A. Chronic Pressure Ulcer – Stage 4 Your patient is a 47-year-old woman who has had.

A. Chronic Pressure Ulcer – Stage 4 Your patient is a 47-year-old woman who has had a history of diabetes for the past 25 years, is a stroke survivor, and has congestive heart failure. She developed a stage 4 pressure ulcer following an above the knee amputation six months ago during her hospital stay. She lives at home with her daughter, who is a nurse, and also has home health care three days a week for Dressing changes Home health care is planned to last for only three weeks. Wound etiology: Pressure ulcer, stage 4 Wound location: Coccyx Thickness: Full Size: 6x4x1.4cm Undermining: 2-10 o’clock, 0.7cm Wound tissue: 80% red granulation, 20% yellow fibrinous slough Exudate: Heavy Bioburden: Yes What dressing order would you choose to benefit your patient most? a. Cleanse wound with normal saline. Pat dry. Pack wound and undermining with calcium alginate. Cover with bordered foam three times a week. b. Cleanse wound with normal saline. Pat dry. Pack wound with wet-to-dry dressing twice daily. Cover with abdominal pads. Secure with paper tape. C. Cleanse wound with normal saline. Pat dry. Pack wound and undermining with silver alginate. Cover with bordered foam daily.

B. Chronic Diabetic Neuropathic Foot Ulcer Your patient is 85 years-old, lives alone and has no family. He has poor vision and limited mobility due to arthritis. He was diagnosed with type 2 diabetes two years ago. He is compliant with monthly diabetic checkups with his physician, and it was discovered that he had an ulcer at the plantar aspect of the right foot. Your patient has been treating the wound himself for three months by soaking his foot in Dreft laundry detergent. The patient has now been referred to the wound care center, where he will be seen weekly. Wound etiology: Neuropathic ulcer, diabetic type 2 Wound location: Right foot, plantar Thickness: Full Size: 4.2×2.3×0.2cm Wound tissue: Pink/red granulation 100% Periwound: Hyperkeratotic Exudate: Minimal to moderate Bioburden: Yes As the wound physician/nurse, what dressing order would you choose to benefit your patient most with his situation? a. Cleanse foot wound with normal saline. Apply collagen particles to wound bed. Cover with bordered foam three times a week. b. Use silver hydrogel gauze dressing, foam, and a total contact cast once a week. C. Cleanse foot wound with normal saline. Apply silver foam dressing. Secure with gauze roll, tape, and one layer of retention dressing (above toes to 1 inch below knee). Change once a week.

C. You are a home health nurse making visits twice a week to a patient with a stage III pressure ulcer. The patient is recovering from a stroke and receives regular visits from a physical therapist for mobility training. The patient’s wife is actively involved in his care. You are planning today’s care. 1. Describe assessments you will make today and on subsequent visits. 2. Summarize factors that could affect the rate of wound healing in this patient. 3. Outline teaching you will provide to help prevent further occurrence of pressure ulcers. 4. List the primary nursing diagnoses that will guide your care and related nursing diagnoses that might apply in this situation. 5. Explore how you would collaborate with the patient, family, and other healthcare providers to promote effective wound healing.