How to avoid pressure ulcers
Discuss the measures to avoiding pressure ulcers
Hello, I am [Insert student Name], Registered Nurse looking after Mr. Fred Boyle today. Mr. Boyle is a 75 year old male, date of birth 07/11/1945 with UR number SDC004. He has been admitted to the hospital due to abdominal pain associated with vomiting.
Mr. Boyle has been transferred from the Emergency Department to the ward. He has presented to the hospital for hydration and pain management due to the increased nausea and vomiting, decreased oral intake, and aches and pain to his back and legs. That is after the open laparotomy for bowel cancer. Currently, he has IV glucose 5% running at 125ml/hr. Morphine 2.5 mg for his pain and metoclopramide 10 mg for his abdominal discomfort.
Mr. Boyle had bowel resection done about 8 weeks ago through open laparotomy. He was then put on chemotherapy for the last two weeks. Due to anemia, he had blood transfused after surgery as the levels were very low at 60g/L. Unfortunately, a hemolytic transfusion reaction occurred, which led to cardiac arrest. Mr. Boyle needed basic support due to his outcome, but was able to recover and was discharged. For the last 15 years, he has suffered from COPD, Osteoarthritis, and Type 1 Diabetes Mellitus. To manage COPD, Mr. Boyle is on salbutamol inhaler. He manages the pain from Osteoarthritis by taking ibuprofen and paracetamol PRN. For his diabetes, the patient takes novorapid PRN (BGL>12) with meals. He lives alone since his wife is deceased and they had no children.
It is evident that Mr. Boyle is hypotensive considering his BP of 104/60. His oxygen level is 92% saturated on room air. His heart rate and temperature are both normal at 98 bpm and 37.4 degrees respectively. The bowel sounds are hyperactive, and the lung sounds are normal with equal air entry. BGL is 5.6 mmol/L. He has attempted to take sips of water, and has vomited 250 mls since arrival on the ward 60 minutes ago. The IDC output for the last hour is 50 mls. His current pain score is 5/10 in the lower back after the administration of analgesia. IV glucose is currently running. The patient is dehydrated as a result of electrolyte imbalance caused by vomiting. His declined mobility places him at risk of developing pressure ulcers.
Considering Mr. Boyle’s risk factors, it is important that his vitals are constantly monitored. The fluid input and output should be monitored to ensure that he is staying hydrated. Also, he should be kept on a strict fluid diet. His skin turgor should be monitored for any signs of irritation. To avoid pressure ulcers, pressure care should be offered constantly. To avoid the risk for falls, all necessary items should be kept within his reach. Water, an emesis bag, and even the call bell should right beside him. Pain assessment should be conducted every four hours. The PRN analgesia should be offered as needed. Since he has no close family to care for him, Mr. Boyle should be referred to social workers. His sister should be contacted for communication on his discharge.