More Subjects
Case No. 1
Holistic Assessment of Patient
Mr. Will Jackson is a 77 years old man, diagnosed with Rectal Ca almost 5 years ago. Currently, he is suffering because of poor oral intake, intermittent pain from his wounds both from diabetic foot ulcer & arterial ulcer. He had CABG 2 years ago alogn with COPD, ETOH, GORD, Postural hypotension & T2DM on insulin. Patient experiences intermittent confusion at times. His medications include Telmisartan 40 mg. b.d, Ventolin 4 puffs t.d.s, Esomeprazole, 20 mg daily, Lantus 20 units (mane), warfarin 2 mg (daily), Frusemide 20 mg b.d. PRNs : Endone 10mg (tds), Hydromorphone 2 mg (b.d).
He was admitted to the ward for pain management, SOB & wound management. Prior to admission, he had a fall at home with a head strike and had a massive bruise over his face. CT scan result: NAD. The doctor stopped his warfarin dose for a week due to this massive bruise.
Mr. Jackson has a diabetic foot ulcer behind his L) toe that requires debridement while in hospital. Apart from this he also has arterial ulcer on his R) lower leg which looks infected. The treating doctor ordered a wound swab to be taken and send to pathology. The result shown that it is infected.
He also has 1 pressure ulcer on his sacrum bone which was discovered when he first admitted into hospital post fall. It is a stage 3 pressure ulcer and caused him a lot of pain especially if he is lying in supine position. Mr Jackson thought it was pain from his cancer in the rectum. The wound base of the ulcer consists of 70% sloughy tissue and 30% granulation tissue.
On day 3 in hospital, patient suffered from a burn because he spilled a hot coffee over his L) arm. He sustained a second degree burn because of this.
Evaluation and Wound Management Plan
Diabetic Ulcer
The management of diabetic ulcers require offloading the wound and cleaning it with saline daily. Furthermore, it requires treatment that would provide moist wound environment.
Wound Management Plan
Moist Wound Healing
Saline or similar dressing
Skin & Risk Assessment
Improper care can lead to infections and gangrene. The care also requires optimal control of blood glucose with the correction of peripheral arterial insufficiency.
Wound Cleansing
Clean with saline on daily basis.
Pressure Support and Relieving Devices
Use therapeutic footwear to provide pressure relief
Preventive Programs
Control blood glucose through proper diet and medications
Wound Dressing Products
Moist dressing. antibiotic ointments
Secondary Dressing (if required)
None
Pain Management Time Frame (if required)
The pain will persist till the wound is open. Pain relief medications are necessary.
Infected Arterial Ulcer
These are poor perfusions i.e. lack of nutrient rich blood delivering vessels to the lower extremities. The covering skin and tissues are deprived of oxygen that kill the tissues and cause the area to create an open wound.
Wound Management Plan
Moist Wound Healing
Saline wash and open dressing to avoid infections.
Skin & Risk Assessment
This can lead to foot deformity, callus formation and lack of joint mobility. Furthermore, it can lead to tissue necrosis and even amputation in case of extreme conditions.
Wound Cleansing
Saline wash for cleansing the wound with topical ointment.
Pressure Support and Relieving Devices
Wearing therapeutic footwear.
Preventive Programs
Physiotherapy, diabetes control and management.
Wound Dressing Products
Open dressing and saline wash. antibiotic ointments
Secondary Dressing (if required)
None
Pain Management Time Frame (if required)
Severe and persistent pain. Pain relief medications are necessary.
Pressure Ulcer
Also known as Bed sores, these pressure ulcers are injuries to the underlying tissues and the skin because of the prolonged pressure of the skin. People with limited capability to move are more prone to these ulcers.
Wound Management Plan
Moist Wound Healing
Dry treatment is required
Skin & Risk Assessment
Improper care can lead to risks such as cellulitis, bone and joint infections, cancers and sepsis.
Wound Cleansing
Saline cleaning is required. However, the wound must be dried off.
Pressure Support and Relieving Devices
The site must avoid any pressures or contact with hard surfaces.
Preventive Programs
Constant repositioning can avoid bedsores. Good nutrition and exercise also helps in avoiding bed sores.
Wound Dressing Products
Dry and open dressing is required, antibiotic ointments
Secondary Dressing (if required)
None
Pain Management Time Frame (if required)
2-4 weeks based on the severity of the wound.
Second Degree Burn on Arm
Second degree burns are the ones in which the epidermis and partial dermis layer is damaged due to burns. The site appears red, blistered, swollen and painful.
Wound Management Plan
Moist Wound Healing
Dry wound healing is required
Skin & Risk Assessment
Improper care can lead to infections and sepsis.
Wound Cleansing
Dry cleansing
Pressure Support and Relieving Devices
Pressure and any contact must be avoided
Preventive Programs
Avoid any hot or burning contact.
Wound Dressing Products
Antibiotic ointments, change of dressing twice a day, daiy cleaning, dead skin removal.
Secondary Dressing (if required)
None
Pain Management Time Frame (if required)
Pain relief medications are required until the wound is fresh.
Health Education Regarding Wound
Since the patient is suffering from immobility and multiple ulcers and wounds, it is important that he must be assisted in cleaning and dressing the wounds as per needed. While other ulcers need once a day cleansing and dressing, the burns must be cleaned twice or thrice day. Patient is unable to do this himself, therefore, he needs assistance at home.
Case No. 2
Holistic Assessment of Patient
Mrs. Miriam Gold, 85 years old patient has fluids overload (dialysis will be ceased due to palliative approach), Pneumonia & metastatic cervical cancer. She is also often drowsy and vague. She : lives home with husband. Pt & family wants no further treatment. Mrs. Gold was admitted to the ward for palliative treatment. Husband and children are not coping at home and she was in a lot of pain due to her malignant wound on her L) groin.
The malignant wound on her groin is oozing a lot of pus and it has developed a sinus. The odour that coming out from the wound is quite strong. The patient requires pain relief before dressing change and for any pad changes/hygiene care. It was reported that her groin and peri-anal area is burning red due to bowel incontinence & discharge from her cervical cancer.
In patient history notes stated that, Mrs.Gold had developed a rectovaginal fistula as a result of disease progress and radiotherapy. In addition to this, the patient has a long standing venous ulcer that is not healing.
Evaluation and Wound Management Plan
Malignant wound on groin
This is an open wound that can be cancerous in nature if nor treated properly. The wound is draining and looks like an open cavity on surface of the skin. The appearance is bumpy and irregular.
Wound Management Plan
Moist Wound Healing
The wound requires dry healing process.
Skin & Risk Assessment
The wound can lead to infections, sepsis, odour, inflammation, extreme pain, etc.
Wound Cleansing
Daily cleansing with saline is important to ensure no infection develops.
Pressure Support and Relieving Devices
The site should be avoided from any pressures or clothing contact.
Preventive Programs
Quality nutrition, skin assessment.
Wound Dressing Products
Antibiotic ointment, dry dressing
Secondary Dressing (if required)
None
Pain Management Time Frame (if required)
4-6 weeks based on the severity. Pain relief medications are important.
Venous Ulcer
This ulcer is more common in women and older individuals. This is also associated with venous hypertension. The clinical features of this ulcer include painful site, bony appearance, etc.
Wound Management Plan
Moist Wound Healing
Daily saline wash is required.
Skin & Risk Assessment
The condition is often associated with edema, venous dermatitis, varicosities, and lipodermatosclerosis
Wound Cleansing
Saline
Pressure Support and Relieving Devices
Leg elevation, compression therapy
Preventive Programs
Thorough skin tests and health assessment
Wound Dressing Products
Open dressing, antibiotic ointment, aspirin, surgical management
Secondary Dressing (if required)
None
Pain Management Time Frame (if required)
Depends on severity of issue.
Health Education Regarding Wound
For this patient, it is important to understand the critical nature of the wounds. Since she has two wounds at the moment – both having similar characteristics but different diagnosis. It is important that she must ensure constant cleaning and draining of her wounds to avoid sepsis and infections. Furthermore, she must ensure healthy and balanced nutrition intake to avoid further skin complications, rashes, blood supply, etc. Personal hygiene is also important to allow good blood supply to the skin and avoiding any infections.
References
Schultz, G. S., Sibbald, R. G., Falanga, V., Ayello, E. A., Dowsett, C., Harding, K., ... & Vanscheidt, W. (2003). Wound bed preparation: a systematic approach to wound management. Wound repair and regeneration, 11, S1-S28.
Bowler, P. G., Duerden, B. I., & Armstrong, D. G. (2001). Wound microbiology and associated approaches to wound management. Clinical microbiology reviews, 14(2), 244-269.
Baranoski, S., & Ayello, E. A. (2008). Wound care essentials: Practice principles. Lippincott Williams & Wilkins.
Meaume, S., & Gemmen, E. (2002). Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers. Journal of wound care, 11(6), 219-224.
Jeffcoate, W. J., & Harding, K. G. (2003). Diabetic foot ulcers. The lancet, 361(9368), 1545-1551.
Trent, J. T., Falabella, A., Eaglstein, W. H., & Kirsner, R. S. (2005). Venous ulcers: pathophysiology and treatment options. Ostomy/wound management, 51(5), 38-54.
Alexiadou, K., & Doupis, J. (2012). Management of diabetic foot ulcers. Diabetes Therapy, 3(1), 4.
More Subjects
Join our mailing list
© All Rights Reserved 2023