Question

A 68-year-old female patient is admitted to your unit. The patient reports her wife died 3 months ago. She was her primary caregiver; the patient now lives alone. Her medical history includes severe osteoarthritis and diabetes. Because of the pain of her arthritis, the patient has a difficult time walking, performing ADL’s, and taking her medication. Your patient shares that she can’t always make it to the bathroom in time, and reports “I have a sore on my tailbone.”

Upon inspection of her coccyx, you note a large, crater-like wound. The adipose tissue is visible, and the skin surrounding the wound is nonblanchable.

How would you classify this patient’s level of incontinence?

What type of wound would this patient have?

What risk factors put this patient at risk for altered skin integrity?

Describe the nursing treatments you would provide to this patient.

Answer 1

1. In this case ,the patient is having functional incontinence which means medications or other health problems making it difficult to reach bathroom. Due to osteoarthritis , patient is unable to reach bathroom when she has the urge to urinate or defecate. The level of incontinence is severe means - severe urinary or fecal incontinence that require constant containment and all over protection, because the patient is having osteoarthritis and also is alone ,both the factors make it difficult for her to reach the bathroom hence , she has functional incontinence and she needs all over day protection.

2. According to the characteristics mentioned :-

- large crater like wound ,adipose tissue visible and skin surrounding the sound is non blanchable.

Patient has stage 3 pressure ulcer . In which there is full thickness tissue loss. Subcutaneous fat is visible ,but bone ,muscles or tendon are not exposed. Sloughs of tissue may be present but does not obscure the depth of tissue loss. Patient has developed bedsore due to immobility rated to osteoarthritis.

3. Risk factors for altered skin integrity are :-

- immobility due to osteoarthritis

- bed ridden due to pain , inflammation of joints symptoms of osteoarthritis

- altered ADL due to the sign and symptoms of osteoarthritis

- impaired compliance of medications due to loneliness and other psychological issues.

- Being alone in the house prone her to be bed ridden , development of pressure sores and impaired compliance to medicines.

4.Nursing intervention are :-

- Assessment of the vital signs including pain.

- Provide bed sore care which include :-

1. Two hourly position change of the patient.

2. Providing bedsore dressing using antiseptic

3. Increased intake of fluids and proteins for wound healing

4. Use of comfort devices to maintain the correct position

5. Providing perineal care after every defecation and urination.

6. Make sure the stripes of diaper are below the ulcer .

7. Avoiding moisture accumulation.

- Catheterization and use of diapers to avoid incontinence related to immobility.

- Teaching the patient range of motion exercises to avoid pressure sore and DVR like complications due to immobility.

- Providing emotional and psychological support to the patient and encouraging her to verbalise her concerns .

- Providing her details about the near by nursing homes ,and other support groups to reach out for help when ever required as the patient is alone in the house.

- Teaching the patient about the importance of medications and encouraging to maintain compliance and regular follow up visits .