Case Study Analysis: Wound Case Scenarios - Patient Care and Outcomes

This assignment presents two detailed wound case scenarios. Case 1 focuses on Mr. Jackson, a 77-year-old man with a complex medical history including coronary artery bypass grafting, diabetes, and multiple wounds, including a diabetic foot ulcer, an arterial ulcer, and a stage 3 pressure ulcer. The case provides a holistic assessment, investigation details, and management plans for each wound type, including pain management and health education. Case 2 involves Mrs. Miriam, an elderly patient with a history of pneumonia, metastatic disease, and a rectovaginal fistula, presenting with a malignant wound and a venous ulcer. The analysis covers wound characteristics, management strategies, and expected healing processes for both wound types, emphasizing the importance of patient education and adherence to treatment plans. The assignment provides valuable insights into the assessment, management, and evaluation of complex wound cases in a healthcare setting.

Running head: WOUND CASE SCENARIOS 1
Wound Case Scenarios
Student’s Name
Institutional Affiliation

WOUND CASE SCENARIOS 2
Case 1 scenario
Holistic assessment
Mr. Jackson has a critical medical history; he has undergone coronary artery bypass grafting
which involves a surgery that focuses on improving the flow of blood to the heart following
ischemic heart disease. He seems to have been undergoing pain and wound related issues for
quite a very long time. his state of health has contributed to developing three wounds: he has
diabetic foot ulcer on his left toe that needs urgent debridement. His right lower leg has arterial
ulcer which seemingly is infected. His sacrum bone has one pressure ulcer that is at stage three;
the pressure ulcer causes him a lot of pain especially when he lies in a supine position.
Diabetic foot ulcer
Diabetic foot ulcer is a type of wound that affects two to ten percent of those having diabetes.
The risk of developing such a wound increase with time. it looks a red crater in the skin. most of
the ulcers are located on the side of the foot or the bottom. The round crater could be surrounded
by a broader of thickened skin, this broader develop over time which is characterized by a light
yellowish color. Diabetes foot ulcer is common in individuals with diabetes. It is majorly causes
by high blood sugar levels because of diabetes, poor circulation of blood, nerve damage, issues
with immune system and infection. some of the investigation required for the wound are blood
tests, X-ray, MRI scans, physical exam and medical history (Armstrong, Boulton& Bus, 2017).
Wound investigation
Medical history, X ray, MRI scans and blood tests will be appropriate in helping investigating
the wound.

WOUND CASE SCENARIOS 3
Wound management
Requires wound offloading by using proper therapeutic footwear
Daily using of saline and dressings to provide environment that is moist
Arterial ulcers
Arterial ulcers are also called ischemic ulcers by poor perfusion r what we call poor delivery of
the food rich in nutrients to the lower extremities. The skin and tissues overlying are then
deprived of oxygen, making the tissues and cells within the area, leading to formation of an open
wound. Additionally, lack of supply of blood could result in cuts or minor scrapes failing to heal
and ultimately developing into ulcers (Riot et al., 2015)
Arteries are usually responsible for carrying nutrients and oxygen that is rich in blood t the
various tissues in the body a restriction of these blood from flowing could lead to arterial ulcers.
Wound investigation
Investigations would involve seeking to know the medical history and performing diagnostic
tests which might involve swabs. They can be investigated through some degree of hypoxia
Wound management
Improving circulation of wound and controlling the pain
use of occlusive dressings to protect the ulcer from infection
Maintain a moist environment.
Pressure ulcer

WOUND CASE SCENARIOS 4
It is usually an injury to the skin and the underlying tissue because of prolonged skin pressures.
Most likely areas to be injured are ankles, heels and hips.
Wound investigation
A history of the injury should be sought before looking out for the bedsores and the level at
which the ulcer has had an impact.
Wound management
Reducing pressure on the affected skin and maintaining a moist environment for wound healing
Evaluation
Diabetes foot ulcer
It looks like a red crater in the skin with multiple ulcerations all-round the border of the thick
boarder skin that appears yellowish.
The surrounding skin is seemingly breaking and not intact. The wound is close to 25mm2 in size.
Wound swab would be appropriate to facilitate testing of the wound.
Arterial ulcer
Wound bed status
They are usually characterized by a punched -out look that is usually round, having a well-
defined margins tat re round. They are mostly found between or on the tips of the toes, or where

WOUND CASE SCENARIOS 5
there is constant pressure from footwear or walking. Often the limb would feel cold or cool to
touch. It measures a size of 30mm2
The skin around the wound is usually breaking down progressively even though it seems intact
when the wound is in its initial stage. Assessments such as swabbing are necessary in carrying
out tests on the wound
Expectation of Healing process
Diabetes foot ulcer
An individual who have good circulation and medical care, it takes a few weeks for the wound to
heal: it takes close to three to six weeks. However, the ulcers that are deep may take 12 to 20
weeks to heal.
Arterial ulcers
There are usually several surgical options that are used to treat arterial ulcers including
angioplasty. The procedure for example uses a balloon to open the artery that is affected to
enhance and improve flow of blood. restriction of blood flow, makes the symptoms vanish.
Health education
Diabetes foot ulcer

WOUND CASE SCENARIOS 6
Encourage uptake of food rich in calcium and even proteins to enable blood clotting and faster
healing of the wound. Encourage the patient not to walk fir long distances but stay in a position
that will nit cause pressure to the place of wound.
Arterial ulcer
Encourage uptake of food rich in calcium and even proteins to enable blood clotting and faster
healing of the wound. Encourage the patient not to walk for long distances but stay in a position
that will not cause pressure to the place of wound
Wound management plan/ Pain management
Diabetes foot ulcer
It is advisable that one sleeps on a chair to et relief from the light pain or rest the part of the body
that has the wound on the object that would reduce the pain.
Antibiotics would do well in managing the pan and enhance medication, however, they cannot
heal the ulcer, they only help in managing
Arterial ulcer
It is advisable that one sleeps on a chair to get relief from the light pain or rest the part of the
body that has the wound on the object that would reduce the pain.
Antibiotics would do well in managing the pan and enhance medication, however, they cannot
heal the ulcer, they only help in managing.
CASE 2 scenario
Holistic assessment

WOUND CASE SCENARIOS 7
Mrs. Miriam’s condition could be associated with the old age and the state of health especially
having a history of pneumonia and metastatic. Because of her malignant wound she had to be
brought and admitted for medications. Her state of mobility is moderate even though she cannot
move that easily. Because of the progressive effect of the disease overtime, Gold developed a
rectovaginal fistula, with frequent radiotherapy malignant wound developed.
Her past medical history reveals that she has had chronic obstructive pulmonary disease, gastro-
esophageal reflux disease and coronary artery bypass grafting.
Malignant wound
They are usually because of cancerous cells getting into the skin and its supporting lymph and
blood vessels resulting in loss of vascularity and hence tissue death. The lesion could be because
if primary cancer (Federman et al.,2014).
Wound management
To properly manage, the malodor and exudate must be addressed as focus is laid on the
discomfort and isolation, however, they are difficult to manage for their location and the odor.
Venous ulcer
They are wounds that are thought to happen to improper venous valves functioning, particularly
for the legs which consequentially causes leg ulcers. Among the 70% and 90%, the wounds have
a higher account for a high percentage. They rea the sires ta develop between the knee and the
toe.
Wound management

WOUND CASE SCENARIOS 8
It is important that the compression stockings or bandages every single day as instructed, they
enhance pulling of the blood, reducing swelling, assist in healing and decreasing pain
Evaluation
Malignant wound
Characteristic of the wound
It is likely to present with odor, bleeding, pruritic, exudation and pain
Venous ulcer
Characteristic of the wound.
The wound has moderate pain that involves improvement in elevation
They are usually irregular sloping edge
It is associated with oedemic
It is associated with hardening of the skin which could probable lead to appearance of the bottle
appearing to the leg.
Health education
Malignant wound
Patients ae to e advice to comply with the medications and effective aeration to the winds.,
aeration will ensue there is no odor
Venous ulcers

WOUND CASE SCENARIOS 9
The patient should always in constant consultation observe the instructional medications as they
thet their condition. It is imperative that individuals with this and of disease remain intact and.
the wounds require close attention and attentiveness so that there will be quick response of
anything unusual.
Healing process
Malignant process
Malignant wounds are difficult to heal; however, it is advisable that the patients follow the
medication plan and carefully adheres to management plan. The wound should be managed but
not may never heal completely.
Venous ulcers
The wound is expected to heal within 3 to four months. Unlike malignant wound which might
fail to heal, venous ulcers have a potential to heal as long as compression therapy is utilized.

WOUND CASE SCENARIOS 10
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.
Raffetto, J. D. (2018). Pathophysiology of chronic venous disease and venous ulcers. Surgical
Clinics, 98(2), 337-347.
Riot, S., de Bonnecaze, G., Garrido, I., Ferron, G., Grolleau, J. L., & Chaput, B. (2015). Is the
use of negative pressure wound therapy for a malignant wound legitimate in a
palliative context? “The concept of NPWT and vitamin”: a case series. Palliative
medicine, 29(5), 470-473.