ISBAR: Handover for Mrs. Zoya Solarian with Venous Leg Ulcer

This document provides a handover for Mrs. Zoya Solarian, a patient with a venous leg ulcer. It includes patient information, current issues, background history, assessment, recommendations, and the role of community nurses.

Running head: ISBAR
Name of the Student
Name of the University
Author Note

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ISBAR:
Hi Liz, my name enter your name, I am one of the community nurses and I am going to provide
the handover.
Identify / patient information :
This is Mrs. Zoya Solarian who is widowed with no children currently lives alone in the 3rd-
floor walk-up apartment and referred to my community.
Situation /current issue:
Mrs. Solarian has a venous leg ulcer on her left leg and the current situation is it requires weekly
dressing.
Background or weekly history:
Mrs. Solarian has a history of:
 Hyperlipidemia
 Type II Diabetes Mellitus
 Cataract, right eye
 Hypertension
Assessment:
 In the current context, wound assessment is required in order to ensure faster healing of
Mrs. Solarian. Require to conduct a comprehensive and detailed assessment in order to
identify additional wound in the body.

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 The assessment for her visual impairment need to conduct along with that cataract
surgery is required to conduct in order to provide good her good eyesight.
 Her blood sugar level is required to monitor in order to avoid the impact on her wound.
 Her Current medication perindopril 4mg OD and Actrapid
Recommendation`:
 It is recommended to monitor her wound for changing her dressing weekly in order to
ensure a faster recovery.
 It is recommended to monitor his blood sugar level in order to ensure a normal insulin
level.
 It is recommended to provide monitor her vision and being reviewed by an
ophthalmologist.
 Monitoring her current medications
Pathophysiology of current condition/s, including assessment of pharmacology
and pharmacokinetics
Venous ulcer defined as a wound present in the skin of the lower leg which is induced
because of pressure in vein caused by a minor injury. The ulcer generally observed because of
inadequate blood flow between superficial and deep vein. The valves in the heart allow blood to
flow towards the heart, preventing it clot in legs (Cullum & Liu, 2017). Because of injury, the
valves damages the blood vessels in the skin which further led the blood to form a clot in legs
followed by symptoms such as inflammation, dry (Weller, Buchbinder & Johnston, 2016).

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Inadequate blood supply causes the skin to be dry which is manifested as skin break down and
open wound.
Type II diabetes:
Type ii diabetes is a disorder where the body is unable to produce enough insulin from
the pancreas. Insulin is the hormone which is responsible for enabling the glucose to enter the
cells where it is broken down to gain ATP. In T2D, this mechanism is impaired which resulted in
hyperglycemia that induces inflammation. In T2D, beta cells unable to meet the high demand of
body and develop T2D (Rise , 2018).
Hypertension and hyperglycemia
The hypertension is defined as high blood flow as a result of increased activity of renin-
angiotensin-aldosterone because of systemic vascular resistance. It is also observed because of
increased activity of the sympathetic nervous system (Coban et al., 2016).
Hyperlipidemia observed because of the high level of cholesterol in the blood
Cataract :
Cataract defined as the clouding of lenses which affected the vision of eye which is
developed as blurry vision.
Perindopril
Perindopril is a nonsulfhydryl prodrug which metabolized in the liver and ACE, the
enzyme accountable for alteration of angiotensin I (ATI) to angiotensin II (ATII)which it
regulates the blood pressure. After absorbed by plasma within 1 hour it is extensively
metabolized in the liver and eliminated through urine (Poulter et al., 2019).

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Actrapid:
It is short-acting human insulin preparation which shows hypoglycemic effects within
30minutes. It lowers the blood sugar levels by attaching with the insulin receptor. The drug
reaches to blood within 2.5 and eliminates after 8 hours (Schmid et al., 2018).
2. Patient cues:
• History of hypertension, cataract and type II diabetes
• Living alone in apartment, Widowed, no children
Assessments required- what further information do you need or would like
prior to your visit.
• Time of venous ulcer, type (Grazed, superficial, deep, unstageable), exudate release
• Since she lives alone, his activity of daily living
• Association with other diseases such as HTN, cataracts
Identify problem/Issue- why are you visiting them? What will you do once
there
• Impact of cataract on daily activity
• Impact of diabetes on the wound
• Finding the area for cleaning his wounds using aseptic technique
Establish Goal-How will you undertake the care required?

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• Provide education for self-management for wound healing and venous diabetes management
• Assists in exercise, diet consumption
• Incorporate family members
• Refer to ophthalmologist
Evaluation- what strategies will you use to evaluate the outcomes
• Wound healing progression
• Regular monitoring of wound healing and documentation
• Monitoring sugar level, exercise level, and diet consumption.
• Evaluate the lifestyle and activities of daily living
Role of the community nurses
The community nurse provides primary care to the patient with an aim of preventing disease,
supporting wellbeing and providing health literacy to maintain a healthy lifestyle.
• Residential care,
• Wound management
• Assistance in the activity of daily living
• Monitoring of diabetes, vision, and hypertension.

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References:
Coban, M., Tasli, L., Turgut, S., Özkan, S., Tunç Ata, M., & Akın, F. (2016). Association of
adipokines, insulin resistance, hypertension and dyslipidemia in patients with psoriasis
vulgaris. Annals of dermatology, 28(1), 74-79. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737839/
Cullum, N., & Liu, Z. (2017). Therapeutic ultrasound for venous leg ulcers. Cochrane Database
of Systematic Reviews, (5). Retrieved from: doi: 10.1002/14651858.CD001180.pub4.
Poulter, N. R., Dolan, E., Gupta, A. K., O’Brien, E., Whitehouse, A., & Sever, P. S. (2019).
Efficacy and Safety of Incremental Dosing of a New Single-Pill Formulation of
Perindopril and Amlodipine in the Management of Hypertension. American Journal of
Cardiovascular Drugs, 1-11. Retrieved from:
https://link.springer.com/article/10.1007%2Fs40256-018-00314-4
Rise Consortium. (2018). Metabolic contrasts between youth and adults with impaired glucose
tolerance or recently diagnosed type 2 diabetes: II. Observations using the oral glucose
tolerance test. Diabetes Care, 41(8), 1707-1716. Retrieved from:
https://doi.org/10.2337/dc18-0243
Schmid, V., Kullmann, S., Gfrörer, W., Hund, V., Hallschmid, M., Lipp, H. P., ... & Heni, M.
(2018). Safety of intranasal human insulin: A review. Diabetes, Obesity and
Metabolism, 20(7), 1563-1577. Retrieved from: doi: 10.1111/dom.13279

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Weller, C. D., Buchbinder, R., & Johnston, R. V. (2016). Interventions for helping people adhere
to compression treatments for venous leg ulceration. Cochrane database of systematic
reviews, (3).