Perfusion Case Study

Our Patient
John Smith- 76-year-old man currently in a wheelchair
His son, Dale, noticed a pressure ulcer on his sacral area. He

immediately brought him to the emergency room.

Upon arrival John seemed distressed and uneasy. He is complaining of
pain on his bottom and that he is tired of sitting in that darn
wheelchair.
After examining the patient, the nurse noticed swelling of the sacral
area, red-purple discoloration, partial thickness loss of the dermis,
excess moisture around the wound site, decreased skin turgor, and
delayed capillary refill. The ulcer was measured to be 3 inches.
The patients vital signs include: BP 128/86, Respirations 18 per minute,
HR 88 per minute, and Temp 99 degrees. The ulcer was assessed to be a
stage 2 ulcer using the Braden scale.
The nurse talked with the patient and found that he eats chips and
drinks soda everyday.

and Teaching Plan

Nursing Process

Assessment:
Subjective data:
Pain on bottom, tired of sitting in that darn
wheelchair

Objective data:
distressed and uneasy demeanor, swelling of the
ulcer on the sacral area, red-purple discoloration,
partial thickness loss of the dermis, excess
moisture, decreased skin turgor, delayed capillary
refill, 3 inch ulcer, BP 128/86, Resp 18, HR 88,
Temp 99 degrees

Diagnosis:

Impaired skin integrity r/t

impaired mobility AEB sacral
pain, swelling and red-purple
discoloration

Planning:
Goal: Repair skin integrity
Outcome: The patients pressure ulcer will decrease in size by

5mm in 3 days and will heal completely within 2 months with

the proper care.

Interventions:
Turn patient every 2 hours
Change dressing every 6 hours
Make sure that the patient can adequately get to the restroom
Clean the wound twice a day
Check the area every hour to make sure it is dry and clean
Apply Hydrogel prn

We will now teach the son how to perform these interventions

Teaching Strategies:
The education session will be an informal one-on-one

discussion with the patient and his son.

The nurse will quickly and discreetly evaluate the literacy level
of the patients son to determine the kinds of learning aids
that will best benefit the patient.
The son will be an active participant in this education session
to best facilitate learning.

Topics to teach the son:

Proper skin care, improved nutrition, and techniques to keep the
patient mobile
Purpose/Rationale:
Teach the son proper skin care for his father. This can reduce the

likelihood of infection leading to sepsis.

Improve nutrition. This can lead to a healthier lifestyle and
improved circulation of oxygen. Heinemann states, Nutritional
problems of various kinds can impair the supply of oxygen and
nutrients to peripheral tissue leading to skin breakdown (2010).
Increase the patients mobility. Teaching the patients son to turn
his father every two hours will improve circulation and lessen
the chance of acquiring a pressure ulcer in the future.

Teaching Goal #1
By the end of the day the patient and his son will be able to

identify factors that can cause pressure ulcers such as:

Improper skin care
Immobility
Nutritional deficit
Affective: son will understand the importance of taking care of his
fathers health along with the importance of turning and dress changing.
Psychomotor: they can name some factors that can affect the chance of
getting pressure ulcers.
Cognitive: provide with a website or pamphlet with a list of factors that
can be avoided to prevent pressure ulcers and to prevent sepsis.

Turning Schedule for Healthcare Providers

This is a turning clock that
HCPs use in the hospital or
nursing home environment.
Placing this chart
somewhere close to the
patient reminds each and
every one of his providers
to turn him frequently, and
which side to turn him on.

Teaching Goal #2
By the end of the day the patient and his son will be able to

identify the four stages of pressure ulcers

Cognitive: Provide a template or a reliable website to view images

and descriptions of the images.

Psychomotor: teach how to measure a pressure ulcer to
characterize the stage.
Affective: the son and patient will realize how severe the pressure
ulcers can get and how important it is to prevent them from
occurring or prevent it from progressing to further stages.

Teaching Goal #3
By the end of the day the son and the patient will know where

pressure ulcers occur

Cognitive: provide them with a visual, an image with the sites

that are more prone to developing pressure ulcers, especially with

someone who is sitting often in a wheelchair.
Psychomotor: they can distinguish all the sites to take care and
observe if there was to develop a pressure ulcer.
Affective: patient and son will know the areas that can occur so
they can check those areas more often to check for redness.

Most likely areas for pressure ulcers to occur

It is vital that patients with
compromised mobility and their
caregivers understand where
pressure ulcers are most likely to
occur. These areas should be
inspected often.

Materials Needed

Informational pamphlets will

be given to the patient and
his caregiver in order to
eliminate the occurrence of
any further ulcers and to
accelerate the healing of the
one he currently has.

The Braden Scale for

Predicting Pressure Sore Risk
should be given to the patient
and his caregivers so that
they may continue to assess
the skin and his risk of
developing more ulcers at
home.

Other Resources

The patient and his caregivers will

be given information about how to

find further reading on the web.
We will demonstrate several sites
with trustworthy information,
including The Mayo Clinic and
Patient Education Center.

Evaluation Plan:
To evaluate the effectiveness of our teaching plan we will use

return demonstration, group discussion, and a follow up visit.

By using return demonstration, we will ensure that the
patients son is confident and understands how to provide the
correct skin care for his father.
We will then use a group discussion period to allow the patient
and his son to ask any questions they may have regarding the
teaching plan.
We also must schedule a follow up visit to determine if the
pressure ulcer is healing adequately and has approximated.

Goals Met:
Goal met
Patients wound has decreased 5mm in size within 3 days. We
will set up a follow up appointment within two months to make
sure the wound has approximated and healed correctly.
Goal met
The patients son accurately demonstrated how to perform
dressing changes, causes of pressure ulcers, and interventions to
use for pressure ulcer reduction.

Summary Notes:
The patient and son were able to properly demonstrate skin

care on patient.
We addressed the appropriate frequency of turning and
cleaning, and both the patient and the son were able to repeat
the instructions.
The patient scheduled a follow up visit in two months.

All of the information presented today and more is available

at:
http://perfusioncasestudy.weebly.com/

References:
Anders, J., Heinemann, A., Leffmann, C., Leutenegger, M., Prfener, F., & von Renteln-Kruse,

W. (2010). Decubitus Ulcers: Pathophysiology and Primary Prevention. Deutsches rzteblatt

International, 107(21), 371382. http://doi.org/10.3238/arztebl.2010.0371
World Union of Wound Healing Societies.Principles of best practice: minimizing pain at

wound dressing-related procedures, a consensus document

Jarvis, Carolyn. Physical Examination and Health Assessment, 7th Edition. Pg 225.

Saunders, 2016. VitalBook file.