payable representative who sustained injury to her neck, back, left shoulder, bilateral knee/foot and lower extremity while she was coming out of the elevator when she slipped and fell forward. Per OMNI, she was initially diagnosed with upper/lower neck, bilateral shoulders/hands, and bilateral ankle and foot sprain/strain.

• Bedside reporting • Wound care • IV insertion & venipuncture • Telemetry monitoring • IV medication therapy • TPN administration • Central line dressing changes • Time management PROFESSIONAL EXPERIENCE WEISMAN CHILDREN’S REHABILITATION HOSPITAL OCTOBER 2017-PRESENT Registered Nurse Marlton, NJ • Assess and treat patients from ages 3 weeks to 21 years of age • Administer medications safely • Performwound care • Communicate effectively with report KINDRED HOSPITAL SOUTH PHILADELPHIA OCTOBER 2017 -PRESENT Registered Nurse Philadelphia, PA • Efficient with bedside reporting • Communicate with doctors and verify orders • Perform IV insertion and blood draws • Trained in central line dressing

The overall goal of the project is to improve patient understanding of his or her wound care discharge education, discharge instructions and follow-up comprehension at St. Joseph Health Network. In 1873, St. Joseph hospital opened its door to resident of Reading, Pennsylvania (PA). Throughout the years the hospital has had several challenges, new management, and relocated to a new state-of-the-art building in 1996. In 2015, the hospital become known as the Penn State Health St. Joseph under the management of a larger health care system known as Penn State Health. The health care network has a predominant inpatient wound care department and an outpatient wound care clinic.

The victim is bed bound, has multiple wounds, a total care patient, some dementia, and relies on a caretaker for help with her ADLS. The victim's daughter removed her from her nursing home placement less than month after admission and isnt maintaining her basic needs. The victim is verbally abused; Ms. Bishop degrates the victim, lacks compassion and symphathy for her condition and providing proper wound care. The victim's wounds get worse and she has a new wound weekly, she's on given 2-3 bites of food before Ms. Bishop stops feeding her; Ms. Bishop feeds the victim whatever she eats. When asked about feeding tubes for the victim, Ms. Bishops lack education that they can be used in the home, and asked if she would have to care for it. When

The first article is about how critical it is to have proper and concise wound care documentation. It talks about this importance from the stand point of a lawyer who deals with a lot of wound care negligent cases. His key points include proper measurements, weekly documentations, pictures and correct diagnosis of the type of wound to have accurate information. He also talks about the importance of having the right employees completing the information or the systems don’t work. Whether it’s an electronic or paper-based system, or photos of the wound, employees must be trained to provide accurate documentation, he said. “Just putting [a system] into place doesn’t make it work” (O’Connor 2012).