2. Case Study Objectives:
By the end of this case study,students will be able to :
Understand bedsores ,their stages,and ethiology through a patient clinical case.
Acquire enough insight about medications and nursing interventions for patients with
bedsores.
Design a nursing care plan that provides healthcare for bedsores patient.
3. Patient’s Scenario
A female patient of 36 years old is diagnosed with bilateral buttocks
pressure ulcers .
She had a history of fall at the level of leg twenty years ago .
After that of five years ,she had amputation of both legs.
The patient gave birth to two children both with C Section
Currently, the patient is suffering from developed bedsores for two years of
4th degree ulcers pressure on both buttocks .
On 9th of August, she had wound debridement.
On 29th of August, she admitted again with the complaint of skin infection
and pus drainage from wound on right buttock.
Signs and Symptoms:
• Swelling and feeling suffocated
• Skin infection with a red pink Wound
• Ulcer extends to muscle or bone
• Tender bilateral area. 3
4. Bedsores
Definition:
A Bedsore is a localized injury to the skin
and other underlying tissue, usually over a
body prominence, as a result of prolonged
unrelieved pressure.
A bedsore develops when blood supply to
the skin is cut off for more than 2 to 3 hours.
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7. Ethiology:
People most at risk of bedsores have medical
conditions (mostly impaired ones) that limit their
ability to change positions:
• Pressure:Constant pressure on any part of your body
can lessen the blood flow to tissues
• Friction: Friction occurs when the skin rubs against
clothing or bedding
• Shear: Shear occurs when two surfaces move in the
opposite direction (when a bed is elevated at the head, then
sliding down in bed)
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9. LAB TEST
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CBC+Auto Differential (5
Parts)includes Hb
CRP (Quantitative)
CREATININE-SERUM
HBSAG
CBC+Auto Differential (5parts)
includes Hb
Anti HCV
SWAB Culture and sensitivity
10. LAB VALUES
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Name unit Value Normal range
%LYMP % 46.0 20- 40
%EOS % 5.7 0.5-5
RDW-CV % 21.1 12.2-18.1
HB % 9.1 12-14
11. MEDICATIONS
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Scarred skin debridement surgery and secondary suturing done on
bilateral side and on skin around the wound.
Post operative medications analgesia and antibiotics were given .
Also:
Sudocream (topical) BID (twice a day)
Chlorhenidine (oral) mouth wash
Omeprazole inj-Iv-OD (daily).
Pipevacillin
Tozobactum in-IV-TID (twice a day
Paracetamol 1000mg / inj-Iv-TID
Taking and tolerating a regular healthy diet.
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Nursing Interventions:
Changing positions often : every 15 minutes if in a
wheelchair and at least once every two hours when in bed
Determine presence of urinary incontinence
Monitor vital signs and evaluate level of mobility
Use comfort devices appropriately.
Assist the physician or surgeon in debridement
Use of air mattress to prevent bedsores.
Elevate heels off the bed by using pillows or heel elevation botts.
Prevent ulcer from being exposed to urine and feces
vitals monitoring and continue anti-biotics medication
Encourage mobilization
Inspect body pains (shoulder...) and skin condition (pale,dry...)
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Continue . . .
Establish individualized turning schedule
Cleaning : It's essential to keep wounds clean to prevent infection.
Clean gloves and practicing proper hand washing before and after wound care.
Open sores should be cleaned with saline solution each time the dressing is changed.
Inspect each pressure sites.
Inspect for dry skin, moist skin, breaks in skin
Evaluate circulatory status (eg. Peripheral pulses, edema)
Evaluate nutritional and hydration status: supplement the diet with vitamins and minerals
Note other health problems.
Avoid dragging the patient in bed
Educate the patient and family regarding the risk factors and prevention of bed sores..
14. COPING THE CHALLENGES
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In this clinical case,eventhough the female patient has bedsores and non supportive members With
her, she has shown strength to cope With the different challenges :
Patient shows feeling of anxiety towards nursing care
Bedsores can put the patient into social isolation and hard to be communicated with
Pressure ulcer affects the patient to let him refuse even family and friends visits.
Patient develops a fear and discomfort of being a burden on others regarding his physical condition
patient have felt embarrassed requiring assistance in changing of dressings
15. FAMILY EDUCATION ABOUT
BEDSORES
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Using support surfaces: special mattresses and
cushions that relieve pressure
Repositioning of patient regularly
Look into a specialty wheelchair which can relieve pressure.
Protect the skin : use moisture barrier creams to protect the
skin from urine and stool
Consult dietitian for nutritional evaluation
Provide a healthy diet including vitamin C ,proteins and Zinc
Evaluate the ulcer progress every 4-6 days
