Question

Patient Introduction

Location: Skilled Nursing Home Care Facility 0800

Report from charge nurse:

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.

Recommendation: You should complete a basic assessment, review the labs, perform a wound assessment and dressing change, and then reposition the patient to optimize venous return. Please provide patient education on improving venous return to prevent further stasis ulcers, and continue compression therapy with the use of elastic bandage and an antiembolism stocking.

Concluding Questions

Describe how you would apply the knowledge and skills that you acquired in Josephine Morrow’s case to an actual patient care situation.

Answer 1

1.In an actual patient care situation i would take measures to improve venous flow

• By instructing the client to wear elastic or compression stockings and to put on elastic stockings each day.
• Instruct the client to avoid prolonged standing or sitting ,constrictive clothing or crossing legs when seated.
• Instruct the client to elevate the legs above the level of the heart when in bed.

information in Wound care

• Provide wound care to the patient as prescribed by the physician.
• Assess the clients ability to wound care and initiate home care resources as necessary.
• The wound is cleansed with normal saline.Betadine and hydrogen peroxide are not used because they destroy granulation tissue.
• Occlusive dressings such as hydrocolloid dressing may be used to cover the ulcer.

Medications.

• Apply topical agents to wound as prescribed to debride the ulcer,eliminate necrotic tissue and promote healing.
• Administer antibiotics as prescribed if infection or cellulitis occurs.