Nursing Case Study on Pressure Injury Assessment and Management

This nursing case study focuses on a patient's pressure injury assessment and management. It includes risk factors, wound healing steps, and effective interventions. The case study also reflects on the importance of effective communication and clinical skills improvement.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the student:
Name of the University:
Author note:

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Introduction:
Pressure injury is defined as the localized damage caused to the skin and underlying tissue over a
bony prominence or linked to medical device (Black 2018, pp. 10-39). The injury may be intact
to the skin or present as open ulcer. Pressure injury occurs due to prolonged or intense pressure
and sometimes in combination with shear. The external pressure is higher than (>30 mm Hg)
internal capillary pressure of bony prominence (Haesler, Rayner & Carville 2012, pp.6). The risk
of pressure injury depends on standardized scale skill assessment of health professionals and it is
staged according to the depth of the wound (Chan et al. 2013, pp.431-440). Pressure injury is
preventable. However, the prevalence of pressure injury is high in the health care and community
setting of Australia (Nguyen, Chaboyer & Whitty 2015, pp.329-336).
The case study will provide the health story of Julia whom I have cared for pressure injury. The
assignment will provide brief information about the importance of pressure injury assessment
and effective communication and I will reflect on my experience in order to improve my clinical
skills.
Case study:
Julia is a 65 years old woman with a background of 30 years of paralysis of lower body due to an
accident and she has a background of paraplegic knife assault. Due to the issue of immobility she
spends most of her time in the wheel chair. Julia has a 5 years history of chronic pressure injury
over the sacrum and buttock. She has undergone antibiotic therapy. Her medical history has
indicated that she is suffering from morbid obesity, type 2 diabetes and thyroid disorder as well.
She maintains a proper diet in order to manage her diabetes and intakes adequate fluid also. Her
diagnosis report has shown that she is suffering from stage two pressure injury. Her injury was
2.5 cm long and 1.3 cm wide with devitalized tissue in the pressure ulcer and partial thickness
loss of the dermis and a shallow pink wound bed with no visible slough and small amount of
serous exudates, nil odor and nil bruising of the peri wound.

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The wound healing steps includes using Pressure injury scale for healing to measure and monitor
her wound and with the help of sharp debridement her devitalized tissues have been removed
from the pressure ulcer. Wound irrigation solution such as Puracyn Plus has been used to clean
the wound. The process has occurred after every two hours following bowel movement.
Prevention Intervention Management Plan or PIMP has been conducted for her. However, her
wound has not healed due to the increase of incontinence and risk of microbial infection has
increased. GP appointment has been provided on the next day and she was commenced to take
Flucloxacillin and Metronidazole for her wound. Advanced clinical assessment of a deteriorating
Pressure Injury by advanced wound nursing practitioner such as palpating of labia to ensure no
mass has been done and she was transferred to the emergency department and placed in the
surgical ward, but no osteomyelitis was detected on scanning.
Discussion:
Due to immobility Julia has to spend most of the time in wheel chair which is another risk factor
because the pressure is increased in this case by 100 mm Hg (Sharp & McLaws 2005, pp.9p).
Increased incontinence due to microbial infection and rubbing in the bed lines is a risk factor for
pressure injury (Posthauer et al. 2015, pp.175-188). The information I have gathered from during
the pressure injury assessment regarding the immobility and dependence on the wheel chair for
10 hours has helped the medical staffs to understand the source of incontinence (Berbari et al.
2015, pp.e26-e46).
Age is a crucial factor in pressure injury, because epidermis becomes thin and near about 20%
reduction occurs in the dermis. Such condition leads to reduction in the blood supply. Thus,
healing takes more time (Haesler & Carville 2015, pp.62). Diabetes is another risk factor as in
case of such patients wound takes more time to heal (Edsberg et al. 2014, pp.313-334). Factors
contributing to the Increased incontinence is another risk of bacterial infection and in severe case
could lead to osteomyelitis (Berbari et al. 2015, pp.e26-e46). However, no osteomyelitis was
detected in case of Julia.
Effective treatment has been provided to her such as proper prevention technique, pressure injury
scale, effective cleaning process and use of appropriate solution in cleaning. Effective
medication has been provided by the GP for the wound. Advanced clinical assessment of a

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deteriorating Pressure Injury by advanced wound nursing practitioner such as palpating of labia
to ensure no mass is important in pressure injury assessment (Samuriwo & Dowding, 2014,
pp.1667-1685). However, her wound has not healed. Still effective interventions have been taken
for example, transferring her to the surgical department. Such process and intervention could
help her to cure pressure injury and maintain well-being.
Such experience is really helpful in order to gather knowledge about managing pressure injury
and improve clinical skills. The case has helped ne to identify the factors such as age, gender,
external diseases and disabilities that could affect the healing process to an extent. I have learned
proper assessment process for pressure injury such as Prevention Intervention Management plan
and Pressure injury scale. I have learned the contribution of incontinency to severe bacterial
infection and severity of pressure injury like osteomyelitis. In this regards I would like to attend
more patient with pressure injury in order to understand different perception regarding the issue.
It is expected that more experience in this field would help me to develop clinical skills and
proficiency in an effective manner.

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References:
Berbari, E.F., Kanj, S.S., Kowalski, T.J., Darouiche, R.O., Widmer, A.F., Schmitt, S.K.,
Hendershot, E.F., Holtom, P.D., Huddleston III, P.M., Petermann, G.W. & Osmon, D.R
2015. ‘2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines
for the diagnosis and treatment of native vertebral osteomyelitis in adults.’ Clinical
Infectious Diseases, vol. 61, no. 6, pp.e26-e46.
Black, J 2018. 'Take three steps forward to prevent pressure injury in medical-surgical patients:
Nursing care is key to pressure injury prevention', American Nurse Today, pp. 10-39.
Chan, B.C., Nanwa, N., Mittmann, N., Bryant, D., Coyte, P.C. & Houghton, P.E 2013. ‘The
average cost of pressure ulcer management in a community dwelling spinal cord injury
population.’ International wound journal, vol. 10, no. 4, pp.431-440.
Edsberg, L.E., Langemo, D., Baharestani, M.M., Posthauer, M.E. & Goldberg, M 2014.
‘Unavoidable pressure injury: state of the science and consensus outcomes.’ Journal of
Wound Ostomy & Continence Nursing, vol. 41, no. 4, pp.313-334.
Haesler, E. & Carville, K 2015. ‘Advancing pressure injury prevention around the globe: from
the Pan Pacific region to an international pressure injury guideline.’ Wound Practice &
Research: Journal of the Australian Wound Management Association, vol. 23, no. 2,
pp.62.
Haesler, E., Rayner, R. & Carville, K., 2012. ‘The pan pacific clinical practice guideline for the
prevention and management of pressure injury.’ Wound Practice & Research: Journal of
the Australian Wound Management Association, vol. 20, no. 1, pp.6.
Nguyen, K.H., Chaboyer, W. & Whitty, J.A 2015. ‘Pressure injury in Australian public hospitals:
a cost-of-illness study.’ Australian Health Review, vol. 39, no. 3, pp.329-336.
Posthauer, M.E., Banks, M., Dorner, B. & Schols, J.M 2015. ‘The role of nutrition for pressure
ulcer management: national pressure ulcer advisory panel, European pressure ulcer
advisory panel, and pan pacific pressure injury alliance white paper.’ Advances in skin &
wound care, vol 28, no. 4, pp.175-188.
Samuriwo, R. & Dowding, D 2014. ‘Nurses’ pressure ulcer related judgements and decisions in
clinical practice: a systematic review.’ International journal of nursing studies, vol. 51,
no. 12, pp.1667-1685.
Sharp, C.A. & McLaws, M.L 2005. ‘A discourse on pressure ulcer physiology: the implications
of repositioning and staging.’ World Wide Wounds, 2005, pp.9p.