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CONNECTIVE ISSUES 2014 Pressure Injury Case Study

CONNECTIVE ISSUES 2014 Pressure Injury Case Study. Outline. Medical History Social History Patient Assessment Lower Limb Assessment Factor affecting healing and goals setting Progress of the wound and reviewing goals What I learnt from this case. Medical History. Mario*: 65 year old man

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CONNECTIVE ISSUES 2014 Pressure Injury Case Study

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  1. CONNECTIVE ISSUES 2014Pressure Injury Case Study

  2. Outline • Medical History • Social History • Patient Assessment • Lower Limb Assessment • Factor affecting healing and goals setting • Progress of the wound and reviewing goals • What I learnt from this case

  3. Medical History • Mario*: 65 year old man • Coronary artery disease • Bisoprolol, Frusid, Astrix • Coronary Artery Bypass Graft (August 2010) • Depression • Endep • Hypertension, Hyperlidaemia • Coversyl, Liptor • Type 2 Diabetes (10 year duration) • HbA1C 8.1% • Diabex • Other

  4. Psychosocial environment • Low mood • Home supports • Retired, lives with supportive wife • Access to services • Metro area, close to hospital • Community Bus

  5. Patient Assessment • Mobility • Nutrition • Pain • 4/10 VAS in wound, intermittent, background • Severe right calf pain when walking +30 seconds

  6. Wound History • 3 week duration • During hospital stay post CABG surgery • “Clear gel” dressing in situ

  7. Lower limb assessment:Peripheral Arterial • Intermittent claudication at 10 metres • Edinburgh Claudication Questionnaire (Leng, 1992) • Pedal pulses • Right – Absent Left – Normal • Audible doppler • Right – Monophasic with faint volume • Ankle Brachial Index • Right – 0.59 Left – 0.94 • Toe pressure • Right – 20mmHg Left – 100mmHg • Conclusion: Severe peripheral arterial disease (International Diabetes Federation (IDF), 2011; Marston et al. 2005; Norgren et al., 2007)

  8. Lower limb assessment • Peripheral neurological • 10g monofilament present • Footwear • Lace up runners

  9. Factors affecting healing and goal setting

  10. Heel pressure Image from: OAPL (2011)

  11. Peripheral Arterial Disease

  12. Hyperglycaemia

  13. Other Factors to Consider • Nutrition (Brown & Phillips, 2010) • Wound pain(Cole-King & Harding, 2001; Solowiej, Mason, & Upton, 2009, WHO 1990) • Psychosocial impact (Finestone, Alfeeli, & Fisher, 2008; Vileikyte, Rubin, & Leventhal, 2004) • Monitor contral-lateral side, risk of other pressure injurys(IDF, 2011; NPUAP, 2009) • Management of other co-morbidities (Nogren, et al. 2007) • Infection? (Lipsky, 2004)

  14. References Brown, K., & Phillips, T. (2010). Nutrition and wound healing. Clinics in Dermatology, 28(4), 432-439. doi: doi:10.1016/j.clindermatol.2010.03.028 Colagiuri, R., Girgis, S., Eigenmann, C., Gomez, M., & Griffiths, R. (2009). National evidenced based guideline for patient education in Type 2 Diabetes. Diabetes Australia and the NHMRC, Canberra. Retrieved from http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/di16-diabetes-patient-education.pdf Cole-King, A., & Harding, K. G. (2001). Psychological factors and delayed healing in chronic wounds. Psychosomatic Medicine, 63(2), 216-220. Retrieved from http://www.psychosomaticmedicine.org/content/63/2/216.full.pdf European Wound Management Association (EWMA). (2004). Position Document: Wound bed preparation in practice. Retrieved from http://www.ewma.org/english/position-documents.html Finestone, H. M., Alfeeli, A., & Fisher, W. A. (2008). Stress-induced physiologic changes as a basis for the biopsychosocial model of chronic musculoskeletal pain: a new theory? The Clinical Journal of Pain, 24(9), 767-765. doi: 10.1097/AJP.0b013e3181790342 International Diabetes Federation (IDF). (2011). International Consensus on the Diabetic Foot. Practical and Specific Guidelines on the Management and Prevention of the Diabetic Foot [DVD]. Leng, G. C., Fowkes, F.G. (1992). The Edinburgh Claudication Questionnaire: an improved version of the WHO / Rose Questionnaire for use in epidemiological surveys. Journal of Clinic Epidemiology, 45(10), 1101-1109. Lipsky, B. A. (2004). A report from the International Consensus on Diagnosing and Treating the Infected Diabetic Foot. Diabetes/Metabolism Research and Reviews, 20(Suppl 1), S68-77. doi: 10.1002/dmrr.453

  15. References Marston, W. A., Davies, S. W., Armstrong, B., Farber, M. A., Mendes, R. C., Fulton, J. J., . . . Hill, C. (2005). Natural history of limbs with arterial insufficiency and chronic ulceration treated without revascularization. Journal of Vascular Surgery, 44(1), 108-114. doi: 10.1016/j.jvs.2006.03.026 National Pressure Ulcer Advisory Panel (NPUAP). (2007). Pressure ulcer stages revised by NPUAP Retrieved from http://www.npuap.org./pr2.htm Norgren, L., Hiatt, W. R., Dormandy, J. A., Nehler, M. R., Harris, K. A., & Fowkes, K. F. R. (2007). Inter-society consensus for the management of peripheral arterial disease (TASC II). European Journal of Vascular and Endovascular Surgery, 33(S1), S1-S75. doi: 10.1016/j.ejvs.2006.09.024 OAPL. (2011) Retrieved from http://www.oapl.com.au/Orthopaedic&Bracing-Catalogue-Web.pdf Ohtani, T., Mizuashi, M., Ito, Y., & Aiba, S. (2007). Cadexomer as well as cadexomer iodine induces the production of proinflammatory cytokines and vascular endothelial growth factor by human macrophages. Experimental Dermatology, 16, 318-323. doi: 10.1111/j.1600-0625.2006.00532.x Schultz, G. S., Sibbald, R. G., Falanga, V., Ayello, E. A., Dowsett, C., Harding, K., . . . Vanscheidt, W. (2003). Wound bed preparation: A systematic approach to wound management. Journal of Wound Repair and Regeneration, 11(Suppl 1), 1-28. doi: 10.1046/j.1524-475X.11.s2.1.x Solowiej, K., Mason, V., & Upton, D. (2009). Review of the relationship between stress and wound healing: part 1. Journal of Wound Care, 18(9), 357-366. Retrieved from http://www.internurse.com.ezproxy.lib.monash.edu.au/ Sussman, G. (2007). Management of the wound environment with dressings and topical agents. In C. Sussman & B. Bates-Jensen (Eds.), Wound care. A collaborative practice manaual for health professionals (3rd ed., Vol. 250-167). Philadelphia: Lippincot Williams & Wilkins.

  16. References UK Prospective Diabetes Study Group. (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet, 352(9131), 837-853. Vileikyte, L., Rubin, R., & Leventhal, H. (2004). Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes/Metabolism Research and Reviews, 20 Suppl 1(1), S13-18. doi: 10.1002/dmrr.437 WHO. (1990). Cancer pain relief and palliative care. Retrieved from http://www.who.int/cancer/palliative/painladder/en/

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