Clinical Care Needs for a Patient with Chronic Venous Insufficiency

This paper thoroughly describes four different clinical care needs for a patient suffering from chronic venous insufficiency. The role of practice or community nurses for the case of this patient is also discussed in the paper.

Case Study: Clinical Care Nursing
Introduction
Gwendolyn Harris is an 82 year old war widow who lives independently at her house with a
cat named ‘Whiskers’. She enjoys her life with gardening, bowling, and having get-togethers
with friends at clubs. She was scratched by her pet six weeks ago on her right lower leg.
However, she did not pay much attention to this wound during those six weeks and the pain
increased. When her daughter noticed the pain she revealed it was there for six weeks and she
used a crape bandage and kept changing the dressing regularly. But, the pain was increasing
and she was then brought to the nurse practitioner by her daughter after being referred by her
General Physician Dr. Greenwood as per the case study. An assessment of Mrs. Harris’s
clinical background is necessary for the treatment progress of her wound (Bozhkov et al.,
2014). This paper will thoroughly describe four different clinical care needs for the patient.
The role of practice or community nurses for the case of this patient will also be discussed in
the paper.
History and background of the patient
Assessment of patients’ family history and medical background is very much necessary as it
reflects the health nature of the patient as well as it helps to determine what types of issues
the patient had already and what were the process of treatment followed For further treatment
these knowledge are highly essential in medical perspective (Eberhardt & Raffetto, 2014).
Mrs. Harris is a war widow and she stays home alone with her pet cat and is very lively and
her lifestyle reflects she enjoys her life a lot with friends, daughter and granddaughter
However, she suffered from some diseases. She had congestive cardiac failure and bilateral
leg varicose veins, leg deep vein thrombosis five years ago. Along with that, she suffered
gastrointestinal bleed, 10 years ago. Even, according to the case study, she underwent
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cholecystectomy surgery 40 years ago. Furthermore she has allergies to penicillin as well as
voltaren. She had a family history which shows her sister died from cardiovascular disease.
She used to take PO OsteoEze ii BD as a pain reliever for her joint pain, she also used PO
Captopril 12.5mg BD to prevent heart failure and PO Blackmores Macu-Vision®, as a source
of antioxidant nutrients. A detailed assessment of her medical background and history will be
helpful in determining the clinical care needs for her current health issue for which she has
come to nursing practitioner vascular clinic (Engbers et al., 2015).
Clinical care needs
The GP of Gwendolyn took a wound swab. It is common practice to determine the infection
causing organisms. It helps in identifying the organism that are creating the infectious
diseases and the determination of the root cause is assistive in choosing the appropriate
therapy (Hyder & Soukas, 2017).Her GP also prescribed antibiotics which is Metronidazole
400 mg and drug, which Ciprofloxacin 500 mg that help in stopping the bacteria to grow. The
course was for one week only. All these were the primary care medicine that worked as
antibiotics. So, after the medication process and the wound swab, Dr Greenwood completed a
referral request to have bilateral ankle brachial pressure index from the NP vascular clinic in
order to proceed towards further treatment of the issue.
In order to determine her arterial or venous health, arterial or venous duplex ultrasounds of
her right leg arteries have been initiated. An arterial brachial pressure index have also been
analysed in the treatment practice in this regard. It is being assessed that her symptoms are
indicating ischaemia. It is resulted in for an inadequate blood supply to any organ of the
human body (Miller, Jerosch-Herold&Shepstone, 2017).The symptom of Oedema has been
found in Gwen due to a combination of her CCF as well as venous insufficiency. . Generally,
oedema is caused by venous insufficiency which is a common condition of human body in
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which the blood cannot return to the heart efficiently from the peripheral areas of human
body. She covered the cat scratched area with a crepe bandage and due to massive pressure
for six weeks, the pressure in the blood vessels leaked fluid in the surrounding tissue which
caused pain. In order to address her issues, some specific clinical care needs are important.
Assessment of together the ulcer and the patient helps in management of chronic ulcers .Four
different clinical care needs are described below.
1. First of all, her wound should be cleaned with an appropriate antibacterial agent to
make it bacteria and germ free. It will be quite difficult for her to visit the GP on a
regular basis and therefore PN should organize a nurse for her wound care
management to change the dressing in the wound. Dressings play a vital role in
controlling and restoring tissues integrity and uphold suitable moisture. In order to
tackle the infection of her leg, she requires a systematic treatment but as an initial
stage, dressing twice weekly and applying antibacterial lotion is the primary care
need to manage wound and in this case the wound was caused by the scratch of
her pet cat so, cleaning is the initial clinical need (Mitchell, Wong & Diabetic
Macular Edema Treatment Guideline Working Group, 2014).
2. Another clinical need for her lower leg is movement, massage and compression.
Movement of her swelling body part and some exercises can help in this regard.
Holding the swollen part of the body at the level of heart and elevating the
affected body part can be helpful for her in managing the pain. Elevation of lower
extremities at the equal level of the head also aids blood flow.Massaging the area
in a firm but soft manner with upward strokes will also be effective. Wearing
appropriate compression stockings prescribed by doctor will assist the patient to
manage her pain.All compression stockings create a pressure gradient towards
knee from ankles .Compression bandage and other compressive binding
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modalities are effective in equally curing and preventing relapses of
ulceration(Nelson, Saha & Mead, 2016).
3. Doppler assessment is important in calculating ankle brachial pressure index. In
leg ulcer assessment, Doppler plays an indispensable role. It is utilised to guide
the treatment of venous or mixed ulcers. The role of PN in Doppler assessment is
also vital. To get the ABPI measurement, PN will locate the pulses in the foot
using Doppler probe and ultrasound gel. Due to the massive and constant pain
Gwen might feel low and it can affect her psychological well-being, and therefore,
PN will assist and support her throughout. PN will motivate Gwen to stay calm
during the treatment and it will also provide her additional mental support from
the community because social support is important. PN will also educate the
process of self-management which will support Gwen to reduce the need for
seeking healthcare.
4. Nutrition plays a vital role in wound healing process. It will be difficult for Gwen
to prepare her own food as she will not be able to stand for hours and requires
potential exacerbation of her leg ulcer also. Her daughter can support her in this
purpose. She can either prepare food for Gwen or arrange a helper in preparing
food for Gwen. PN can play the main role in informing her daughter about the
need of nutritious food with sufficient calories. Balanced meal and snacks that
include plenty of protein and fruits along with vegetables is appropriate for wound
management. Stying well-hydrated with water can also help in this regard.
Nurses role in the clinical care needs
The role of nurses in managing the patients need and requirement is very much significant. In
the case of Mrs. Harris, nurses’ intervention is necessary. In order to manage the wound,
nurses play the most important role. The primary care is cleaning the wound with appropriate
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antiseptic and antibacterial solution such as Cadexomer Iodine and others as per the
recommendation of Health Practitioner (Liu et al., 2015). Dressing of the wound and pressure
bandage is also necessary. Nurse should handle the patient’s wound with proper care such as
wearing proper gloves for protection. At the time of applying anti-biotic lotion, the patient
might feel irritation on the skin and she also may try to avoid applying that. But, the nurse
should deal with the patient in a soft manner as the area will be very sensitive. The specific
role of a PN is to educate the patient and their families to take proper care in managing the
wound. In this regard, the next clinical care need is movement, massage and compression. In
this process PN should assist the patient by showing some useful exercises that can help the
body part to maintain its normal movement (Traboulsee et al., 2017). Along with that, nurse
will show how upward strokes with hand in a soft massaging way can be effective for the
patient and it will be effective in reducing the pain also. While giving the massage or
showing the process of massaging it is important to be very much careful as a rough and hard
massage can cause massive pain which may result in serious issue. PN will involve her
daughter to learn the exact messaging technique that will be delicate for Gwen. Compression
is another clinical care need for Mrs. Harris as her leg is swollen. Nurses should help her
wearing compression bandaging to provide light pressure to the affected area so that the
swollen part heals as early as possible. Choosing the right compression stockings might be
difficult for patient, so nurses should guide her in this regard. Nurses should make the patient
aware of her diet. Having sufficient amount of balanced nutritious food in the daily diet is
very much necessary in the treatment procedure and it is very vital as a primary care need.
There should be sufficient inclusion of protein in her diet. Patient might not know about this,
so nurses’ intervention is necessary to make her and her daughter aware of this.
Conclusion
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The patient is suffering from swelling and pain in lower right leg.? The constant and acute
pain can make her mentally weak in which nursing intervention is required to provide her
additional mental assistance. After a primary treatment using antibiotics by her general
practitioner, the patient was referred to the local tertiary hospital outpatient to attend the
nursing practitioner vascular clinic. She needs some clinical care in order to recover her
problem. The clinical care need for the patient should be addressed by the nurses with proper
care strategy. This paper provided four clinical care needs and also reflected the nurse role in
this regard. Changing of the dressing and proper massaging is also very much important
clinical care need. Doppler assessment and informing the patient and her family about the
intake of nutritious food is also essential. The paper described role of practical nurses in this
regard. However, the patient is allergy prone to some medicines and she has a history of
cardiac failure. So, a little more caution while treating the patient is necessary to recover her
issues.
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