Patient Case Study- Bedridden Patient in the Emergency Room

Patient Case Study- Bedridden Patient in the Emergency Room

Patient Profile

Mrs. J.K. is a 75-year-old woman who was brought to the emergency department from a long-term care facility and was admitted. She has been bedridden for the past year because of severe osteoarthritis and multiple comorbidities. She was brought to the emergency room due to the concern that the pressure ulcers were getting worse.

Past Medical History

Mrs. J.K. is a known type 2 diabetes, hypertension, and osteoarthritis patient. She has been living in the long-term care facility and receiving care from the staff for two years now. She has been taking metformin, lisinopril, and paracetamol for managing pain.

Subjective Data

Mrs. J.K. reports discomfort and severe pain in her left heel and sacrum, where her pressure ulcers are located. On enquiring, she rates the pain 8/10 on the pain scale.

Objective Data

Skin: Pressure sores on the right knee and the sacrum with visible signs of infection and necrotic tissue. The sore was categorized as stage 3.

Vital signs: BP- 150/90 mmHg, HR-92bpm, RR- 20 breaths/min, Temp- 98.6^oF (37^oC)

Neurologic: The patient is mentally alert and oriented but is visibly weak and in pain.

Respiratory: breath sounds are clear in all lobes.

GU/GI: Normal bowel sounds were heard, and the urinary catheter was in situ with normal urine output.

Interprofessional Care

After admission to the emergency room, a thorough wound assessment was done. Mrs J.K. received intravenous pain medication for pain management, and her pressure sores were cleaned and dressed. Further assessments and recommendations were made in consultation with the wound care team. Also, she was started on antibiotics as a prophylaxis for the infection concerns.

Laboratory Tests

WBC: 15,000/µL, Hemoglobin: 10.2 g/dL, Albumin: 2.5 g/dL, Creatinine: 1.6mg/dL, Blood glucose: 180 mg/dL

Outcome Status

Mrs. J.K. was admitted to the hospital for wound care and pressure ulcer management. During her stay at the hospital, she underwent debridement and specialized wound dressings daily. Furthermore, physical therapy was started to prevent further breakdown of the skin and improve mobility. Mrs. J.K. was later discharged to the long-term care facility with a comprehensive plan for continuous wound care and pressure ulcer prevention.

Discussion Questions

What strategies would the caregivers at the long-term care facility have used to prevent the development of pressure ulcers?

What are the proper interventions that could have improved pressure ulcer healing in bedridden patients?

What are the possible complications that would arise from untreated pressure ulcers?

Priority Decision

In this scenario, present collaborative problems include impaired tissue perfusion, risk of pressure ulcer infection, and risk of continued skin breakdown due to immobility. Improving tissue perfusion requires the skin to be kept dry and clean by the use of odourless skin cleaners and the regular application of a simple layer. Pressure ulcer infection should be managed by administering antibiotics as prophylaxis (Zaidi & Sharma, 2022). Continued skin breakdown can be prevented by continuous remobilization that prevents prolonged pressure to bony eminences and other susceptible areas (Al Aboud & Manna, 2022). Addressing these issues would require coordinated collaboration between healthcare professionals.

Critical Thinking Test Question

Taking into consideration the patient’s immobility nature, what interventions could the nurses implement to ensure sufficient skin perfusion and prevent additional pressure ulcer development?

References

Al Aboud, A. M., & Manna, B. (2022). Wound Pressure Injury Management. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532897/#:~:text=Pressure%20ulcers%20are%20caused%20by

Zaidi, S. R. H., & Sharma, S. (2022, August 9). Pressure Ulcer. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553107/

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Below is an example of the Patent Case Study that should be derived from a patient you have cared for related to your PICO question. The rubric includes the 10 categories being filled out (see exemplar below) that need to relate to your patient. Use the referenced website to assist you with your categories, as well as previous resources from your coursework related to definitions of the categories.

Guideline Categories:

Use the following pattern as your Guideline Categories for your Patient Case Study Exemplar is based on Septic Shock Abbreviated, (Harding et al., 2020):

Patient Profile A.M. is an 81-year-old man who was brought to the emergency department (ED) via an ambulance from a local nursing home. He was found by the nurse on their 6:00 AM rounds to be very confused, restless, and hypotensive.
Past Medical History A.M. has type 1 diabetes and a history of prostate cancer, myocardial infarction, and heart failure. He has been a resident of the nursing home for 2 years. His wife had to place him because she could no longer take care of him at home. He has had an indwelling urinary catheter in place for 5 days because of difficulty voiding. Until today, A. M. has been well-oriented and cooperative. His current medications include metoprolol (Lopressor) lisinopril (Zestril) hydrochlorothiazide isosorbide (isordil) and insulin.
Subjective Data: Denise, any pain or discomfort (but the patient is confused, and this information may be unreliable)
Objective Data:
Neurologic: Lethargic, confused about place and time, easily aroused, does not follow commands; moves all extremities in response to stimuli
Cardiovascular: B/P 80/60; HR112 bpm and regular.; Temp 103 F (40 C) axillary; heart sounds normal without murmurs or S3, S4; peripheral pulses weak and thread
Skin: warm, dry, flushed
Respiratory: RR 34 and shallow; breath sounds audible in all lobes with crackles bilaterally in the bases
GI/GU: Abdomen soft with hypoactive bowel sounds; urinary catheter in place draining scant, purulent urine
Interprofessional Care
In the ED, 2 16-gauge IVs were inserted, and 700 ml of normal saline was given over the first hour. The patient was placed on 40% oxygen, via a face mask. The patient was started on IV antibiotics and transferred to the intensive care unit (ICU) with a diagnosis of septic shock resulting from gram-negative sepsis.

Laboratory Data
Outcome Status
A.M.’s BP continued to drop despite several litres of crystalloids. In addition to more fluid administration, norepinephrine was started and titrated up as needed to try to maintain the patient’s BP. Despite all efforts, including intubation and mechanical ventilation, A.m., Died on the sixth hospital day. The cause of death was MODS caused by gram=negative sepsis.

Develop at least 3 critical questions that relate to your patient cases study. Below are some examples of critical thinking questions.
What risk factors for septic shock were present in A.M>?
What preventive measures could have been taken by the nursing home staff in regard to A.M.?
What are the major pathophysiological changes associated with sepsis?
Discuss the mechanism for hypotension in the patient with septic shock.
Explain the causes for assessment findings in this patient and any nursing interventions that can improve the patient’s condition.
What are the overall goals for this patient on admission?
Why was a pulmonary artery catheter indicated for A.M.?
Analyze the results of the ABGs.
Describe the changes in the hemodynamic pressure that would be expected as A.M.’s condition worsened.
Explain the reason for fluid therapy and the use of norepinephrine.
Priority Decision: …what collaborative problems are present? 299-300
Write one critical thinking test question related to your patient case study.