Patient History
A patient is a 75-year-old man who admitted to an emergency department with pain on his hip. After the death of his wife (three years ago), he lives alone. He has two children who live separately and does not want to bother them with his problems. During the last two months, the man did not leave the house because of weather conditions and a fear to slip and get a trauma. His children bought food and other products as per his request. As soon as the weather got better, he decided to go shopping but felt pain in the right hip area. Due to his 20-year-old diabetes history, he visited a hospital.
Wound Etiology
Both hips of the patient were under constant pressure due to lying in bed or sitting on the couch for the last two months, with short walking rounds around the house. Older adults with limited mobility are at high risk of having bedsores.1 The pressure prevents the normal blood supply to a damaged area of skin, and tissue can no longer be healthy. There is a threat that bacteria could infect the wound due to the developed ulcer. Pressure from the bed and the couch are the hard surface causes of the wound in this case.
Wound Size and Measurement
The measurement of the skin wound is required to provide healthcare workers with an opportunity to record and monitor the ulcer area. Diabetic ulcers are well-demarcated, and the margins of the wound could be easily identified.1 A transparent grid and a photo of the wound were the tools to measure the wound size (5 cm x 3 cm on the left part of the right hip). The presence of the non-blanchable erythema proves Stage 1 of pressure ulcer.
Condition of the Periwound Area
The periwound area usually includes about 4cm around the wound. The general look of the area is dry, clean, and intact. No unpleasant odor is noted, but slight redness around talks about the intention of the patient to scratch it from time to time. There is no need to create a barrier between the wound and the periwound area, but the size has to be monitored.
Debridement Techniques
Debridement technique plays an important role in healing pressure ulcers. It includes the removal of dead tissue by means of various mechanical, biological, enzymatic, and surgical techniques.2 Mechanical debridement was used as the removal of unhealthy tissues in this way to prevent the damage of healthy/new tissues.
Lavaging Agents
Due to the bedsore stage (one) and the lack of serious complications, no lavaging interventions were applied to this case. This technique includes the necessity to remove chemical stimulants and the sources of infection by means of hydraulic pressure. In the diabetic patient, the debridement technique brought positive results.
Dressing
The wet-to-dry dressing is an obligatory part of the chosen debridement method. Hydrocolloid dressing is used to treat patients, promote flexibility and body motions, and provide a moist environment.2 The man could walk, and the removal of the dressing is painful as the substance does not stick to the wound.
Special Testing and Considerations
Regarding the nature of the wound and the possibility to stabilize the patient’s condition, no significant considerations should be made in this case. However, the control of the skin condition is required, and the Pressure Ulcer Scale for Healing (PUSH) tool could help. In terms of this method, a nurse monitors the wound within regular intervals and makes notes about the length/width, exudate amount, and tissue type.
Conclusion
In general, the patient made the correct decision to ask for professional help as soon as he felt discomfort in the area he could not observe. Due to his desire to stay independent from his children and his diabetic history, it is normal that his skin problems had to be the concern of medical experts. The chosen mechanical debridement technique and dressing should help the patient to prevent complications and stabilize the damaged area.
References
- Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database Syst Rev. 2017.
- Jaul, E, Barron, J, Rosenzweig, JP, Manczel, J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr. 2018.