The aim of this assignment is to holistically evaluate the Bio-psychosocial factors and influences on health and well being, of a lady in her sixties who is living with chronic venous leg ulcers. It will begin with a patient profile, and in order to comply with the Nursing and Midwifery Council Code of Conduct (NMC) the name of the patient has been changed to Martha (NMC, 2008). Informed consent was gained by the patient prior to this assignment being written. It will then go on to briefly discuss the Roper Logan and Tierney model of nursing which will be used as a framework for this assignment. In order to have an understanding on how venous ulcers occurs a description of the normal and abnormal anatomy and physiology of the venous system will be addressed. It will then show how the effect of pain due to the chronic ulceration has affected Martha’s ability to carry out two of the 12 activities of living (Roper et. al 1990). It will discuss the biological issue such as pain, odour and exudate which restricted Martha’s mobility resulting in social isolation and the psychosocial issue such as pain and anxiety which affecting her ability to sleep and comply with prescribed treatment. To summarize the contents of this assignment a conclusion will be provided.
Martha is a sixty six year old lady who was referred to the district nurses for the evaluation and daily treatment of chronic non-healing venous leg ulcers to her right leg. The main signs and symptoms she was experiencing were constant pain, skin loss, oedema, odour and exudate. Martha has suffered chronically with non-healing leg ulcers for the last four years and has tried various treatments including maggots and honey and compression therapy. Unfortunately none of these therapies have worked for Martha. Martha’s been married to her current husband for six years but sadly, she lost her first husband to cancer twenty one years ago. Martha has four children, one of which still lives with her and two dogs which she used to take for walks daily. She also used to go swimming quite a lot. Martha lives in a privately rented semi-detached house and has done for the past thirty years. S he attended secondary school and upon leaving school she went on to work for Woolworths and has had various other jobs in several factories. Martha is a complex patient with an underlying history including a dislocated right shoulder, asthma, hypertensive disease, sterilization, osteoarthritis and a total right prosthetic hip replacement. Martha has also got a complex medication history which includes co-codamol 30mg/500g, zopiclone 3.75mg, rampril 2.5mg, furosemide 40mg, ventolin evohaler 100mcg and clenil modulate 100mcg (BNF, 2010). Martha did state that she had started smoking at the age of eleven and gave up eight years ago.
The Roper Logan and Tierney model of nursing provides a holistic care approach and involves important component of daily activities (Roper et. al 2001). It is made up of five components: Activities of living (ALs), Lifespan, Dependence/Independence continuum, Factors influencing ALs, and Individuality in living (Roper et. al 2001). The Roper, Logan and Tierney model was first developed in 1980 based upon the work by Nancy Roper in 1976 (Roper et. al 1990). The model is based on the twelve activities of living. Due to word limitation the twelve activities of living are listed in appendix 1.
When blood is pumped into the arteries by the heart it is pushed forward under high pressure. The blood in the arteries is then pushed into smaller and small vessels, until the blood reaches the capillaries (Spouse et. al 2008). Once the blood has reached the capillaries and through to the veins there is little pressure left so the contraction of the calf muscle provides a pumping action which helps to push the blood back up the veins (Anderson et. al 2008). Increased venous pressure allows blood to flow towards the heart...