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Case Study
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Traumatic right leg ulcer and the use of polymeric membrane dressings Janis Harrison, CWCN, COCN, Pender Community Hospital, Pender, NE Clinical Problem: An 80-year-old woman presents with a right leg trauma wound on December 14. She fell at home and bumped her right leg on a cupboard door. Patient complained of difficulty walking. A wound culture was obtained with negative results. The patient has a history of atrial fibrillation, diabetes mellitus, hypertension, cardiovascular accident and hypercholesterolemia. She was diagnosed with a severe hematoma and cellulitis to the right leg. Her nutritional status was good and included a multivitamin daily. Patient was transferred to a long term care facility on December 16th with orders to include oral antibiotics. The wound measured 5.7 cm x 8.5 cm with 80% eschar and 15% yellow slough tissue and 5% pink granulation tissue. The patient was followed in the outpatient wound clinic for a non-healing wound on January 31. A wound care nurse was consulted for wound care.Past wound care management included an antimicrobial cream to the right leg ulcer and whirlpool treatments. These treatments showed no signs of improvement. Current Clinical Approach: Patient continued on oral antibiotic therapy, conservative surgical debridement along with enzymatic debridement agent and polymeric membrane dressing used as a primary and secondary dressing that was changed daily. Compression therapy was added to the treatment to decrease leg edema. Patient Outcome: The wound was healed within 4 months of initiation of polymeric membrane dressings. Conclusion: Polymeric membrane dressings are an excellent type to use as a primary and/or secondary dressing from initiation to wound closure. Cutting KF, White RJ. Criteria for identifying wound infectionÑrevisited. Ostomy Wound Manage. 2005;51(1):28Ð34 Evans E. Nutritional assessment in chronic wound care. JWOCN. 2005;32(5):317Ð320 Lorimer K, Harrison M, Graham I, Friedberg E, Davies B. Venous leg ulcer care: how evidence-based is nursing practice? JWOCN. 2003;30(3):132Ð142 Banks V, Bale S, Hardening K, Harding EF. Evaluation of a new polyurethane foam dressing. J Wound Care. 1997;6:266. |
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