Fall Prevention Strategies for this Patient - Case Study Nursing Assignment Help

Assignment Task:

Task:

The student is required to analyse the following case studies and respond to the posed questions.

CASE STUDY PART 1

A 72-year-old woman was admitted to your ward yesterday after a fall in her bathroom 4 days ago. The patient has a major wound on her right lower leg (see Figure 1 below) her general practitioner sutured the wound and prescribed a daily oral antibiotic for the past 72 hours. She saw a locum general practitioner yesterday who advised she be admitted to hospital for further treatment of her leg wound.

The patient’s medical history reveals that she has severe osteoarthritis for which she has had a right hip replacement and a left knee replacement many years ago. She still requires a Canadian crutch for mobility, but she is an active lady, even though she has back pain, which is related to the osteoarthritic changes in her lower spine. She also has Diabetes Mellitus Type 2 since the age of 50.

On examination you find the following:

-Airway is clear and the patient is speaking well

-Breathing is at a rate of 16 breaths per minute; and her chest movement is normal and air entry is equal in both lungs

-Circulation assessment shows good popliteal and pedal pulses, a HR of 90 beats per minute and regular; BP 85/40. The ECG attended on her admission showed IHD.

-A disability assessment shows the patient has normal cognitive function, although requires assistive aid for walking.

-Exposure shows a very large wound on the right lower leg

- Fluid assessment shows that the patient is normally hydrated and the fluid balance chart shows that she is in a negative balance of 500mls. (i.e. her output is more than her intake). A ward level urinalysis showed pH6.5, SG 1.000, and no abnormalities.

-Glucose assessment shows that her BGL has been done b.d. and is ranging between 7-11 mmol./L via the ward glucometer.

The student is required to:

• provide a comprehensive assessment of the wound given in the above image

• Explain the factors which may have led to the patient’s fall and the severity of the leg wound

• Formulate an evidence-based wound management plan for this patient’s wound (this is to be written in essay format – tables will not be accepted). 

• Discuss fall prevention strategies for this patient.

CASE STUDY PART 2

The medical team that involve plastic surgeons decide to treat the wound conservatively for 7 days.  However the patient’s wound does not improve and her temperature has been increasing and is ranging from 37-38.5 degrees centigrade. The patient is also complaining of severe pain when she is walking which is limiting her mobility greatly. She is also quiet depressed and teary. Further she has expressed her horror at how her leg is looking as she likes to wear dresses.

The medical team decide to take her to theatre and debride the wound. The patient recovers well from surgery and her wound looks like the image below. The medical team expect the nursing staff to manage wound care.

The student is required to:

• provide a comprehensive assessment of the wound given in the above image and compare it to the wound on admission (Figure 1).

• Formulate an evidence-based wound management plan for this patient’s wound and compare it to the management of the wound on admission (this is to be written in essay format – tables will not be accepted).

The patient, unfortunately, does not progress as expected and she undergoes further surgery which involved a skin graft two weeks following the initial surgery. The patient is still very upset about the scarring and the ‘dent’ in her leg as she puts it. After the skin graft, the patient progresses well and is discharged 7 days following the skin graft, however, the patient will require wound dressings to be continued. 

• Formulate a comprehensive discharge plan for this patient (this is to be written in essay format – tables will not be accepted) based on good evidence.

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