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Clinical
case study:
Bedsores
Presented by
Arooj Fatima
Clinical Replacement C2 Ward
1
 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.
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
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.
4
5
6

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bedsores (8).pptx

  • 1. Clinical case study: Bedsores Presented by Arooj Fatima Clinical Replacement C2 Ward 1
  • 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. 4
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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) 7
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  • 9. LAB TEST 9 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 10 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 11  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.
  • 12. 12 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...)
  • 13. 13 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 14  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 15 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
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  • 20. References: 1. Bruner & Suddarth's text book of Medical-Surgical Nursing 2. Porth's Pathophysiology 20