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Case Study
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Interdisciplinary care of a patient with multiple sclerosis and complex pressure ulcers Janice Hon, O.T. Reg.(Ont.), Suzanne Lu, Ann Marie McLaren, James L. Mahoney, MD, FRCSC, FACS, Laura Teague, RN, MN, ACNP.. Patients with progressive multiple sclerosis are at risk of developing pressure ulcers due to a number of factors including motor deficits(resulting from ataxia, spasticity and limb contracture), poor nutritional status, lack of community support and equipment. A coordinated interdisciplinary approach is essential for the resolution of pressure ulcers Here we present 32-year-old woman with chronic progressive multiple sclerosis accompanied by severe flexion contractures bilaterally in the hips and knees, severe ataxia, poor nutritional status and suboptimal community support. The patient suffers from multiple pressure sores on ischial tuberosity (Stage IV), greater trochanter (Stage III) and foot (Stage IV) The treating team (general medicine) along with all members of the wound care team (Plastic surgeon, RN, OT and Chiropodists) and other consultative services including orthopedic surgery were involved in treating/managing the pressure ulcers. Interventions include: hospitalization for medical management, nutritional work up, occupational therapy to ensure proper pressure relief and positioning in bed and wheelchair, bilateral tendon releases and wound management (debridement, treatment of osteomyelitis, negative pressure therapy and dressings) Within 6 months, this multidisciplinary approach resulted in the resolution of all pressure ulcers. The patient is able to assume proper sitting posture in a manual tilt wheelchair, with a pressure relieving cushion. Upon 6-months follow up, the ischial tuberosity, greater trochanter and foot wounds remain closed This case reflects the positive impact of coordinated and focused interdisciplinary management.. Dolynchuk K, Keast D, Campbell K, et al. Best practices for the prevention and treatment of pressure ulcers. Ostomy Wound Manage. 2000;46(11):38Ð52 Sibbald RG, Williamson D, Orsted H, et al. Preparing the wound bed: debridement, bacterial balance, and moisture balance. Ostomy Wound Manage. 2000;46(11):14Ð35 Assessment and management of stage 1 to 4 pressure ulcers. Toronto, Canada: Registered NursesÕ Association of Ontario, 2002 Haher JN, Haher TR, DevlinVJ, Schwartz J. The release of flexion contractures as a prerequisite for the treatement of pressure sores in multiple sclerosis: a report of ten cases. Ann Plast Surg. 1983;11(3):246Ð249 Lerrelring J, Thompson AJ. Spasticity, ataxia and fatigue in multiples sclerosis. Baillieres Clin Neurol. 1997;6(3):429Ð445. . |
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