A 36-year old female patient presented with bilateral buttocks pressure ulcers of stage 4 severity that had developed over two years. She had a history of leg amputation following a fall and two C-section deliveries. Her current symptoms included swelling, skin infection, and pus drainage from her wounds. Nursing interventions included frequent repositioning, wound cleaning and debridement, nutritional supplementation, and patient/family education on prevention. The case study aimed to understand bedsore etiology, stages, and treatments through examining this clinical case.

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

5. 5

6. 6

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

8. 8

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

16. 16

17. 17

18. 18

19. 19

20. References:
1. Bruner & Suddarth's text book
of Medical-Surgical Nursing
2. Porth's Pathophysiology
20

21. Thank you
21