Pressure UlcersPATIENT STUDY ONE
DM is 68 years old and has a 12 year history of coronary heart disease. She underwent quadruple coronary artery bypass surgery approximately one month ago. She was in the operating room for 11 hours due to post-operative bleeding, and remained on a ventilator until post-operative day 5 due to congestive heart failure. Upon admission to the intensive care unit, she was placed on a therapeutic pressure reduction surface and was unable to turn herself for 24 hours due to her clinical condition.
A large, red "butterfly" shaped wound on the sacrum was recorded on post-operative day three although no measurements were made. On day five the wound had turned black with a sloughy edge to the left rim. Scant tan exudate with erythema surrounds the wound.
You have been called in to assess the wound and treat the patient.
Here is a picture of the wound.
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Leg UlcersPATIENT STUDY TWO
VC is a 74-year-old female who has had a history of chronic diverticulitis for the past 25 years. She developed a deep vein thrombosis following surgery on her hip eight years ago and for the last five years has suffered from oedema which worsens during the day.
VC lives in warden controlled accommodation (assisted care living facility) and spends most of her day sitting in her favourite armchair.
On initial assessment the patient suggested that her wound was the result of an insect bite three years ago, which didn't heal. She has been treating it herself with a cream her sister gave her but over the last six months the wound has become larger, more painful and smelly, exuding large amounts of fluid.
Here is a picture of the wound
Diabetic Foot UlcersPATIENT STUDY THREE
FJ is 65 years old and lives alone. He has poor vision and limited mobility because his hips are painful. He was diagnosed with Type II diabetes three years ago and has been poorly maintained on oral hypoglycaemics since then. He intermittently attends his local diabetic clinic and, during his last visit, it was discovered that Fred had an ulcer at the base of his right big toe. Fred had been treating the wound himself for 3 months by bathing it in salt and water.
On initial assessment the patient had a large, necrotic wound on the base of his right big toe. The wound was painless and dry. The skin at the base of the toe was red.
Trauma Wound PATIENT STUDY 4
This 50-year-old woman is obese and has a history of oedema related to chronic venous insufficiency, and cellulitis. On examination she has hyperpigmentation and hemosiderin deposition to her left leg. She has previously been prescribed compression hosiery to control oedema and prevent venous ulceration, but has not been wearing the stockings. As a result her legs are markedly oedematous.
This middle-aged lady caught her leg on the edge of a low wall in the garden, which resulted in an open wound to the medial side of her left calf measuring about 3cm by 1.5cm. She had applied a bandage to the wound but after a week of self-care and frequent bandage changes, the exudate produced by the wound was so copious that it was running down her leg. On first assessment by a healthcare professional the wound did not appear to be healing but apart from the ongoing discharge of wound fluid, the wound showed no other obvious signs of infection.
Burn Wound PATIENT STUDY 5
This 11-month-old baby girl was healthy and normally developed prior to this trauma incident. On examination, she’d had all of her required vaccinations and had no previous trauma history. At the time of the accident the baby was able to stand with assistance, but was not yet walking unassisted.
This young child was admitted to the paediatric burn unit after hot coffee spilt over her face, neck, shoulder, forearm and chest in an unsuspicious domestic accident. The burns occurred approximately 30 minutes prior to admission. The child had managed to pull herself up to a work surface and reach up and grab a cup of coffee that the mother thought was out of the child’s reach.
The coffee had been made with boiling water a few minutes before the accident occurred. The child pulled the cup over herself, and approximately one third of the contents spilled over the child’s face and upper torso. The mother covered the burns with cold flannels almost immediately after the accident, and then called an ambulance.
On admission, the burns were cleaned with normal saline solution and then assessed for depth and area.
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