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Wound Care Patient Case Studies

Executive Summary

Incorrect wound care treatment can result in an increased economic impact on the healthcare system and significantly affect the health of a patient. Here are a few selected case studies that indicate the effects of wound care on the patient.

For more information see the following article: Wound Care Overview

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Patient story 1: 

  • Patients with erythematous skin are likely to receive a diagnosis of cellulitis; however, the accuracy of this diagnosis is approximately only 33%. A 50-year-old man was admitted to a general hospital with the diagnosis of cellulitis. He was initially treated with systemic antibiotics without improvement. Following consultation with a wound management physician, the patient received a diagnosis of a pretibial abscess and was treated with surgical evacuation and postoperative systemic antibiotic therapy guided by tissue cultures. (for more information: Looking Beyond the Cell in Cellulitis)

 

Patient story 2:

  • A 95 year old patient went through four different hospitals in the Toronto area for other medical reasons. The wound was not assessed by a physician but was managed by a number of wound nurses, who applied a variety of different wound care products. The patient was referred to my clinic by her family doctor for a pressure ulcer. When I assessed her the location was wrong, none of the lesions resided over a bony prominence. I biopsied it and squamous cell cancer was diagnosed. This patient died four weeks later. 

 

Patient story 3:

  • In a study, non-healing leg ulcers and the nurse-patient relationship. Part 1 and Part 2, the perspective of patients living with a wound was contrasted with that of the treating nurses. The patients themselves expressed that there seemed to be little insight into the complexities of living with leg ulceration. They wanted to feel that they mattered, and to have their suffering eased by a sensitive collaboration with their clinicians. From the nurse perspective, their expectations were that patients would follow their instruction, be positive and participate and that healing was a priority of care. If the patients endeavored to self-manage, they were considered ‘difficult’ or ‘uncooperative’. This study demonstrates a real mismatch between the rights and needs of patients living with delayed healing wounds compared to the perception of the clinicians. 

 

Patient story 4:

  • In a hypothetical case study, Jack is a 66-year-old community-dwelling male receiving care in a short-term acute care hospital after being hit by a car. His other comorbidities include hypertension, type 2 diabetes, coronary artery disease, and chronic obstructive pulmonary disease. After 6 weeks he was transferred to a transitional care center (TCC). Due to COPD exacerbation and hypoglycemia, he is transferred back to the short-term acute care hospital. While his surgical wound continues to be dressed there has not been much progress. Once his comorbidities are under control he is transferred to a transitional care hospital for wound care and medical management. Due to a positive stool culture for Carbapenem-Resistant Enterobacteriaceae (CRE) that was taken before discharge, he is transferred back to acute care for infection control. Once the infection is under control through the use of IV antibiotics and the wound is nearly closed the patient is sent home with his wife, a home care nurse, and home health. At home, the patient is refusing medications and is yelling at his wife when she tried to help with ADLs. (for more information: Jack's Care Transition Story)

 

Patient story 5:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • A qualitative study used the grounded theory method to investigate district nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centers in Stockholm, Sweden. Group interviews were conducted with 30 nurses. The results describe how district nurses strive to stay on track in order to follow clinical guidelines and remain motivated despite prolonged wound treatment and feelings of hopelessness. Three main obstacles to following the guidelines were found. District nurses used compensating strategies so the obstacles would not lead to negative consequences. If the compensating strategies were insufficient, perceived prolonged wound treatment and feelings of hopelessness could result. District nurses then used motivating strategies to overcome these feelings of hopelessness. Sometimes, despite the motivating strategies, treatment in accordance with guidelines could not be achieved. With some patients, district nurses had to compromise and follow the guidelines as far as possible (for more information: ​District nurses' experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study )