Case Study Analysis

This case study analysis provides a comprehensive assessment of wound, identifies factors that led to the patient's fall and severity of leg wound, and formulates evidence-based wound management plan. It also discusses fall prevention strategies for the patient.

Case Study Analysis
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TABLE OF CONTENT
INTRODUCTION...........................................................................................................................3
PART 1............................................................................................................................................3
Provide the comprehensive assessment of wound.......................................................................3
Identifying the factors which may have led to patient’s fall and severity of leg wound.............4
Local factors that influence patient’s fall and severity of leg wound..........................................5
Formulate evidence based wound management plan for this patient’s wound...........................6
Discuss fall prevention strategies for this patient........................................................................7
CASE STUDY 2..............................................................................................................................8
Comprehensive assessment of the wound and compare it to wound on admission....................8
Formulate evidence based wound management plan for this patient’s wound and compare it to
the management of the wound on admission...............................................................................9
Formulate a comprehensive discharge plan for Patient.............................................................10
REFERENCES..............................................................................................................................12
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INTRODUCTION
Wound is defined as injury to body that is mainly involve laceration and breaking of
membrane. It is based on the case study about 72-years old women, admitted to ward yesterday
after a fall in her bathroom 4 days ago. This documentation will describe about the
comprehensive assessment of wound, identifying the different factors that lead to patient fall and
severity of leg wound. In this report, it will describe about formulation as per evidence based
wound management plan for patient in context of wound treatment. It will describe different fall
prevention strategies for patient. Furthermore, it will described about the wound management
plan for patient and comparison with the management of wound during admission. However,
formulating the comprehensive discharge plan that help for patient to identifying specific need
and requirement on regular basis.
PART 1
Provide the comprehensive assessment of wound
As per given scenario, A 72 year old women was admitted to hospital after fall in her
bathroom 4 days ago. The patient has a major wound on her right leg her general practitioners.
Initially, specialist has prescribed the antibiotic within 72 hours and afterwards, specialist
provide the advice to admit in hospital for further treatment.
The accurate wound assessment and effective management requires proper understanding
of physiological would healing, Also combined with knowledge of actions (Ge & Qin, 2020).
This will help for providing the better treatment in regards of comprehensive wound assessment.
When conducting the ongoing wound assessment that are following process which undertaken to
provide better treatment. It will be examined type of wound, tissue loss, clinical appearance,
location and skin, measurement, pain, infections.
Moreover, medical professional have thoroughly wound assessment and consider as
important aspect in term of optimal care (Zwanenburg, Tol & Boermeester, 2020).. The overall
wound assessment server two important purpose: firstly, it can be determined the wound severity
in order to identify the expected rate of wound healing and then developing an effective
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comprehensive plan for treatment purpose Secondly, To act a reliable outcome measure that
used to assess the effectiveness of wound treatment.
Make a better measurement
Size
A critical step in wound assessment that can be measured the centimetre by using clock
method. In order to calculate the surface area, length and width.
Location
The most important thing is location of wound which become consider as valuable
information especially, when dealing with ulcer. The wound is basically located into leg so that
identified the surrounding surface of wound and their tissues.
For instance, Patient has a Diabetes Mellitus Type 2 since the age of 50. In this way, it is
becoming difficult for providing the better treatment because there are lot of complex situation
occurred during treatment. In most of cases, diabetes can indicate which area of leg is having the
most pressure. It should be taken into account when identifying the suitable areas.
Color and type of wound tissue
Moreover, it can be examined the wound areas and important to consider different tissues
such as slough, eschar, epithelial and granulation (Gould, Abadir & White-Chu, 2020). When
identifying the chronic wound if the surface is covered the redness, yellow and fibrinous tissue.
In which case healing can only possible when giving the better medications on regular basis.
After examined the particular condition or situation of wound.
Skin condition
it also focused on the surrounding skin which is one of the most important way to
determine efficiency of wound dressing. Maceration is that when surrounding skin become
breaks, softened down because of exposure to moisture. The wound has been representing the
depth cut and continuously discharge of blood.
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Adjunctive Therapies
This type of therapy will help for patient to reduce pain, and recovery wound in proper
manner by using therapy, it should provide the better support for patient and feel relax and give
rehabilitation services. It plays important role to identify the wound condition before and after
treatment.
Identifying the factors which may have led to patient’s fall and severity of leg wound
Many factors can interfere with one or more phases of would management processes.
Thus, causing improper and impaired would healing. There are different factors such as
transforming growth, platelet-derived growth factor, epidermal growth and fibroblast growth
faster. Once bleeding is controlled whereas inflammatory cells migrate into leg wound. In order
to promote the inflammatory phase which is becoming characterized by sequential process of
infiltration of lymphocytes, neutrophils and other macrophages.
Different factors are related with systematic act through local effects affecting the
patient’s fall and severity of leg wound. Local factor involves infection, oxygenation, and venous
sufficiency (Singh & et.al., 2020). On the other hand, Systematic factor involves Stress, gender,
diabetes, disorder and hereditary.
Local factors that influence patient’s fall
Oxygenation: it is important for maintaining cell metabolism, especially when patient’s
fall and injured with critical wound. Oxygenation is helping to prevent wound from infection,
induce angiogenesis and also fibroblast proliferation. Generally, it can promote wound
contraction. As per given scenario, patient has a diabetes problem and become older age. At that
time, it will be creating impaired vascular flow and poor perfusion create hypoxic wound
(Haddad, Shakya & Bergen, 2020). Sometimes, it will be increasing the complex situation of
medical professional to deal with effectively. In this way, it has summarised that proper oxygen
level is becoming crucial for optimum wound healing. Otherwise, it can develop infections,
inflammation surrounding surface of wound.
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Systemic factors that influence patient’s fall
As per case study, a patient is 72 years old women so that increase major risk factor for
impaired wound healing. Usually, it is commonly identified that older people, effects aging
causes a temporal delay in chronic wound healing. Sometimes, it is associated with the
inflammatory response such as T-cell infiltration into surrounding area of wound. In order to
decrease the secretion of growth factor and also increased strength of wound on day by day.
In additional, Holistic assessment of patient is one of important part of wound
management. There are considered both local as well as general factors that can delay or impair
wound healing.
Local:
 The wound assessment practices: the primary goal is to optimise the wound environment
so that they can help for healing processes in proper manner.
 Balancing the moisture so that designed to promote a proper dressing and protect from
moisture
 The wound temperature is constantly maintained for approximately 37c, which has been
shown to effect on the process of healing. Another way, it is directly impacts on
maintaining the neutral and reduce risk of bacterial colonisation.
General:
 Underlying the disease such as diabetes. The reason is to identify the condition and
impair healing includes delayed infiltration of inflammatory cell, angiogenesis
impairment. This can happen due to reduce the host resistance and poor epidermal
vasculature.
 Applicable for disorder sensation in context of improvement.
Formulate evidence based wound management plan for this patient’s wound
Wound management plan for this patient consist of provision of proper medication or
drugs so that infection can be prevented and patient can be provided with relief in pain. They can
also be provided with mobility equipment’s so that wounded leg can be protected (Rando & et.
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al., 2018). Other than this proper time to time cleaning and dressing of wounds can also be done
so that chances of infection can be reduced. First of all, proper medication can be provided to
patient so that management of wounds can be done, effectivity of wound healing can be done.
Medication also helps in preventing low or high blood pressure management, diabetes
management so that it does not impact healing of wound.
For effective management of wound. It can be performed the daily cleaning of wound
areas or place nursing staff can perform to protect from infection. This will help for healing the
wound in quickly manner. While cleaning the wound antiseptic can be used so that all kinds of
foreign bodies that can impact healing of would can be removed. Time to time dressing of
wounds can also be done. It is one of the main and important steps of wound management as it
helps in reducing exposure of wound to open air or environment so that chances of infection
reduced and effectively of healing can be enhanced. Lastly, with this mobility equipment like
crutches can also be provided to patient so that pressure upon wounded leg can be reduced. It is
important to provide support to this patient so that pressure upon wound can be reduced. If
pressure upon wound is high then it can result in exposure of wound, opening of stiches, reduced
effectively of healing. In this case all the above methods can be used for wound management
plan so that patient can be provided with comfort and her leg can be healed properly.
Discuss fall prevention strategies for this patient
There are various kind of fall prevention strategies that can be used for this patient to
reducing probability of fall. Some of the main type of strategies that can be used for this patient
are:
 Patient can be provided with strength training or exercises can be provided to the patient for
strengthening their muscles so that support to their joints, bones can be provided for proper
balancing especially for patients who are above 75 years of age (Shuman & et. al., 2019).
These muscles strengthening exercise programs can not only help in improving balance but
can also help in reducing fear of fall despite of their osteoarthritis, back pain.
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 For older patients and patients with osteoarthritis, vitamin D is an extremely important
component that can help in strengthening their bones. After consulting doctors, such patients
can start taking vitamin D supplements so that their bone strength can be enhanced.
 Most of the time patients fall in bathroom due to slippery times or floor. In order to reduce
possibility of falling, patients should wear comfortable and sensible shoes whose grip is quite
good. Good soes helps in preventing fall in a much better manner.
 Especially in places like bathroom assistive devices can be used like non-slippery wooden
steps, raised toilet seat with an arm rest, or sitting or holding arrangements so that in case
patient loses their balance then they would have something to sit on or to hold on.
These are some preventive measures that can be used for fall prevention for this patient.
CASE STUDY 2
Comprehensive assessment of the wound and compare it to wound on admission
Comprehensive wound assessment is an important part of wound management of patient.
It helps in defining overall status of patient’s wound (Borda, Macquhae & Kirsner, 2016). It
helps in defining overall status of patient’s wound so that obstacles in healing process of patient
can be identified. Comprehensive wound assessment of patient helps in evaluating current status
of the wound and points upon which healthcare professionals or nurses need to focus upon for
effective wound healing. It is done on the basis of following parameters such as: location, size,
colour, type of wound tissue, amount of wound exudate, odor, peri wound skin condition, wound
margins, pain, adjunctive therapies, patient knowledge, dressing management and many more.
Comprehensive assessment of the wound of patient after surgery has been explained below:
 Wound is present on right leg of patient, below knee on front side of calf muscles.
 Color of wound is red and it is Granulation type of wound tissue that has red uneven
mounded texture. Wound even after surgery did not improve.
 Patient was in lot of pain, especially when she was walking. Due to which her mobility was
getting impacted drastically.
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 After surgery she was provided with support and bed rest. Nurses were expected to manage
the wound care in a proper manner after surgery. The wound was first debriding was done so
that any kind of foreign particular can be removed and its healing process can be enhanced.
 After surgery for wound management it was cleaned for effective healing dressing was done.
If it compared to comprehensive assessment of wound before surgery and at the time of
admission then it can be said that at the time of admission the surface of the wound was swollen
and reddish yellow as well as had fibrinous tissue (Cancio & et. al., 2017). At that time, she was
provided with medications and condition and wound and its healing was observed for
consecutive three days. Even after medication provided to her, she didn’t feel good and was in
terrible pain that impacted her mobility. Her wound did not look good and slowly puss her
wound became painful and swollen. Different in both the wound was that initially would be
swollen and reddish yellow in colour but after surgery infected skin was removed, and only
reddish wounded skin was let which was further covered after dressing so that its healing can be
enhanced.
Formulate evidence based wound management plan for this patient’s wound and compare it to
the management of the wound on admission
Wound management is one of the most important things which is required to be focused
upon by nurses and healthcare professionals after surgery This is because after surgery wound is
open and it is prone to get infected. Proper and effective wound management after surgery can
help in enhancing overall healing process (Hommel & Santy-Tomlinson, 2018).. Wound
management plan for this patient after surgery includes: cleaning of wounds, dressing of wounds,
provision of antibiotics, and time to time changing dressing of wounds in order to avoid infection
and enhance healing process. After surgery first of all wound was cleaned using antiseptic and
non-touchable technique so that chances of infection can be reduced. Then after cleaning the
wounds, dressing of the wound will be done do that chances of infection for the patient can be
reduced. Dressing of wound after cleaning will also help the open wound to be protected from
foreign particles, water (Cancio & et. al., 2017). Not only this, dressing of would will also help
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in providing support and comfort to the patient so that itchiness and pain can be reduced.
Dressing of wound will be changed every day so that healing of wound can be enhanced and
infection chances can be reduced. Patient will also be provided with antibiotics so that healing of
wound can be enhanced and pain level can be reduced. With this, simultaneously patient will
also be educated so that she can understand ways in which she needs to take care of her wound,
ways in which she can reduce pressure upon her leg for enhancement of healing process.
If this wound management plan after surgery is compared to wound management plan on
admission then it can be said that initially management of wounds were not much effective
because of which patient was not getting relief in pain and healing of the wounds was also
getting affected (Lockwood & Mabire, 2020). As a result, she was not able to walk properly
because of which her mobility was getting impacted, she had to use crutches. But in initial
management of wound she was not educated about ways in which she can enhance her healing
process, take care of wound. Not only this, medications provided earlier were also not much
effective and due to this even her body temperature was rising from 37-38.5 degrees centigrade.
But in current wound management plan her antibiotics treatment will help in reducing her pain
level, enhance her healing process. Providing education to patient will help her in taking care of
her wound in a proper manner so that it can be protected from any kind of protection and her
mobility can be increased.
Formulate a comprehensive discharge plan for Patient
A comprehensive discharge plan must consider as entire scope of patient’s health needs,
including input, feedback from patient and their family. As per given scenario, the patient
unfortunately does not progress as expected, she undergoes further treatment or surgery. Usually,
she feel nervous and fear about the causes of wound in their entire health condition (Lockwood
& Mabire, 2020). When afterwards successfully complete the surgery, medical professional
should consist of written discharge plan. In order to record all information about medications,
patient support, follow-up appointment, requirement of nutrition, essential resources, health
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literacy and social problems. In this way, it will be developing the effective discharge plan
documentation so that patient can identify all need and requirement.
As per case study, the purpose of discharge planning for patient on the basis of their need
and requirement. It is always support for continuity of health care between setting and
community. This will help for describing as critical link between treatments received in hospital
by older patient (Gordon & Et.al., 2020). The post-discharge care will be provided through
community, ensuring the continuity of quality care between patient and hospital. The discharge
planning is use of reduce the hospital length and unplanned way to take admission within
hospital for purpose of medical treatment.
After treatment, specialist has recommended the centred discharge plan whereas patient
can select for intensive interventions such as high- risk condition heart failure. Including all
disciplines or specialists are involved in the procedure. The hospitals are standardizing and
formalizing the entire discharge process for patient to include a proper documentation, education
details.
Discharge process includes
Assessment the ability of patient after performing surgery for purpose of healing chronic
wound. It can be including problem solving, decision-making, sign or symptoms and other type
of cognitive functions.
Medical professional will be developing the comprehensive shared healthcare with the help
of decision- making approach. It is always supports for consider patient values and preferences,
social as well as medical requirements.
Specialist should complete up to date discharge summary and medication plan, also
preparing the suitable goals, questions.
Discharge planning for wound healing
The comprehensive discharge planning is support for older patient with chronic wound
problem which may increase the health complication. This chronic wound can be reduced re-
admission rate significant so that it is an essential for improving health outcome such as survival,
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quality of life without increasing price/cost (Gordon & Et.al., 2020). As per case study, Patient is
72 years old so as needs to consider better discharge planning intervention by nurse can improve
their physical results.
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REFERENCES
Books and Journals
Borda, L. J., Macquhae, F. E., & Kirsner, R. S. (2016). Wound dressings: a comprehensive
review. Current Dermatology Reports. 5(4). 287-297.
Cancio, L. C., & et. al. (2017). Guidelines for burn care under austere conditions: surgical and
nonsurgical wound management. Journal of Burn Care & Research. 38(4). 203-214.
Ge, B. & Qin, S., (2020). Comprehensive Assessment of Nile Tilapia Skin (Oreochromis
niloticus) Collagen Hydrogels for Wound Dressings. Marine Drugs. 18(4). p.178.
Gordon, S.A. & et.al., (2020). Improving On-time Discharge in Otolaryngology
Admissions. Otolaryngology–Head and Neck Surgery. p.0194599819898910.
Gould, L.J., Abadir, P.M. & White-Chu, E.F., (2020). Age, Frailty, and Impaired Wound
Healing. Principles and practice of geriatric surgery. pp.465-482.
Haddad, Y. K., Shakya, I. & Bergen, G. (2020). Injury Diagnosis and Affected Body Part for
Nonfatal Fall-Related Injuries in Community-Dwelling Older Adults Treated in
Emergency Departments. Journal of Aging and Health. 0898264320932045.
Hommel, A., & Santy-Tomlinson, J. (2018). Pressure Injury Prevention and Wound
Management. In Fragility Fracture Nursing (pp. 85-94). Springer, Cham.
Lockwood, C., & Mabire, C. (2020). Hospital discharge planning: evidence, implementation and
patient-centered care.
Rando, T., & et. al. (2018). Simplifying wound dressing selection for residential aged
care. Journal of Wound Care. 27(8). 504-511.
Shuman, C. J., & et. al. (2019). Older adults' perceptions of their fall risk and prevention
strategies after transitioning from hospital to home. Journal of gerontological
nursing. 45(1). 23-30.
Singh, H. & et.al., (2020). Factors that influence the risk of falling after spinal cord injury: a
qualitative photo-elicitation study with individuals that use a wheelchair as their primary
means of mobility. BMJ open. 10(2). e034279.
Zwanenburg, P.R., Tol, B.T. & Boermeester, M.A., (2020). Meta-analysis, meta-regression, and
GRADE assessment of randomized and nonrandomized studies of incisional negative
pressure wound therapy versus control dressings for the prevention of postoperative
wound complications. Annals of surgery. 272(1). pp.81-91.
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