A 77 year old Italian gentleman has been admitted to hospital from a long-term facility with an ankle ulceration. The patient suffers from hypertension and type 2 diabetes. The patient speaks and understands very little English and no Maltese. At the facility he received different types of antibiotics with no result. Last evening, the nurse noticed that the wound was foul smelling and a wound culture was taken and sent. Patient was lethargic and febrile and he was referred to hospital.
• Remind the goals (student doing the exercise.
• Ask about the feeling during the exercise.
• What happened – describe what happened step by step (student)?
• What went well?
• Why specific decisions were made?
• How it should be done (ideas are generated by students, the tutor leads to the right conclusions)?
• What to do to make it better?
• Students’ questions.
• What do you remember from the exercise (each student says 1 item – preferably everyone should say something different?
• Point out step by step what the students’ behavior should look like – exemplary.
• Motivate students to think reflectively while deceiving strengths and correct paths.
I can demonstrate knowledge regarding head to toe assessment.
I can demonstrate knowledge regarding wound assessment and different treatment methods.
I can complete a head to toe assessment.
I can accuratley document patient assessments and mediations.
I can demonstrate proper therapeutic communication with the patient.
I can implement proper actions in patient’s care.
I can integrate resourceful teamwork in providing patient centred care.
I can understand the importance of proper communication techniques so that the patient understands the way forward with treatment.
Wound assessment and implementation of appropriate interventions
Guiseppe Valentino is a 77 year old Italian gentleman currently residing at a local long-term facility. For the past month he has developed an ulcer on his ankle after he bump it against the door. He received different multiple antibiotics that didn’t work. When the nurse was doing the dressing she noticed that the wound was not healing and it had a foul smell and he was referred to hospital.
Past medical history of the Patient: Hypertension and type 2 Diabetes Mellitus.
Medical History: Lisinopril 20mgs po daily
Metformin 500mgs po TDS
Current Treatment : Iv pump with 0.9% N/Saline running at 75mls/hr
Duoderm dressing on wound.
Vital observations: BP 188/98, P 108, RR 12, O2 sat 99%, T 38.2 C
Blood glucose: 18mmo/l
REFERENCES, MATERIALS FOR CLASSES
The scenario was prepared based on the content contained in the literature:
- Greatrex-White, S. and Moxey, H. (2013). Wound assessment tools and nurses’ needs: an evaluation study. International Wound Journal, 12(3), pp.293–301.
Li, W.W., Carter, M.J., Mashiach, E. and Guthrie, S.D. (2016). Vascular assessment of wound healing: a clinical review. International Wound Journal, 14(3), pp.460–469.
- Welsh, L. (2017). Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review. International Wound Journal, 15(1), pp.53–61.
- The student has knowledge on wound management and the use of wound management assessment tools.
- The student is familiar with different treatment and dressings to manage wounds in the elderly.
The scenario is a simulation of a 77 year old Italian gentleman admitted to hospital from a long-term facility with an ankle ulceration. The patient speaks and understands a little the English language. At the facility he received different types of antibiotics with no result. Last evening the wound was foul smelling and a wound culture was sent. Students should assesss the patient and implement appropriate interventions.
CURRENT CLINICAL CONDITION
Vitals: BP 188/98, P 108, RR 12, O2 sat 99%, T 38.2 C
Patient is very lethargic and can barley speak.
The student should assess through simple questions the cognitive capabilities of the patient and she can ask for an interpreter to help her do the patient’s assessment.