Patient Introduction
Location: Skilled Nursing Home Care Facility
Time: 0800
Report from charge nurse:
Situation: Josephine Morrow is an obese, 80-year-old female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing 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 nearby skilled nursing 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 stable and are performed weekly. Lab results from yesterday 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 x 1 to get out of bed to the chair or to 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 obtain vital signs, perform a wound assessment and dressing change, and afterwards reposition the patient to optimize venous return. You will find the dressing orders in the chart. I would also like you to review the labs for nutritional status and reinforce education on diet’s influence on wound healing. Please also provide patient education on improving venous return to prevent further stasis ulcers.
