|Medical Diagnosis:Decubitus ulcers(15 yr. old disabled/bed-bound, epileptic patient, who suffered neglect from parent)|
|Pathophysiology: Decubitus ulcers, also known as pressure ulcers, are usually caused by inappropriate blood supply that results in interruptions of blood circulations, hypoxic tissue damage, and even necrosis (Liao, Burns, & Jan, 2013). The main factors that may contribute the development of this disease include pressure when contact surfaces and bony prominences are compressed, moisture caused by poor hygiene, shearing forces that are caused by wrong placement, and friction when something rubs the body (Garcia-Fernandez, Agreda, Verdu, & Pancorbo-Hidalgo, 2014). |
Etiology: One of the main risk factors is decreased mobility that may be caused by various situations, including spinal cord injuries, bed-bounding, sedation, or some cognitive impairment. Usually, people above 65 years are under a threat. Still, this disease can be a problem for people of different age due to such factors as neglect, poor hygiene, and even laziness. Poor nutrition and hydration should be mentioned because if a person does not get enough protein and calories, the development of pressure ulcers is possible (Beeckman, van Lancker, van Hecke, & Verhaeghe, 2014; Garcia-Fernandez et al., 2014).
Signs/Symptoms (Clinical Manifestations): Unusual changes in the color of skin or a new texture of skin should be identified as the main symptoms of decubitus ulcers. Swelling and tender areas are important. Temperature change can occur. In general, possible signs of decubitus ulcers are change of skin color, infections, pain, no reactions to touch, and soft skin.
Medical/Nursing Intervention: As soon as decubitus ulcers is diagnosed, it is necessary to provide the patient with appropriate treatment and care. In this case, the development of the disease is caused by parental neglect and the inability to provide a patient with care. So, preventive steps are not effective. Therefore, it is necessary to develop a plan with the help of which the already made mistakes and omissions can be improved. First, it is necessary to define the stage of the disease. The next step is the reduction of pressure. The patient has to be properly located on a mattress or a specially equipped bed. Then, it is obligatory to clean a wound (or wounds), remove damage, eliminate infections, and put a bandage (if appropriate). Drugs to control pain or prevent infection can be used.
Prognosis: Pain should be reduced. Wounds have to drag on. The patient is expected to feel comfort and enjoyment lying on a bed. Follow-ups and cooperation with physicians are obligatory.
|Nursing Diagnosis: Ineffective Individual Coping|
|Nursing interventions:||Expected outcomes:|
|1. The nurse will assist the patient with a promotion of hygiene and appropriate living conditions that have been damaged due to parental neglect. It is necessary to assess the patient’s ability to move and desire to eat healthy food, be cleaned, and be properly treated.||1. The patient should share all important personal information and support the idea of contact with a nurse to choose a healthy diet, a high-quality care, and movements with the help of which it is possible to observe some changes in 1-2 weeks.|
|2. The nurse will talk to the patient’s parents in order to discuss the conditions under which the patient has to live every day. Regular care, treatment, communication, and support are required for the patient, and family members are the best sources of such type of support.||2. It is expected to improve communication with the patient family in 3-4 days. Parents have to learn how to take care of the child and spend much time with the patient. In one week, certain improvements in the relations between the patient and their parents and care provision can be obtained.|
Beeckman, D., van Lancker, A., van Hecke, A., & Verhaeghe, S. (2014). A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Research in Nursing & Health, 37(3), 204-218.
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Garcia-Fernandez, F.P., Agreda, J.J.S., Verdu, J., & Pancorbo-Hidalgo, P.L. (2014). A new theoretical model for the development of pressure ulcers and other dependence-related lesions. Journal of Nursing Scholarship, 46(1), 28-38.
Liao, F., Burns, S., & Jan, Y.K. (2013). Skin blood flow dynamics and its role in pressure ulcers. Journal of Tissue Viability, 22(2), 25-36.