University Nursing: Wound Management Plan Case Study of Mr. Jackson

This assignment presents a wound management plan for Mr. Jackson, a 77-year-old patient with multiple health issues, including rectal cancer, IHD, COPD, and type 2 diabetes. The plan addresses three types of wounds: a diabetic foot ulcer, a stage 3 pressure ulcer, and an arterial ulcer, all of which require specific treatment strategies. The plan includes regular wound evaluation, which involves assessing the wound's characteristics, surrounding skin, and exudates. The management plan emphasizes observation of the wound healing process, medication administration, topical antimicrobial treatments, and proper wound dressing. Health education is crucial, focusing on motivating the patient, teaching about wound prevention, and controlling diabetes. Pain management is also a key component, involving communication with the patient, medication administration, and mobility assistance. The assignment provides a detailed overview of the nursing interventions needed to promote wound healing, manage pain, and improve the patient's overall health, referencing relevant literature to support the strategies outlined. This comprehensive approach aims to improve the patient's quality of life by addressing the physical and emotional aspects of wound care.

Running head: WOUND MANAGEMENT PLAN: SCENARIO 1
WOUND MANAGEMENT PLAN SCENARIO 1
Name of the Student
Name of the University
Author Note

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WOUND MANAGEMENT PLAN: SCENARIO 1
Holistic assessment
Mr. Jackson a 77 year old patient with rectal cancer has other medical histories including
IHD, CABG, COPD, ETOH, GORD, postural hypotension and type 2 diabetes mellitus and takes
insulin. He has a past history of IHD and thus CABG has been performed 2 years ago. He lives
alone and his recent condition is severe as he cannot eat food properly and mobility is confined
to short distance. He takes several medicines for his condition including Telmisartan 40 mg,
Ventolin 4 puffs, Esomeprazole 20 mg daily, Lantus 20 units (mane), warfarin 2 mg (daily),
Frusemide 20 mg, Endone 10mg, Hydromorphone 2 mg. He was found with diabetic foot ulcer
after the admission in the hospital for fall and also with pressure ulcer and arterial ulcer. His
pressure ulcer was in stage 3 and gave him lot of pain. Diabetic foot ulcer is an issue caused by
diabetes mellitus and creates ulcer and results in reduction of tensile strength of the tissue
(Armstrong, Boulton& Bus, 2017). Pressure ulcer is the cause of the reduction of blood supply to
a particular tissue of the body due to immobility or other cases and leads to damaged tissue and
the ulcer (McInnes et al., 2015). Arterial ulcer on the other hand forms in the lower portion of leg
and caused by inadequate blood supply to the tissues and tends to be chronic disease (Federman
et al., 2016).
Wound evaluation
Based on the patient’s condition the evaluation of the wounds would be required in
regular intervals. The evaluation would be comprised of bed colour of the patient, character of
the wound, wound measurement, condition of the skin surrounding the wound, exudates
secreting from the wound and others. On the basis of the evaluation it has been found that Mr.
Jackson has diabetic foot ulcer in under the left toe, pressure ulcer on the sacrum bone and one
arterial ulcer which was found to be infected when the wound swab test was done in the

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pathological lab. It has also been found that his pressure ulcer was in stage 3 as the wound base
consisting of 70 percent sloughy tissue and 30 percent granulation tissue. This sloughy condition
of the tissue can be impacting on the wound thus the wound cannot be healed properly. Here
patient neglected this pain as he thought it is causing by his rectal cancer and the severity of the
wound lead to the 3rd stage. On this condition of the patient the wound bed should be brown or
black as the pressure ulcer is in 3rd stage. Hence, the cleaning of bed would be needed in regular
intervals otherwise an infection can be able to develop from that wound and the severity of the
wound would become more effective and sepsis can also occur. Character of the wound that is
the arterial ulcer can be seen to be with microbial colony that can be stated as infected. The
microbial infection can be able to form sepsis in the body of the patient. On this context it can
also be seen that the condition of the diabetic foot ulcer is also in a severe condition as he felt
pain in the toe as well. The condition can lead to the foot amputation as well if the portion is
found to be infected on the basis of the evaluation of the tissues of the wound. All these wounds
would be secreting pus of yellow to brown colour based on the condition of the patient (Hudson
et al., 2015).
Wound management plan
As Mr. Jackson have 3 types of wounds and different chronic diseases his wound
management plan would be requiring different aspects. The wound management plan would be
comprised of observation, treatment and consultation with doctor. The nurse should be able to
assess the wounds on the basis of the characters of the wounds and also observing the changes in
the wounds. First the nurse needs to observe the changes that is the four steps of the wound
healing process of the body which includes hemostasis, inflammatory stage, proliferative phase
and maturation phase. On the basis of the observation the pressure ulcer and the nurse should

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WOUND MANAGEMENT PLAN: SCENARIO 1
change the position of the patient in every two hours gap in order to manage the pain of the
wound. On the basis of the diabetic foot ulcer it can be stated that the nurse should administer the
prescribed medicine of the doctor in proper dose and timing based on the age of the patient and
also based on the wound type of the patient (Norman et al., 2016). The diabetic foot ulcer also
needed to be treated with topical antimicrobial ointments and the wound should be dried and
dressed properly in regular intervals for the moisture control of the wound. The healing of the
wound also includes the factor of the cleansing of the wound which would be done in daily and
also providing the wound with disinfectant or antimicrobial agents along with providing a dry
condition to the wound. The process of the arterial ulcer treatment the nurse should follow the
doctor prescribed process and also implement the disinfectant in order to remove the infection of
the tissue. The wound must be dried to the point in which the tissue would be getting the
required moisture and also dressed well in order to eliminate the risks of the infection and
amputation. Other than all these the nurse should follow the doctor and the dietitian prescribed
diet for the patient as the patient has diabetes mellitus type 2 along with the processes of
controlling the diabetes mellitus type 2 of the patient. Hence, on this context it can be stated the
wound management plan would be developed on the basis of the observation, position changing
of the patient time to time, dressing the wound areas and recording the changes along with
assessing the changes in the surrounding areas of wound skin. Most importantly the moisture of
the wound and the surrounding tissues should be maintained as well (Vowden&Vowden, 2017).
Health education
The patient Mr. Jackson should be empowered with the implementation of the holistic
approach. Thus it can be stated that the nurse should be able to motivate the patient with proper
medication administration and proper dietary intake. The nurse should also taught the patient

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about the severity of the wounds and what steps should be followed in order to prevent the
infection and the pain. The health education should also consider the factors of the diabetes
control such as diet, exercise and proper exercise. The nurse needed to be delivering the
knowledge to the patient as the patient lives alone and the medication along with the dietary
intake and mobility also would be requiring for the elimination of these wounds.
Pain management
The nurse also should be able to determine the pain of the patient on the basis of the
communication with the patient about the condition of him in regular basis. Based on the
conversation the nurse should inform the doctor about the condition and follow the proper
medication that doctor prescribe for the patient. The nurse should try to help the patient in
mobility in order to reduce the risks of the pressure ulcer and the pain of the wound. On the other
hand the nurse should rotate the patient within two hours to eliminate the pain of the patient as
well (Tan, Law & Gan, 2015). The changes of the patient should be recorded and based on the
doctor’s assessment the nurse should be able to treat the patient in required way.

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References
Armstrong, D. G., Boulton, A. J., & Bus, S. A. (2017). Diabetic foot ulcers and their recurrence.
New England Journal of Medicine, 376(24), 2367-2375.
Federman, D. G., Ladiiznski, B., Dardik, A., Kelly, M., Shapshak, D., Ueno, C. M., ...&Hopf, H.
W. (2016). Wound healing society 2014 update on guidelines for arterial ulcers. Wound
Repair and Regeneration, 24(1), 127-135.
Hudson, D. A., Adams, K. G., Van Huyssteen, A., Martin, R., & Huddleston, E. M. (2015).
Simplified negative pressure wound therapy: clinical evaluation of an ultraportable, no‐
canister system. International wound journal, 12(2), 195-201.
McInnes, E., Jammali‐Blasi, A., Bell‐Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N.
(2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic
Reviews, (9).
Norman, R. E., Gibb, M., Dyer, A., Prentice, J., Yelland, S., Cheng, Q., ...& Edwards, H. (2016).
Improved wound management at lower cost: a sensible goal for Australia. International
wound journal, 13(3), 303-316.
Tan, M., Law, L. S. C., &Gan, T. J. (2015). Optimizing pain management to facilitate enhanced
recovery after surgery pathways. Canadian Journal of Anesthesia/Journal
canadiend'anesthésie, 62(2), 203-218.
Vowden, K., &Vowden, P. (2017). Wound dressings: principles and practice. Surgery (Oxford),
35(9), 489-494.

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