Chuck Tilley MS, ANP-BC, ACHPN, CWOCN. Skin Failure, Avoidable vs. Unavoidable Pressure Ulcers and Treatment Strategies: Are We Using Evidence-Based Practice?. Objectives.
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(Langemo & Brown,2005)
(Goode & Allman, 1989)
(Langemo & Brown, 2005)
(Langemo & Brown, 2005)
Case: 82yo female with a history of NIDDM, HTN, CKD Stage III,
HLD, Vascular Dementia and weight loss of 20lbs over 5
months admitted to a hospice residence with a L Trochanteric
Stage III pressure ulcer s/p 1 week stay at a local hospital for a
fall at home with surgical pinning of R hip
Advance Directives: DNR/DNI/DNH, HCA: husband, HCP states
she doesn’t want artificial nutrition/hydration:
no tube feeds, IV fluids/TPN
Functional: A & Ox1, bedbound, total care for all ADLs, incontinent
of B & B, eats 25-50% of most meals (NAS, NCS diet),
frequently spits out meds, egg crate mattress, uses adult
diapers and soap and water to manage incontinence
Pain: Moans and calls out with facial grimacing when
turned- especially onto R hip: turns self onto left
side where she appears comfortable
PE: Dry flaky skin, poor turgor, oral mucosa slightly
moist, cachectic, temporal wasting, observed
intermittently coughing after meals, incontinent
of urine Q2H, stools at
least twice daily
VS: 132/86 98-88-20
FS range: 244-288
BMI: 18. 1
Braden Score: 9
Labs: Albumin 2.0
Advance Directive: DNR/DNI/DNH
Diet: NCS, NAS Pureed consistency
Aspiration precautions, Nutrition consult
Activity: Bedrest, T & P Q2H
VS: Routine Weights: Weekly
Wound Care: Hydrocolloid L Hip Q72H
Meds: MVI 1 po daily, Zinc 220mg po daily, Vitamin
C 500mg po BID, Lisinopril 10mg po daily,
Metphormin 500mg po BID, Metoprolol 25mg
po BID, Tylenol 650mg po/PR Q6H PRN
Therapy: Swallow evaluation for diet recommendations
Orders (Day 19):
Wound Care: Hydrocolloid Q72H to both
Meds: Vitamin C 500mg po BID, MVI 1 po
daily, Zinc 225mg po daily, Augmentin
875mg po BID x10D, Roxanol 5mg
po/sl Q2H PRN pain/tachypnea/dyspnea
Diet: NPO except meds
Incontinence Care: Attends, soap and water
Oxygen: O2 2L NC humidified
Nutrition: Routine Vitamin C & Zinc supplementation
supplementation remains unproven”.
(Gray & Whitney, 2003; Gray, 2003)
administration of supplemental zinc will promote
healing of pressure ulcers. In fact, doses of zinc greater
than 40mg per day may effect copper levels with
Turning and positioning: Q2H
(Moore & Cowman, 2009; Pieper, 2007)
Dressing Selection: Hydrocolloids
and can aggravate wounds/IAD etc.
Support Surfaces: Egg Crate Mattress
Incontinence Care: Soap and Water/ Adult Diapers
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