Carefully read the case study below and respond to all related questions in your initial post. Provide support from a minimum of two scholarly sources:
Janice Pressley is an 84-year-old Black woman residing in a long-term care (LTC) facility. She has been immobile since undergoing an open reduction and internal fixation of the left hip following a fall. Mrs. Pressley had lost 9 pounds since the fall one week ago. The AGPCNP notices a darkened circular area to the left heel and redness to the coccyx upon return to the LTC facility.
ROS: The family denies fever, chills, nausea, vomiting, diarrhea, excessive bleeding or bruising, weight gain. The medical record shows a 9-pound weight loss since the fall. The family reports poor appetite, constipation, impaired memory, and occasional shortness of breath. Patient cries out and yells during repositioning or movement of left leg.
Social History: Retired music teacher and pianist. A widow for six years. Denies tobacco or illicit drug use. Reports she used to drink brandy at bedtime. She has two daughters; one lives locally, and the other lives in Jacksonville, FL. Before her memory deteriorated, she used to teach private piano lessons.
PMH: Alzheimer’s with dementia, constipation, HTN, and HF.
PSH: Open reduction, internal fixation of left hip, total right knee replacement, cholecystectomy, bilateral cataract surgery
Allergies: No known drug allergies.
Current Medications: MVI daily, enoxaparin 40 mg SC daily, donepezil 10 mg at bedtime, metoprolol succinate 25 mg daily, furosemide 40 mg daily, ramipril 2.5 mg daily, lubiprostone 24 mcg daily w/food, hydrocodone 5 every six hours as needed for moderate to severe pain, acetaminophen 500 mg every 4-6 hours as needed for pain
Vital Signs: Temperature: 98.1 – Pulse: 78- Respiration: 20 – BP: 146/86 – Weight: 92 pounds – Pain: The patient cannot rate pain on a scale, but she continually yells out when repositioned or the left leg is touched.
Labs: WBC 8.2; H&H: 9.0/27; Platelets: 201; Sodium 130; Potassium 3.9; BUN 9; Creatinine 1.1; Albumin 2.3
Physical Examination: General: Frail older Black woman. Head: NC/AT. Neck: Supple. Carotid pulses 2+ bilaterally. Cardiovascular: Regular rate and rhythm. Lungs: Thorax symmetrical. Lungs diminished. Abdomen: flat, soft, non-tender, non-distended, and no HSM. Hypoactive bowel sounds in all four quadrants. No guarding or rebound tenderness. Musculoskeletal: Moves all extremities with decreased ROM left hip. Extremities: Non-pitting edema to the left lower extremity. Pedal pulses 1+ bilaterally. Skin: left hip incision open to air, well-approximated. No drainage, minimal redness to incision. Turgor is non-elastic. Nails are without clubbing or cyanosis. No rashes. Skin color is uniform, even toned with pink undertones except for the left heel and coccyx. The darkened area to the heel measures 6 cm in diameter. The redness to the coccyx measures 3×5 cm, with a break in skin noted.
Answer the following questions for the initial post:
1. What risk factors does Mrs. Pressley have for developing pressure ulcers?
2. Explain the probable cause of the darkened circular area to the left heel and redness to the coccyx.
3. The Wound Healing Society uses the mnemonic TIME to describe impaired wound healing. Using the TIME mnemonic, what assessments should the AGPCNP perform for Mrs. Pressley’s heel and coccyx wounds?
4. Describe the likely stages of the wounds above.
5. What treatment strategies could the AGPCNP order to treat pressure ulcers (stages I-IV)? Be sure to include both pharmacological and non-pharmacological treatment strategies.
6. What laboratory and diagnostic tests should the AGPCNP order for a patient with impaired skin integrity?
7. What other disciplines could the AGPCNP consult with to manage Mrs. Pressley’s wounds? Please provide a rationale for each.
8. What education could AGPCNP provide to help educate the nurses in this LTC facility on preventing pressure ulcers?
Rubics
Week 7 Case Study Discussion Rubric
Week 7 Case Study Discussion Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeApplication of Course Knowledge:
The student post contributes unique perspectives or insights gleaned from personal experience or examples from the healthcare field. The student must accurately and fully discuss the topic for the week in addition to providing personal or professional examples. The student must completely answer the entire initial question.
1. What risk factors does Mrs. Pressley have for developing pressure ulcers?
2. Explain the probable cause of the darkened circular area to the left heel and redness to the coccyx.
3. The Wound Healing Society uses the mnemonic TIME to describe impaired wound healing. Using the TIME mnemonic, what assessments should the AGPCNP perform for Mrs. Pressley’s heel and coccyx wounds?
4. Describe the likely stages of the wounds above.
5. What treatment strategies could the AGPCNP order to treat pressure ulcers (stages I-IV)? Be sure to include both pharmacological and non-pharmacological treatment strategies.
6. What laboratory and diagnostic tests should the AGPCNP order for a patient with impaired skin integrity?
7. What other disciplines could the AGPCNP consult with to manage Mrs. Pressley’s wounds? Please provide a rationale for each.
8. What education could AGPCNP provide to help educate the nurses in this LTC facility on preventing pressure ulcers?
(8 critical elements)
30 pts
Excellent
All 8 critical elements are present and addressed substantively
27 pts
V. Good
All 8 critical elements are present, but some information may be superficial in places
25 pts
Satisfactory
Discussion of some critical elements is minimal OR 1 critical element is missing
15 pts
Needs Improvement
2-3 critical elements are missing
0 pts
Unsatisfactory
More than 3 critical elements are missing
30 pts
This criterion is linked to a Learning OutcomeSupport from Evidence-Based Practice (EBP)
1. Initial discussion post fully supported by evidence from appropriate sources including National Guidelines.
2. Journal articles published within the last five years unless approved by instructor. Most current version of CPGs used.
3. Content of journal articles represents a logical link between the article content and the assigned topics/case study information.
4. In-text citations and complete references are provided.
(4 critical elements)
30 pts
Excellent
All 4 critical elements are present
27 pts
V. Good
All 4 critical elements are present with 1-2 minor omissions
25 pts
Satisfactory
1 critical element is missing or all 4 critical elements are present with 3-4 minor omissions
15 pts
Needs Improvement
2 critical elements are missing or all 4 critical elements are present with 5-6 minor omissions
0 pts
Unsatisfactory
More than 2 critical elements are missing or greater than 6 omissions
30 pts
This criterion is linked to a Learning OutcomeInteractive Dialogue
1. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources)
2. Respond to at least one peer
3. Responds to all direct questions posed by faculty
4. Includes evidence from at least one scholarly resource to support interactive dialogue
(4 critical elements)
20 pts
Excellent
All 4 critical elements are present
18 pts
V. Good
All 4 critical elements are present with 1-2 minor omissions
17 pts
Satisfactory
All 4 critical elements are present with 3-4 minor omissions
10 pts
Needs Improvement
1 critical element is missing
0 pts
Unsatisfactory
2 or more critical elements are missing
20 pts
This criterion is linked to a Learning OutcomeOrganization
1. Case study responses are presented in a logical format
2. Responses are in sequence with the numbered questions
3. The case study response is understandable and easy to follow
4. All responses are relevant to the case topic
(4 critical elements)
10 pts
Excellent
All 4 critical elements are present
9 pts
V. Good
All 4 critical elements are present, may not be fully organized.
8 pts
Satisfactory
1 critical element is missing
5 pts
Needs Improvement
2 critical elements are missing
0 pts
Unsatisfactory
More than 2 critical elements are missing.
10 pts
This criterion is linked to a Learning OutcomeGrammar, Syntax, Spelling, & Punctuation
Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*
(*) APA style references and in-text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.
10 pts
Excellent
0-1 errors in grammar, syntax, spelling, punctuation, or APA format*
9 pts
V. Good
2-3 errors in grammar, syntax, spelling, punctuation, or APA format*
8 pts
Satisfactory
4-5 errors in grammar, syntax, spelling, punctuation, or APA format*
5 pts
Needs Improvement
6-9 errors in grammar, syntax, spelling, punctuation, or APA format*
0 pts
Unsatisfactory
10 or more errors in grammar, syntax, spelling, punctuation, or APA format*
10 pts
This criterion is linked to a Learning OutcomeParticipation
0 pts
Discussion late penalty deductions
A 10% late penalty will be imposed for discussions posted after 11:59 p.m. MT on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., student will receive an automatic 0)
0 pts
Total Participation Responses
A 10% penalty will be imposed for not entering the minimum number/type of interactive dialogue posts OR not posting on at least two separate days. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., student will receive an automatic 0)
0 pts
