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Case Study
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In the pink Candy Kishman, LPN, Specialty Hospital of Lorain, Lorain, OH History: A 68-year-old man with diagnosis of chronic non-healing sacral ulcers x 4 months. Complex medical historyÑcongestive heart failure, severe generalized debility, chronic renal failure requiring hemodialysis, severe peripheal vascular disease with previous right leg bypass procedure zand left below knee amputation, history of recent severe anemia of unclear etilogy, hypertension with orthostatic hyppotension, coronary artery disease, status post-successful resuation of cardiopulmonary arrest, and daibetes mellitus with autonomic neuropathy. Hyperlypedemiaa, obesity, history of depression with psychotic features, and recent hyperkalemia Treatment: Treatment included IV antibiotics for infection, flagyl, and vancomycin. Trilaminate polyurethane hydrocellular foam. The patient was put on alternating pressure, low air loss mattress, 2-hour side to side turns, limiteds time up in chair.Dietary was consulted to increase protein. We started with a pre-albumin of 6, increased it to 24 in 3 weeks time. The wound was cleansed with normal saline solution. No-sting skin prep and pink foam sacral dressing applied, change every three days and as needed Outcome: The wound on admission measured 17.5x14.0 x 1.0cm.,moderate amount exudate. second week 12.5x12.0x0.8, yellow fibrous slough remains, 25% granulation.Moderate amount exudate. Week 3ÑThree seperate open areas, islands have formed inbetween. The areas measure 2.0x2.5, 8.0x3.0,3.5x3.0 depth in all areas 0.5, 50% granulation. Reepithelization appeared at this time. Week #4: one area 6.0x2.7x0.4. Week #5: 4.0x 2.0x0.2 depth, 90% granulation. Week #6: area closed. Patient discharged after 6 weeks of treatment. The wound was closed with mild erythemia remaining. Patient/caregiver education included nutrition. and wound healing, skin care, frequent repositioning and support surfaces. |
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