Case Study: Congestive Cardiac Failure and Venous Leg Ulcer Management

This case study presents a comprehensive analysis of a 78-year-old male patient, Robert, diagnosed with a venous leg ulcer and a history of congestive cardiac failure, following his discharge from the hospital. The case study meticulously details the patient's presentation, including his medical history, social context, and current health status. It delves into the pathophysiology of venous leg ulcers, exploring their causes and impact. The study then applies nursing theories and models, such as Fawcett's metaparadigms, to guide the assessment, planning, implementation, and evaluation of patient care. The nursing process, as defined by NMC (2010), is thoroughly followed, encompassing pain management, nutritional considerations, and mobility assessments. The implementation section outlines specific interventions, and the evaluation assesses the effectiveness of the care provided. The study concludes with recommendations for improved patient outcomes, emphasizing a holistic approach to care and wound healing management. The case study also adheres to data protection guidelines and ethical considerations, including verbal consent for patient participation.

Holistic assessment and wound healing management
of an individual presenting with Congestive Cardiac
Failure and Venus Leg Ulcer following hospital
Discharged: Case Study
SID: 1511896
Word Count: 4800

Table of Contents
INTRODUCTION..........................................................................................................4
Patients Presentation....................................................................................................5
PATHO-PHYSIOLOGY LEG ULCER...........................................................................7
OVERVIEW OF NURSING THEORIES AND MODELS..............................................8
THE NURSING PROCESS........................................................................................14
ASSESSMENT...........................................................................................................14
PAIN ...........................................................................................................................16
Eating and Drinking....................................................................................................17
Mobility........................................................................................................................17
Planning......................................................................................................................18
Implementation...........................................................................................................20
Evaluation...................................................................................................................21
Conclusion..................................................................................................................22
Recommendation........................................................................................................23
REFERENCES...........................................................................................................24
APPENDIX 1...............................................................................................................26
APPENDIX 2...............................................................................................................26
APPENDIX 3...............................................................................................................27

INTRODUCTION
The venous leg ulcer is complicated and chronic disease which affects
most of the patient of 65 years old. The sensitive body of old people will easily
get in contact with these viruses that attached with their lives for long time. This
disease is prevalent in the UK among the people above the age of 60- 80 years
of old. The reason behind occurrence of the diseases in these peoples is weaker
immunity of old people and lack of white blood cells and the platelets in order
to fight against the dangerous diseases. According to posnett el at (2009),
CVLU affects 1- out of 2% of the UK population with over half having an
active ulcer.
The cost incurred in the treatment of this dangerous diseases estimated by
the National Health Service accounts for 5.3 billion each years as per the recent
study conducted in 2013-2014 in the UK. The study also reveals that the
patients suffering from this dangerous diseases will be counted all above the age
of 18 years as there is record of patients having this disease below 18 years.
The study reveals that the practised nurses are involved in treating patients in
order to avoid social isolation. The practice of the hospital starts that 18.6
million practices nurses and doctors are form part of this event, 1.09 million
doctors and paramedical staffs also visits communities and 3.4 million hospital
also gathers and treats outpatient visits through organising camps.
NHS Choices defines venous ulcers as wound which occur on skin of human
being due to improper functioning of venous valves. Moreover, the patients past
medical history (PMH) are also incorporated in the report which further helps in
as well as reason for planning, implementation and evaluation of patient care
with the use of appropriate model has also been explained.
The current essay will cover critical evaluation on report of care for patient. In this
regard, practical and theoretical elements regarding care planning as well as examination of
patient ailment has been explored under the report. Though, case study assignment related to
leg ulcers has been taken into account by taking specific situation of patient. In this manner,

report is completed in four steps such as nursing process as per the NMC (2010) along with
models of nursing as well as theories. It would be effective to provide holistic and and system
demonstration of care provided to patients and accordingly conclusion and evaluation have
been done. Furthermore, verbal consent has been taken for promotion of concordance,
respect difference in context of autonomy and maintaining dignity of patient.
Patients Presentation
Under the current study anonymity of patients has been maintained by complying
Data Protection Act 1998 and NMC 2015. At this juncture, pseudonym will be applied in
overall presentation.
The medical history of the patient will help the doctor in order to design
the best treatment for their patient. The history is essential in order to know the
allergies of the patient in order to prescribe accurate medicines to heal the
patients.
The current study is about Robert who is a 78year- old man who lives
alone in a one-bedroom flat. Mr Robert is active person who are educated and
are settled in their life as he is married and have two children. This person
belongs to the rich family who have status in the society and who speaks
English and all other languages. He worked in good company and enjoys higher
position in the business. The background of Mr Robert will not help him as they
are suffering from social isolation as different society members discriminate
them among different individuals.
He was admitted in the social home care with venous leg ulcer patients to
facilitate the patients. They feel more comfortable with all the individuals
suffering from the same disease and get motivated in terms of taking treatment.
Social isolation is the basic problem faced by these people which will be
reduced to relieve their pain. Robert will meet and greet all the individuals
suffering from identical diseases which reduces their mental distress level. The
mental stress will get reduced by focusing on other activities.

The loneliness of Robert will be minimized by breaking the social
isolated boundaries of their room. The consent of Robert has taken in verbal
form by talking face to face with the patient by asking various questions related
their problem and mental status by living in the society. The information
obtained regarding their prescribed medicines, allergy, reactions, blood and
sugar level will be very helpful in analyzing their nursing needs.
The medical findings of the doctor diagnosis suggest that Mr Robert has
past medical record of congestive cardiac failure. This current discovery of
evidences related to their diseases will help in planning perfect prescription for
providing perfect treatment to the patients.
Robert had a patient who has controlled analgesia which is also known as
PCA, a urinary catheter, which allows them to monitor the pain which is
worked as pain relief machine. The programmable machine and functioning has
intended that will not deliver overdose of the medication. It allows patient to
take a complete set of vital signs to monitor their own temperature, pulse,
respiration, blood pressure and oxygen saturation level.
The results related to their blood pressure and the medicines taken by them
reveals that the 140/80 blood pressure level which is under the control of the
doctors. The medicine taken by Robert for Blood pressure is LOSAR-50 mg
tablets to control their current blood pressure levels.

PATHO-PHYSIOLOGY LEG ULCER
The Venous ulcer is described by The Wound, Ostomy and Continence
Nurse Society (WOCN) as an open wound on the lower leg of venous origin or
ankle of person. The most common causes of VLS are chronic condition and
venous hypertension. The higher pressure of venous tends to become reason of
vales in the lower leg veins. However, vales perform the work to prevent back
flow of venous blood at the time of calf muscle congresses the veins to pump
the blood return to the heart (Viv as, Lev-Tov and Kirsner, 2016). Owing to
this, in case vales are incompetent then form of ulceration can be found in skin
as venous pooling and congestion leads to leak the blood into the tissue as
edema.
The venous ulcers is that disease which occurs due to lack of venous
valves in the body of an individual. This valves usually found in or around the
areas of leg near the muscles. The insufficient amount of venous valves will
affect the soft tissues of the legs that easily contracted with the attack of viruses.
The clotting of blood will raise the effect of this disease on the body of a
person.
The normal time taken by these diseases in the normal body of an
individual is around 6 weeks to get rid of this disease.
 Swollen ankles
 Darkening of skin
 Skin around the ulcer gets hard
 Feeling heaviness in the legs
The diagnosis of this disease as discovered that the assurance
will not be provided on the certainty of the ulcer. The existence of the
ulcer is due to disturbances created in the venous valves. The slow

movement of the blood properly to all the veins will contribute highly
in occurrence of these kinds of ulcers.
OVERVIEW OF NURSING THEORIES AND MODELS
There are different nursing theories and models which helps in rendering
good quality of services to its patients. The nursing staffs in the community
adopts systematic and holistic assessment of patients whereby health can be
recovered in relatively less time span. At this stage, Fawcett's concept of four
metaparadigms highlighted Nursing, environment and Health as well as person
(Lazarus and et. al., 2016). This concept shows that people who are getting
services from nursing staff can be individuals, families and communities. It is
well known fact that various dimension of nursing is associated with open,
interrelated and interactive way where nursing staff which has require to put
their efforts with informed choices. It proves to be effective in rendering good
quality of services to patients by following above mentioned dimensions.
Patient care- This approach focuses states that peoples which has explained
from the perspectives of the patients that they get feeling of home as their care
has been done by different peoples. An individual need intensive care from
nursing staff or therapists as well as doctors to fulfill their needs and objectives.
Patients are well treated ion home cares which helps all the patients to forget
their pains and enjoy with the nurses as they demand attention which is nor
provided to them in normal society and by their family members. They faced
issue related to language and cultural diversity which affect them as people
working in health care have different cultural backgrounds.
Giving importance to patients- Human beings are considered as the most
valued persons in care home where care workers require in giving respect to all
the patients by providing their services. In the given case Robert will be
informed related to their treatment as his consent will matter for care homes.

Taking consent of Robert will mentally prepare them in order to feel good
which in turn helps doctors to treat them without any consequences.
Creating friendly atmosphere- The healthy environment is another factor of
this model which includes set of values, mores, expectations and customers as
well as societal beliefs which is directly related to both service users and
providers. According to Petherick, Pickett and Cullum (2015).There are
different elements found under environmental considerations such as cultural,
historical, physical psycho social and development processes which tends to
provide peaceful environment to the patients. It tends to create good atmosphere
for services users and accordingly time and quality is managed and maintained
by care workers.
Health is another element of Meta paradigm as it is dynamic process that
stresses on two major points that is wellness and illness. It reflects that level of
health is sort of expression which is derived from mutual interactive process
between environment and humans.
The health of human being is directly related to feeling of caring by
another person which in turn motivate them to ensure their good health by
focusing upon various healthy standards. This also involves minimizing the
stress level of a person by focusing on their weaknesses in order to convert them
into their strengths.
Moreover, nursing practice is another most important element of
Metaparadigm. This is science of holistic health care which is guided through
set of choice, responsibility, and human freedom. The nursing practices uses
various logical analysis, researcher and theory of development which in turn
provides complete package of good quality of services.
According to Guest, Ayoub and Greaves (2015) Nursing staff uses
critical thinking and clinical judgment through which they can effectively treat
patients who are suffering from several kinds of disease. In this regard, caring

attitude is required for nursing staff through which they can understand the
exact need of users which in turn transform their actions in a correct way to
provide all the services in effective way. Van Gent and et. al., (2015) explained
that the nursing staff follow different approaches for rendering services to users
which consists of clinician, learner and leaders. However, they take the
responsibility to provide supportive, technologist and therapeutic care as per the
needs and expectations of the patients.
This is very basic level in which there are three main key components of
nursing model exists. One among the model includes different set of beliefs and
values which facilitates in carrying out various activities that are related to
prescribing medication. However, statement of the goals is framed under which
the model will represent the application of nursing practices which will helps in
achieving the same.
Similarly, Filkor and et. al., (2015) knowledge and skill are also acquired
by nursing staff in accordance with set objectives. A counter argument might be
that nursing models focus upon four central concepts which are already
explained. It has been found that nursing models include complex terms such as
care requisites, self-care deficit and health deviation affect learning to a great
extent. Furthermore, ineffective use of English language is the commonly found
barriers while interacting with various set of customers.
Roper-Logan-Tierney- The selected model for the study is of Roper-Logan-
Tierney (RLT) model of nursing which is based upon activities of living (AL).
This model at first developed in 1998 where basis was Nancy Roper 1976. This
RLT model is highly based upon activities of daily living under which is
generally used in UK. However, this model was updated in 2001 in accordance
with societal needs.
Roper-Logan-Tierney Model

Patients
care
Providing
independence
Enhancing
learning

The central focus of this model was on care of patients through which
nursing staff can easily implement the standards set by health care sector (Jozic
and et. al., 2015). It can be critically evaluated that care homes of UK uses such
kind of approaches just for checklist on admission. By using such kind of
approach, experts come to know that how life of a person has been changed due
to certain illness or admission to hospital. Though, it does not shed light on
increasing Independence or patients and quality of his life.
The activities of living covers in this model reflects that independence of
patient should be enhanced by putting efforts in the same direction (Vilela and
et. al., 2016). The basic purpose of implementation of this model is to judge
how an individual can improve own health and challenges. It also determines
how care patients can be ready to cope up with changes.
This aids to provide learning among patients and they follow the positive
behavior for recovering their health in relatively less time span. Furthermore,
Fox and et. al., 2015 stated that activities of living assesse exact independence
of individual and potential for independence on the range from complete
dependence to self-dependence to analyze the interview which form the basis
for increasing the self-dependence. At the same time, activities required to
compensate the dependence are also assessed for enhancing the learning of
sufferers towards health or maintaining the sound health. Roper's model is
considered most helpful as it shows that nurses should adopt such kind of
behavior in their care towards patients.
Lin and et. al., 2016 asserted that different activities covered under
activities of living are; maintaining a safe environment, communication,
breathing, elimination and washing & dressing. Along with that, controlling
temperature, mobilization and sleeping as well as working & playing are also
included which must be there at part of patients. These activities of living cover

all the important activities which are related to human being or patients so they
are referred at the time of admission of patient on a ward or service.
This is the major reason where older people are vulnerable to risk because
they need to be cared by others. Here, the first factors effective living activities
as biological reflects that how nutritional activities of a person different
between one who is having issue of diabetes and the one who is not having the
same. On the other hand, psychological factor shed light on spiritual beliefs and
ability to understand by patients.
For instance, if a person is educated enough then he will be sufficient
self-dependent in term of health promotion. In this manner, overall thinking,
believing, hoping and feeling are considered. It aids to determine influence of
psychological factor on dependence of patient as Judie (Harding, 2016).
Furthermore, Filkor and et. al., (2015) stated that socio-cultural factor
presents the expectations and values in accordance with actual health. This is
because all culture follows different set procedures and accordingly they tend to
behave in different manner. The eating habits and caring attitude is perceived by
individual based on culture.
However, expectations and assumptions of societies also matter under
which care workers will come to know that whether patient is self-dependent
(Marshall and et. al.,2015). On the other hand, environmental damages also
have direct impact on health of one person. Here, people do care of themselves
in case they are residing in an unfavorable environment. Moreover, last factor as
politico-economic also affect activities of living because of violent conflicts,
easy to access to benefits provided by government.