3rd May 2011
The following assignment will take the form of a case study. The subject is a 79-year-old sikh gentleman, who will be known as patient X. Patient X only speaks English as his second language. Patient X has developed a wound on his right hip after being admitted a few days previously, after suffering from a stroke. Patient X has a history of a mild stroke and has slow mobility and uses the aid of a frame to mobilise. Patient X is obese, a heavy smoker and now has right-sided hemiplegia. Patient X resides with his elderly wife, son and daughter-in-law in a first floor flat, being cared for by his wife and daughter-in-law.
Incontinence of urine has become an issue following admission with patient X failing to make staff aware of his need for the toilet. He has loss of appetite and would rather stay in bed than mobilise. Personal hygiene has also become an issue, with patient X only wanting his wife or daughter-in-law assisting him. A small red area was noticed on his right hip two days after admission. This was discovered when Patient X was being showered. Nursing staff although it was raised during patient handover did not follow this up. By day four a large, deep cavity had developed on his right hip, filled with yellow slough. This is where patient X is complaining of a pain.
Good practice and best practice suggests that we do in fact owe those we care for, a duty of care. This duty in its widest sense according to Fullbrook (2007) is a duty not to cause harm. Fullbrook (2007) also claims we should review the concept of risk assessment, how we act so as to avoid causing harms or allowing harms to occur, by undertaking an assessment of risk, prior to any events that could occur (Fullbrook, 2007). Was this the case with Patient X?
If we are to treat people with wounds effectively we must carry out an assessment, not just of the wound, but also of the person with the wound (Benbow, 2002). A thorough assessment enables you to determine what factors led to the wound developing and how these may affect healing. Assessing the wound and also the person who has the wound enables you to assess the extrinsic factors (the factors affecting the person who has the wound) and the intrinsic factors, such as the site, size and stage of healing of the wound. We must consider the person’s physical and mental health and carry out a complete assessment that enables us to identify all the factors that may affect wound healing and inform treatment choices (Miller, 1999). When assessing the person with a wound, it is important to ascertain his or her normal level of ability. Is the person usually able to carry out certain activities of daily living? (Harding, 1996).
Patient X has several factors that may compromise wound healing:
Extrinsic Factors Which Compromise Wound Healing
• Age- As age increases the metabolic process slows down, this will prolong tissue repair. Immune competence drops and wound infection becomes more common. Elderly people are more at risk of chronic concurrent illness and this may delay healing (Rainey 2002). • Mobility- Reduced mobility for any reason will dramatically increase the risk of developing pressure damage (Rainey 2002). • Obese- Obesity carries the risk of reduced oxygen pressures in the tissues. Adipose tissue has large areas of dead space, this is due to a poor network of blood vessels, and this will reduce the oxygen tension (Rainey 2002). • Smoking- According to Dealey (2005) smoking can cause vasoconstriction and can act as an appetite depressant, leaving the smoker deficient in several key vitamins such as B1, B12 and C. It significantly reduces subcutaneous oxygen tension...
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