Case Background
The patient in question is a 57-year-old male who works as a truck driver. He has been diagnosed with cardiovascular peripheral arterial disease (PAD) and peripheral vascular disease (PVD), which are affecting his circulation and causing vascular wounds, specifically arterial wounds. These wounds are often difficult to heal due to poor blood flow to the affected area.
As a nurse, it is important to focus on managing the patient’s symptoms and preventing further complications. This may involve working with the patient to develop a treatment plan that includes medication, lifestyle changes, and wound care. The nurse should monitor the patient closely for any signs of infection and provide education on proper wound care to promote healing and prevent further damage. Thus, the nurse’s goal should be to improve the patient’s quality of life and help him manage his condition to avoid more serious health issues in the future.
Pathophysiology
The patient has been diagnosed with peripheral vascular disease (PVD) and peripheral arterial disease (PAD), which are both secondary to underlying cardiovascular problems, heart failure, and high cholesterol. These conditions can lead to poor circulation, resulting in symptoms such as pain or numbness in the legs, muscle weakness, and skin changes (Camm et al., 2018). The most common cause of PVD is atherosclerosis, which is the buildup of plaque inside the blood vessels.
History
The patient has a history of diabetes mellitus, end-stage renal disease, and cirrhosis, which can further complicate wound healing due to the disease process. The patient’s medical history and current health conditions may require ongoing treatment, including medication, lifestyle changes, and wound care to manage symptoms and prevent complications. The patient’s previous treatments include surgeries, such as vascular surgery to improve blood flow, and medication to manage underlying health conditions. As a nurse, it is important to have a comprehensive understanding of the patient’s medical history and current treatment plan to provide appropriate care and support.
Nursing Physical Assessment
The patient’s health stats are as follows: HgA1C level is 8.9, blood pressure is 156/88mmHg, and daily blood glucose levels are above 250mg/dL, indicating poor blood sugar control. Additionally, LDL levels are above 280, which is high and increases the risk for cardiovascular disease (Camm et al., 2018). Upon physical assessment, the diagnostic results showed monophasic flow in peripheral arteries, as well as monophasic venous flow. This signifies poor oxygen and carbon dioxide levels in the tissues, which can lead to complications such as non-healing wounds. As a nurse, it is important to monitor the patient’s vital signs closely and work with the healthcare team to develop a treatment plan to manage the patient’s health conditions and promote wound healing (NAM, 2021). This may include medication management, lifestyle changes such as diet and exercise, and wound care interventions.
Related Treatments
It is important to note that wounds are often difficult to heal in patients with existing conditions due to the disease process and compromised circulation. The patient is receiving medication management for these conditions. In addition, his wound care treatments are aimed at promoting healing and preventing infection and lifestyle modifications from improving overall health (Camm et al., 2018). Therefore, further analysis is necessary to supplement or alter the current treatment approaches to improve their effectiveness.
Nursing Diagnosis & Patient Goal
The main nursing diagnosis for this patient is impaired tissue integrity related to poor circulation and non-healing arterial wounds, which may be due to underlying health conditions such as diabetes, peripheral arterial disease, and peripheral vascular disease. The main problem for this patient is the risk of further tissue damage, infection, and reduced quality of life as a result of these wounds.
As a nurse, the goal is to promote wound healing, prevent further tissue damage, and enhance the patient’s overall quality of life (Camm et al., 2018). This can be accomplished through careful monitoring and management of the patient’s wounds, including dressings, debridement, and topical treatments. The nurse can provide education to the patient on wound care and lifestyle changes to manage underlying health conditions and improve overall health. Working alongside the healthcare team to create a personalized treatment approach, monitoring the patient’s response to treatment, and providing ongoing support and education are all critical in achieving the goal of promoting healing and improving overall health for this patient.
Nursing Interventions
As a nurse, I believe there are several interventions that could be implemented to promote wound healing and improve the overall quality of life for this patient. One important intervention was obtained through arterial and venous Ultrasound Doppler to bilateral lower extremities to rule out deep vein thrombosis (DVT) secondary to pain. This intervention was supported by the literature, with studies showing that ultrasound Doppler was an effective diagnostic tool for DVT and could help guide treatment decisions (Ibrahim & Tahtabasi, 2020). This was important because DVT could lead to complications such as pulmonary embolism, which could be life-threatening. Ultrasound Doppler was a non-invasive diagnostic test that could provide information on blood flow and identify potential issues such as DVT.
Another important intervention was to elevate the patient’s lower extremities at all times while in bed and as tolerated. This could assist in boosting circulation and minimizing swelling, which may play a role in wound healing. These measures were backed by research, with studies indicating that elevating the legs and utilizing heel protectors may aid in lowering the likelihood of pressure ulcers and improve wound healing (Davies, 2018). Thus, heel protectors, such as Prevalon boots, could be used to reduce the risk of pressure ulcers and protect the skin from further damage.
Wound care was an important nursing intervention for this patient and was performed according to MD orders. Depending on the type and severity of the wounds, the patient may have benefited from consultation with a wound specialist. Additionally, the patient was placed on a low-air loss mattress for wound management. This type of mattress could help reduce pressure on the wound and improve circulation, which could help promote healing. The studies show that wound care interventions, consultation with wound specialists, and vitamin supplementation could help improve wound healing and overall patient outcomes (Zinder et al., 2019). Therefore, vitamins were prescribed to support wound healing, including vitamin C and zinc.
Thus, by implementing these nursing interventions, the goal of promoting wound healing and enhancing this patient’s general well-being was achieved. These interventions were supported by the literature and could help reduce the risk of complications and improve patient outcomes (Camm et al., 2018). It was important for the nurse to collaborate with the healthcare team to develop an individualized treatment plan and provide ongoing support and education to the patient.
Evaluation
After implementing the nursing interventions, there were slight improvements in the patient’s condition. The ultrasound Doppler test ruled out DVT, which was a relief and reduced the risk of life-threatening complications such as pulmonary embolism. Elevating the patient’s lower extremities and using heel protectors helped to improve circulation and reduce swelling, contributing to better wound healing. The wound care was performed according to MD orders, and consultation with a wound specialist helped to manage the wounds. The low-air loss mattress and vitamin supplements played a role in promoting wound healing (Camm et al., 2018). While the improvements were not significant, they were still positive, and the nursing interventions helped to reduce the risk of complications and improve the patient’s overall quality of life. Ongoing support and education from the healthcare team will be essential in continuing to monitor the patient’s progress and adjusting the treatment plan as necessary.
Recommendations
Based on the patient’s medical history and current interventions, it is recommended that the patient continue with wound care for vascular or arterial wounds. This would involve cleansing the wound with normal saline, patting it dry, and applying collagen powder and hydrogel. The wound should then be covered with an ABD pad and secured with rolled stretch gauze daily for 14 days (Camm et al., 2018).
Additionally, the patient should continue taking vitamins to support wound healing and elevate the bilateral lower extremities as much as possible. It is recommended that the patient see a vascular surgeon for further evaluation and management of their peripheral vascular disease and peripheral arterial disease (Camm et al., 2018). The nurse should ensure that the patient is following the wound care regimen and has a follow-up appointment scheduled with the vascular surgeon (Camm et al., 2018). It is important to monitor the patient’s progress and communicate any changes or concerns with the healthcare team.
References
Camm, A. J., Luscher, T. F., Maurer, G., & Serruys, P. W. (2018). The ESC textbook of cardiovascular medicine (3rd ed.). Oxford University Press.
Davies, P. (2018). Preventing the development of heel pressure ulcers. Nursing Standard, 33(7), 69-76. Web.
Ibrahim, I. G., & Tahtabasi, M. (2020). Doppler ultrasound diagnosis of brachial artery injury due to blunt trauma: A case report. Radiology Case Reports, 15(8), 1207-1210. Web.
NAM. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity (1st ed.). National Academies Press.
Zinder, R., Cooley, R., Vlad, L. G., & Molnar, J. A. (2019). Vitamin A and wound healing. Nutrition in Clinical Practice, 34(6), 839-849. Web.