Complex Case Study: Managing Acopia, Pressure Injuries and Leg Ulcers

This case study presents two scenarios involving elderly patients with complex health issues. The first case focuses on Mrs. Wong, who suffers from Acopia, urinary incontinence, and general frailty, leading to potential pressure injuries. The analysis explores the impact on healthcare staff and the physiological changes associated with aging that increase the risk of pressure ulcers. Nursing interventions aimed at reducing pressure injury risk are discussed, including risk assessment, skin assessment, patient education, nutrition, hydration, and moisture control. The second case involves Mr. Adomos, who has leg ulcers, and the study examines the impact of leg ulcers on his physical and mental well-being, along with the increased risk of adverse drug reactions in older adults. Nursing interventions for adrenal insufficiency, a potential adverse reaction to codeine, are also outlined. Desklib offers more solved assignments and resources for students.

Case study

Table of Contents
CASE STUDY: ONE ......................................................................................................................1
ANSWERS.............................................................................................................................1
CASE STUDY: TWO......................................................................................................................2
ANSWERS.............................................................................................................................2
REFERENCES ...............................................................................................................................4

CASE STUDY: ONE
ANSWERS
1: As per case study, it is examined that Mrs. Wong face the issue of Acopia which is
directly linked with body mobility which completely restricted. In this case, the potential impact
on staff is analyse that they must take proper monitoring of patient in order to fulfilled their
demand or requirement because the patient is not in state to make movement and fulfil their
requirement. As per this, it creates challenge and callous situation for the staff to undertake
proper monitoring in term of need and wants of patient (Li, Lin, Thalib, and Chaboyer, 2020).
On other hand, Mrs. Wong is also facing the issue of urinary incontinence and general frailty
where patient is usually measure deal with frequent urination and due the Acopia they require
support and care that is fulfilled by staff. With this, the potential impact which is also analyse
within the patient is that due to urinary incontinence and Acopia where they must require proper
support and care to fulfil requirement (Weller, Team, V. and Sussman, 2020). In this, Mr. Wong
does not show any aspect of movement and they must move due to the urination which is occur
due to the urinary incontinence. It is callous for Mrs. Wong to resist themselves for such events
where they think they do not require any support (Peko, Barakat‐Johnson, and Gefen, 2020).
2: In this, the physiological change of ageing enhances the risk of Mrs. Wong developing
the pressure injury that is pressure ulcer among the elder people when they stay longer in
hospital. As per this, where pressure ulcer incidence was showing the significant associated with
enhancing age that is happen with Mrs. Wong if she stays longer in hospital (Pittman and et. al.,
2019). There is well documented physiologic change that usually occur in human body that may
be associated with integumentary system and other body system which impacted due to change
in physiologic during the ageing process decreased body fat, decreased muscle mass, cellular
senescence change, change on the skin PH, decreased metabolism, decline in the immune
function and poor hydration. Such change that affect skin integrity and also wound healing and
raise the pressure risk of related skin injury. So, these are some of the pressure risk which is well
associated with Mr. Wong (Sink and et. al., 2018).
3: The nursing intervention with rationale that should be implemented for Mrs Wong that
is related with reduction in pressure injury risk that may impact health of Mrs. Wong. Pressure
injury risk assessment, skin assessment, patient and family education, nutrition and hydration and
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moisture control and skin care. As per this, the above stated prevention and management is
useful to reduce the chance of pressure injury. As per this, the pressure injury risk assessment
allows the user to provide the range of prevention aspect that is controlled by using risk
screening. With this, the skin assessment is also act as prevention act to decline the issue of skin
damage (Skipper and et. al., 2020).
CASE STUDY: TWO
ANSWERS
4: Leg Ulcers are often associated with pain and social isolation along with instances of
sleep disturbances. The prevalence of chronic ulcers leads to loss of time from work along with a
significant increase in the financial costs of treatment. These factors have a severe impact on the
perception of pain experienced by patients (Cigna & et. al., 2021). The development of ulcer in
Mr. Adomos will seriously hamper his ability to walk. The patient is more likely to lose control
of his balance and exudate unpleasant odour, which might negatively impact the quality of life.
Chronic venous leg ulcers hamper the mobility, which increases the chance of getting hit and
falling. The movement is often restricted due to presence of ulcers and the patient might find
themselves in a self-imposed isolation. The presence of chronic venous leg ulcers pose a threat to
the physical functioning of the patient. Unpleasant smell and increased feelings of anger and
resentment lead to limited interactions of the patient in a social setting. High amounts of
exudates and malodour cause increased levels of emotional hardships (Cavassan & et. al., 2019).
The mental and psychological distress experienced by patient fosters a negative environment,
which might not be apt for healing of venous leg ulcers.
5: Old adults, such as Mr. Adomos, are more likely to experience adverse drug reactions
as elder individuals are more prone to falls, orthostatic hypotension, renal failure, intracranial
bleeding, gastrointestinal bleeding and delirium. Age related changes occur in pharmacokinetics
and pharmacodynamics, which is directly linked to increased risk of developing an adverse drug
reaction. Some anatomical factors that lead to increased intensity of adverse drug reactions are
back and neck pain, osteoarthritis, COPD, diabetes, hypertension and dementia (Barzilai, Cuervo
& Austad, 2018). The density and size of bones shrink, which increases the risk of loss of bone
through fractures. The loss of flexibility leads to decreased strength. Physiological changes
associated with ageing include decreased cardiac output, a significant increase in blood pressure
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and the development of arteriosclerosis. The progression of age decreases the vital capacity in
lungs along with gradual expiratory flow rates. There is a significant change in behaviour such
as changes in emotions and cognition that affect the overall well-being and the ability to make
decisions. These changes during ageing are associated with an increased sensitivity to various
drugs (Khan & Kamal, 2021). Multiple problems associated with altered composition of the body
and a decrease in functioning of liver, kidney makes old people vulnerable to adverse drug
reactions.
6:
Adrenal Insufficiency (Nursing), 2022 [Online] Available through <
https://www.ncbi.nlm.nih.gov/books/NBK568707/ >
The administration of codeine leads to adrenal gland problems, such as adrenal
insufficiency. Nursing intervention for this particular adverse drug reaction includes starting
normal saline infusion in Mr. Adomos for replacement of extracellular fluid and treating
metabolic alkalosis. Investigation of a possible blood infection through blood culture is
important. The lab values will be monitored including CBC, Lactate and arterial blood gases for
overall assessment of the patient along with reviewing of vital signs. The nursing intervention
will encourage the flow of oral fluids in patients in order to prevent fluid volume deficiency due
to the inability of kidneys to preserve sodium in the body. Assessing the patient for fatigue and
other sensory deficits will be done to analyse possible signs of hyperkalaemia. This is because of
the deficiency of aldosterone might lead to retention of potassium. Assessment of colour,
concentration and levels of urine. The nursing intervention will also include analysis of blood
pressure and heart rate for an understanding of orthostatic changes occurring in Mr. Adomos'
body. The skin of the patient will be monitored for turgors and mucous membranes for different
signs of dehydration.
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REFERENCES
Books and Journals
Barzilai, N., Cuervo, A. M., & Austad, S. (2018). Aging as a biological target for prevention and
therapy. Jama, 320(13), 1321-1322.
Cavassan, N. R. V., Camargo, C. C., de Pontes, L. G., Barraviera, B., Ferreira, R. S., Miot, H. A.,
... & Dos Santos, L. D. (2019). Correlation between chronic venous ulcer exudate proteins
and clinical profile: A cross-sectional study. Journal of proteomics, 192, 280-290.
Cigna, E., Pierazzi, D. M., Sereni, S., Marcasciano, M., Losco, L., & Bolletta, A. (2021).
Lymphatico‐venous anastomosis in chronic ulcer with venous insufficiency: A case
report. Microsurgery, 41(6), 574-578.
Khan, H., Ullah, H., Martorell, M., Valdes, S. E., Belwal, T., Tejada, S., ... & Kamal, M. A.
(2021, February). Flavonoids nanoparticles in cancer: Treatment, prevention and clinical
prospects. In Seminars in cancer biology (Vol. 69, pp. 200-211). Academic Press.
Li, Z., Lin, F., Thalib, L. and Chaboyer, W., 2020. Global prevalence and incidence of pressure
injuries in hospitalised adult patients: A systematic review and meta-
analysis. International journal of nursing studies, 105, p.103546.
Peko, L., Barakat‐Johnson, M. and Gefen, A., 2020. Protecting prone positioned patients from
facial pressure ulcers using prophylactic dressings: A timely biomechanical analysis in
the context of the COVID‐19 pandemic. International Wound Journal, 17(6), pp.1595-
1606.
Pittman, J., Beeson, T., Dillon, J., Yang, Z. and Cuddigan, J., 2019. Hospital-acquired pressure
injuries in critical and progressive care: avoidable versus unavoidable. American journal
of critical care, 28(5), pp.338-350.
Sink, K.M., Evans, G.W., Shorr, R.I., Bates, J.T., Berlowitz, D., Conroy, M.B., Felton, D.M.,
Gure, T., Johnson, K.C., Kitzman, D. and Lyles, M.F., 2018. Syncope, hypotension, and
falls in the treatment of hypertension: results from the randomized clinical systolic blood
pressure intervention trial. Journal of the American Geriatrics Society, 66(4), pp.679-686.
Skipper, A., Coltman, A., Tomesko, J., Charney, P., Porcari, J., Piemonte, T.A., Handu, D. and
Cheng, F.W., 2020. Position of the academy of nutrition and dietetics: malnutrition
(undernutrition) screening tools for all adults. Journal of the Academy of Nutrition and
Dietetics, 120(4), pp.709-713.
Weller, C.D., Team, V. and Sussman, G., 2020. First-line interactive wound dressing update: a
comprehensive review of the evidence. Frontiers in Pharmacology, 11, p.155.
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