Case Studies, Chapter 32, Skin Integrity and Wound Care

1. You are a nurse in a medical-surgical unit in a hospital caring for a 27-year-old

professional football player who underwent surgery to repair a compound

fracture of his femur. The surgery went smoothly and you are responsible for his

postoperative care after he returns from PACU. (Learning Objectives 1 and 2)

a. What is his skin’s role in preventing infection before surgery?

- It is the first line of defense in the human body. It is a barrier that

protects from external factors, preventing from infection.

b. Describe how you would expect his wound to heal.

- It would heal starting with hemostasis, inflammation, prolifertation,

and lastly maturation/remodeling.

c. Indicate factors that could affect the healing of his surgical wound.

- Nutrition, age, gender, race/ethnicity, home environment, obesity,

smoking/alcoholism.

d. For which complications would you monitor his wound?

- Infection, dehiscence, and bleeding

e. Outline signs and symptoms that might indicate his wound is infected. In

what time frame might they appear?

- Pain, fever, any drainage, especially slough/purulent, increased WBC.

2. You are a visiting nurse caring for a 32-year-old writer who became paraplegic

as a result of a motorcycle accident 1 year ago. He is recovering from a

subsequent depression; your visits are to monitor not only his emotional outlook

but also to encourage his hygienic self-care and offer strategies for his success.

He wears a leg bag and is incontinent of stool. You are monitoring a red spot on
his left buttock, which has progressed to a pressure injury in which

subcutaneous fat is visible. (Learning Objectives 3, 4, 5, and 6)

a. Outline the mechanisms that contributed to the development of the

pressure injury.

- Depression related to traumatic experience, immbolity, incontinence.

b. What specific assessments should be performed to prevent formation of

pressure injuries?

- Focused assessment and Braden scale, for any administered

medications, a time-lasped assessment is necessary.

c. How would you stage his pressure injury?

- I would stage this injury as a stage III pressure ulcer.

d. Indicate the information that would be included in an assessment of his

wound.

- COCA, time/date, any pain indicated by the patient, size, any warmth,

swelling, patient tolerance

e. Identify appropriate outcomes for this patient’s care plan.

- Help with depression, offer appropriate resources like therapist,

mediation to relax, etc.

- Educate on proper nutrition, positioning, wound care

- Wound healing and prevention of ulcer.