Josephine Morrow – venous stasis ulcer

Next of kin: Daughter- Sandra Hughes
Situation: Mrs. Morrow is an obese, 80-year-old white female who developed a venous stasis ulcer on her right
medial malleolus while still living at home. She moved into our skilled nursing home care facility 3 days ago.
The current plan of care is focused on promoting wound healing, improving venous return, and preventing skin
breakdown.
Background: Mrs. Morrow has a past medical history of chronic obstructive pulmonary disease (COPD),
chronic venous insufficiency, and deep vein thrombosis (DVT). Peripheral arterial disease is ruled out by
duplex ultrasound. Her daughter had her admitted to this skilled nursing home care facility due to concern for
her safety with impaired mobility, an unhealthy diet, and inability to adequately care for herself at home.
Assessment: Mrs. Morrow is alert and oriented, but sometimes forgetful of recent events. Vital signs have been
within normal limits and are performed weekly. Results from yesterday’s labs are in the chart. She is on a
regular diet with nutritional supplement and has been eating the majority of her meals since admission. She
requires assistance with positioning in bed and assistance times 1 to get out of bed to the chair or ambulate.
Her gait is unsteady, and she is easily fatigued. Her Braden Scale score is 16, and her skin is intact except for
the venous stasis ulcer on the right medial malleolus. She has brown hyperpigmentation on both lower legs
with +2 edema. The venous stasis ulcer is covered with a hydrocolloid dressing, which is due to be changed. In
preparation for her dressing change, she was medicated for pain half an hour ago.
Recommendation: You should complete a basic assessment, review the labs, perform a wound assessment
and dressing change, and then reposition the patient to optimize venous return. Please provide patient
education on improving venous return to prevent further stasis ulcers, and continue compression therapy with
the use of elastic bandage and an antiembolism stocking.
Taylor, C., Lynn, P., Bartlett, J. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered
Care, 9th Edition.
Factors Affecting Skin Integrity, Chapter 32, pp. 1045-1047
Types of Wounds, Chapter 32, p. 1048, Table 32-1
Principles of Wound Healing, Chapter 32, p. 1049, Box 32-1
Factors Affecting Wound Healing, Chapter 32, pp. 1050-1052
Pressure Injury, Chapter 32, pp. 1053-1059
Wound Assessment; Pressure Injury Assessment, Chapter 32, pp. 1062-1066
Preventing Pressure Injury, Chapter 32, 1068-1070
Documentating Wound Care; Evaluating, Chapter 32, pp. 1082-1085
Diagnostics
Expert Clinical Content from Lippincott Advisor
Albumin level test Albumin level test
Prealbumin test Prealbumin test
Pharmacology
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Aspirin Aspirin
Acetaminophen Acetaminophen
Signs and Symptoms
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Edema (leg) Edema (leg)
Treatments
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Wound care (irrigation) Wound care (irrigation)
Wound care (pressure ulcer) Wound care (pressure ulcer)
Procedures
Expert Clinical Content from Lippincott Procedures
Antiembolism stocking application, knee-length Antiembolism stocking application, knee-length
Assessment differences in the older adult, long-term care Assessment differences in the older adult, long-term