Alex is an 84 year old single male, 180cm tall weighing 75kg, who has been socially isolated. He has not been to see his GP for over 5 years so is not taking any medication. He has been reasonably fit for most of his life but has a history of varicose veins and DVT 25 years ago.
He has presented for care of a wound on the gaiter region of the right leg.
Alex reported that ‘the sore just happened after the dog scratched him’ bout 6 months ago and that he has been covering it with zinc cream and gauze.
You are required to assess Alex for wound management. The wound is a venous ulcer
Discuss the following problems and write a nursing diagnosis for each using the NANDA nursing diagnosis format.
Weight to height ratio – nutrition
Venous disease – venous ulcer
Other that a registered nurse (who may be a community nurse), who else would you consult when planning for Alex. State your rational…
Using the information from case history for Alex and visual assessment of photo 27 discuss the criteria to be used in developing a wound management care plan for Alex. Base your care in the principles of moist wound management and evidence based practice for care of venous ulcers. The ulcer is NOT infected. Include rational for product choice and frequency of care.
How would you engage with Alex for him to be a partner in planning his care and instigating the care of a venous ulcer?