Question

PT 3-Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago. The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin breakdown.

Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD), chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.

Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been within normal limits and are performed weekly. Results from yesterday's labs are in the chart. She is on a regular diet with nutritional supplement and has been eating the majority of her meals since admission. She requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate. Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In preparation for her dressing change, she was medicated for pain half an hour ago.

1.   What are you on alert for today with this patient?

2.    Why is this important?

3.    What are the important assessments to make?

4.    Why are these assessments important

5.    What complications may occur? What could go wrong

6.    Relate the assessment data to the potential complications that may occur.

7.    What interventions will prevent complications?

8.How will the interventions prevent complications?

Answer 1

1- This is a serious condition that has been linked to heart attack and stroke if its not treated,in this condition blood flow to the arms ,legs ,kidneys and other vital organs can be limited.If it is not treated well chance of developing atherosclerosis ,and leads to blochage of bloodvessels.In this situation make sure that all the vitals are stable and risk factors are reduced., and bloof flow to the organs are adequate.Her health status is deterioted,bradden score is low indicates chance of developing preassure sores.

2-Peripheral aretery disesae is dangerous because these blockages can restrict circulation to the limbs,organs,and brain.Without adequate bloodflow vital organs ,legs,arms,feet and brain suffer damage.Left untreted the more gangrenes willl develop.

3- In this condition vascular examination includind palpation of lower extrimity pulses ,femoral,popliteal,dorsalispedis and posteriar tibial must be note,auscultation for femoral bruits and inspection of the legs and feet.In this patient she is diabetic consider the risk of another ulceration formation,assessement of musculoskeltal and neurological status of the foot is essential in addition to the vascular supply.

Measuring ankle brachial preassure index- a manual sphygmomanometer along with an appopriate sized cuff is palced just above the ankle,inflated to occlude the artery and slowly relesed.If the vessel cannot be occluded this should be recorded as in incompressible.The return of signal indicates the systolic preassure by doppler and should be taken in PT and DP in each foot.Take an eelectrocardiogram to identify any evidance of myocardialinfraction and arrythmia .Blood test should be done for full blood count urea and electrolytes and lipid screen.

4- Clinical examination is an essential component for the assessment of patients with peripheral artery disease to prevent complications .

5-Complications include

• tissue death
• pale skin
• pain ate rest and with movement
• severe pain that restricts mobility
• wounds that takes time for heal
• life threatening infections of the bones and blood stream
• If tissue death and ulceration not treated can lead to amputation of limb.

7&8 -Interventions can reduse th risk of complications.it includes

• Physical activity -effective treatment for this condition,simple walking regimens,leg excercises,
• Diet -A diet low in saturated and trans fat can help lower blood cholestrol levels,but cholestrol lowering medication may be neccessary to maintain cholestrol level.
• Medication
• Managing diabetis
• Manage diabetis