Location: Skilled Nursing Home Care Facility 0800

Patient Introduction

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Location: Skilled Nursing Home Care Facility 0800

Report from charge nurse:

Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago. The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin breakdown.

Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD), chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.

Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been within normal limits and are performed weekly. Results from yesterday’s labs are in the chart. She is on a regular diet with nutritional supplement and has been eating the majority of her meals since admission. She requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate. Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In preparation for her dressing change, she was medicated for pain half an hour ago.

Recommendation: You should complete a basic assessment, review the labs, perform a wound assessment and dressing change, and then reposition the patient to optimize venous return. Please provide patient education on improving venous return to prevent further stasis ulcers, and continue compression therapy with the use of elastic bandage and an antiembolism stocking.

Josephine Morrow

Guided Reflection Questions

Opening Questions

How did the simulated experience of Josephine Morrow’s case make you feel?

Talk about what went well in the scenario.

Reflecting on Josephine Morrow’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change?

Scenario Analysis Questions*

S                What priority problem(s) did you identify for Josephine Morrow?

PCC         Identify in Josephine Morrow’s health history any factors that predisposed her to having chronic venous insufficiency.

PCC/S    Discuss the assessment findings and diagnostic studies that correlate with chronic venous insufficiency and venous stasis ulceration. Provide the reasons behind these findings.

S                What is the rationale for the daily dose of ASA?

EBP/I      What is the rationale for compression therapy?

EBP/I      What is the rationale for performing a Braden scale assessment on Josephine Morrow?

T&C         What other interprofessional team members should be involved in Josephine Morrow’s care?

Concluding Questions

Describe how you would apply the knowledge and skills that you acquired in Josephine Morrow’s case to an actual patient care situation