Roper-Logan-Tierney Care Plan

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A pressure ulcers is ‘ a localised area of cellular damage resulting from direct pressure on the skin causing ischawmia, or from shearing or friction forces causing mechanical stress on the tissues’ (Chapman and Chapman 1981). Common places for pressure ulcers to occur are over bony prominences, such as the sacral area, heels, hip, and elbow. (NICE 2005)

Initially to maintain confidentiality the patient will be referred to as Mr Brown. Mr Brown has given permission for his nursing notes and details to be referred to through out this assignment. He is also aware that is identity will remain unknown and that a false name was chosen for assignment purposes. This can be identified in the NMC Code in ‘respecting people’s right to confidentiality.’(NMC Code 2008)Moreover the workplace will remain anonymous and be referred to as Ward 1.

Mr Brown is 90 years of age, he lives alone in sheltered housing and has careers three times daily to maintain housework and basic care needs. He has a past medical history of angina and is a non insulin dependent diabetic.

Initially Mr Brown was admitted to hospital via A and E due to chest pains, which indicated Acute Coronary Syndrome.Mr Browns cardiac issues have been resolved in another ward prior to his referral to Ward 1.However Mr Brown needs help with improving mobility caused by the cardiac problems therefore he has been moved to Ward 1 which is a rehab ward to help Mr Brown to improve his mobility and analyse if his care package needs to be increased.Prior to admission to Ward 1 Mr Brown had pressure ulcers present on his left and right buttocks. From the Priliminary Pressure Risk Assessment carried out on admission to ward 1 it can be identified that Mr Brown has seven broken skin ares on his sacrum,which have a EPUAP grade of 2.(Tissue Viability 2009). When using the Adapted Waterlow Pressure Area Risk Assessment Chart, Mr Browns initial score was 12 putting him on treatment plan B when admitted to hospital. However due to cardiac issues causing mobility problems, Mr Browns score significantly increased over the period of 11 days so that when assessed in ward 1 it give him a score of 20,putting him at high risk of developing pressure ulcers and to follow treatment plan C.

Step 2

When admitted to Ward 1 Mr Brown was having issues with dealing with urinary incontence, which lead to the skin becoming excoriated due to the excess moisture(Tissue Viability 2009).This becomes a risk of developing further pressure ulcers as urine causes the skin to become macerated and makes it easier for the epidermis to erode.(Kozier et al.2008) therefore nursing staff felt as a last resort a catheter should be put in place as this was effecting the healing process. Further issues of incontence lead to Mr Brown becoming doubily incontent within the space of two days.Faecal incontenance will create micro-orgasms that irritate the skin leading to further breakdown of the epidermis and increased risk of infection (kozier et al.2008). Moreover this causes external risks with the dressings that Mr Brown has for his Grade 2 pressure ulcers that are already present.This is due to the dressing acting as a barrier that will increase the risk of infection.

Additionally an intrincic factor leading to increased risk of pressure ulcer is the fact that Mr Brown is 90 years of age which indicates that his skin is less elastic due to lack of collagen in the dermis,the sebaceous glands produce less oil causing dryness to the skin and a thinning of the epidermis.(kozier et al.2008). Therefore his skin is a lot more fragile. As we age the rate that skin heals is decreased; also glands in the skin such as the sebaceous glands lose there ability to function; as a result there is an increase in water loss. ( Christiansen and Grzyboskii 1993)Therefore healing time is increased.

Additionally nutritional and fluid intake is an intrinsic risk factor that determines the development of pressure...
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