Caring Of Patients In Hospital Based On Case Of Patient Daisy

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Question :


You are required to use the case study 'Daisy' as the basis for this assessment. Your assignment should have an introduction, body, and conclusion with referencing as per the APA guidelines. Heading are appropriate if desired.


Q1: Outline the 2 types of wounds Daisy has (using the information in week 1) and discuss them in relation to the phases of wound healing. [approx 1000 words] [LO2, LO3]

Q2: Discuss the holistic management of these 2 wounds (using the information in week 1) making sure to mention both aseptic technique and interprofessional management. [approx 1000 words] [LO1-LO4 ]

Q3: Discuss the nursing care for Daisy's pressure ulcer that is developing in week 5 [approx 500 2 words]. [LO2-LO4]

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Answer :

Case Study of Daisy 


Patient centered care can be defined as  the practice in which  care of the patients as well as families of patients  in such a way that is valubale and meaningful to patient and family. It involves listen to them,  inform them and involve them in the care of the patients.(Grol et al., 2013). The following report will be analyzing the caring of patients in hospital based on a case study of a patient, Daisy. The patient, Daisy Warthen is a 72 year old person who has medical history of diabetes mellitus or the type 2 diabetes, which was under control until the last year with the help of strict diet and light exercise. At the time, she was prescribed Metformin that helped in controlling her blood glucose level. 

1. Skin Tear

Daisy has experienced a bad skin tear on her left knee and a leg ulcer on her left ankle. 

It is common injury that most of the people faces in their lives. Occurance of skin tears take place when the dermis begin to separate. People experience sharp pain in their body parts while they occur and might lead to infection if the wound remain untreated (Strazzieri-Pulido et al., 2015). Skin tear that people often experience are of different types, which can be analyzed by the condition of the wound. Category 1 refers to the tears that have not lost any of the tissues from the parts of the body of the patients and the wounds are often linear or flat (Baranoski, LeBlanc & Gloeckner, 2016). In category 2, the patient has lost a certain part of his or her tissues from the area that has been experiencing skin break. The wounds that are scant in nature generally have less than 25 percent of the loss of epidermal cells, while the moderate wounds have 25percent or more loss of the epidermal. The category 3 involves complete loss of tissues from the area of skin break and the entire flap is missing (Koyano et al., 2016).

In case of the patient, Daisy, she has experienced the category 2 skin break, with a measure 4 to 5 centimeters cut on her left knee. The wound due to skin break on her left knee is quite serious and bleeding. Even the sin cover has partly removed from the wound and the estimated loss of epidermal is more than 25 percent. The wound is not very deep as the bones on her leg are invisible. 

The following of certain precautions among the patients will help in the reduction of experiencing skin tears in the patients who are at risk and among those who are experiencing the symptoms of skin tears. Creating a safe environment for the patient, Daisy would prevent skin tear. The patient need to pad and protect the areas that are sensitive and might experience skin breaks, maintenance of the integrity of the skin by undergoing a continuous skin care treatment as well as proper nutritional and fluid intake and avoid the use of adhesive products on the skin especially while they are fragile. 

While providing treatment to the skin tear, the main goal is to prevent skin flap and  nearby tissues. The edges of the flap would be covering the wound and there must not be any kind of stretches that might cause more and infection. The wound should also be protected from further harm and infections (Holmes et al., 2013). 

Leg Ulcer

In the following case study, the patient, Daisy has been suffering from venous leg ulcer, which approximately measures 2x1.5 centimeters. The ulcer is on the left leg of the patient, the skin is darkened on the sides of the ulcers. Besides, the main part, there are two small ulcers which are developing on the same leg of the patient. The foot of the patient is also swelled up which is one of the symptoms of venous ulcers. 

A leg ulcer is a type of breakage in the skin on the leg of patients that allows air and microbes such as bacteria to get inside the underlying tissues (Ashby et al., 2014). This is usually caused due to a minor injury that results in breaking of the skin. In most of the people, this type of injury is healed up without much difficulty within a short span of time such as a week or two. However, when a patient experiences problem with the underlying tissues, the skin is not healed up by itself, increasing the size of the breakdown. This causes chronic leg ulcer. 

Leg ulcers are of different types that include aterial leg ulcers, which occur due to poor circulation of blood in the arteries. Diabetic leg ulcers are caused due to high blood sugar  and diabetes. The other types of leg ulcers include vasculitic leg ulcers that are related to chronic disorders of inflammation like lupus and rheumatoid arthritis. Traumatic leg ulcers are caused due to leg injury. Malignant leg ulcers are caused with the occurrence of tumor on the skin of the leg. 

Causes of Leg Ulcers

The diseases of the leg veins are common cause for the chronic leg ulcer leg. The disease of venous is the most comman cause that results in over 75% of the leg ulcers. The Venous Disease is caused by either due to dysfunctions of the veins of the legs in patients’ accounts for nearly 80 percent of leg ulcers or due to dysfunctions of the arteries of the legs in patients’ accounts for nearly 15 percent of leg ulcers. The other causes of leg ulcers includes dysfunction of the internal organs and the disease caused such as diabetes and rheumatoid arthritis and other certain rare conditions accounts for nearly 5 percent of the leg ulcers (Green et al., 2014). There are certain cases where two or more conditions are the result of such leg ulcers. 

Symptoms of leg ulcers 

The venous ulcers are usually open, have sores on the skin, are often painful, and take more than a month to heal. These ulcers are generally developed on the skin’s inner part of the leg mostly above the ankle (Agale, 2013). The venous leg ulcer is often affected to bacteria infection. The symptom of a leg ulcer that is infected includes a pain that is becoming worse, a unpleasant green discharge oozing from the ulcer, swelling of the skin surrounding the ulcer, redness  and a high fever in most of the patients. 

A patient suffering from the leg ulcers might also experience certain medical conditions such as oedema or swelling of the ankle, the skin might get dark and pale on the sides of the infection or ulcer, the skin surrounding the ulcer gets hardened that often makes the leg hard. The patient usually experiences a feeling of heaviness, pain and swelling in the leg, often the skin of the leg becomes red. 

Treatment of the Ulcer

Cleaning and dressing the ulcer

Removing the the dead tissues or debris from the surface of the ulcer followed by application of proper dressing (O’Meara et al., 2014). This is the best treatment of the ulcer to heal quickly. A non-sticky and simple dressing is applied for dressing of  ulcer. This is usually changed once in a week. Many people are able to manage the execution of cleaning,  dressing own wound under nurse’s supervision. 


To improve blood circulation within the vein of the legs of the patients and to treat the swelling of the legs, a firm compression bandage is generally applied over the leg that has been infected with the ulcer. The bandages are designed in such a way so that they are capable of squeezing the legs of the patients and allow the blood to flow to the upper parts if the body of the patients (Serena et al., 2014). Different kind  of bandages or elastic stockings used in the treatment of venous leg ulcers that are made in different layers. When the bandages are first applied on the unhealthy ulcer, the patient has to suffer a lot of pain. Generally, the bandages should be changed weekly while the dressing is being changed.

2. Management of Skin Tears 

The patient visits the hospital with a case of skin tear and gets a first aid treatment as reported by the minor injuries unit and pressure is applied on the wound as well as the leg is elevated so that the bleeding can be controlled, if the wound is not in a serious condition. The medical expert performs a complete analysis of the wound and checks the records of the patients. The patient receives treatment according to the conditions of the wound and certain treatment goals are set by these experts. After the examination of the wound is complete, the experts approximates the wound edge and if there are skin flap the wound is first covered by it and appropriate dressings are applied over it. Later the experts reassess the wound and find the changing conditions such as if the wound is healing quickly or taking a lot of time. The reassessment of the wound helps the medical experts further proceed with the adoption of other techniques such as surgeries in case the wound is taking more time to recover than expected.

Holistic Management for Leg Ulcer 

Holistic management of a patient refers to considering a patient as a complete individual, psychologically, socially, physically and spiritually in the management and [prevention of diseases. 

Pain Management 

The level of pain that is felt by a patient needs to be obeserved, monitored, documented on regular basis during the dressing change. It can be done through visual analogue scale which is very simple to use and highly objective system. Compression therapy might help in reducing the level of pain in the patient (Alavi et al., 2016). 


Mobility of the patient is very essential with the use of compression therapy as it helps in minimizing the complications of the surgery. It is most important to encourage the patients to be mobile. There are evidences that suggest hosiery kits are more favorable compared to bandages, as it does not restrict the mobility of the patient (Franks et al., 2016). The patients should be asked to walk, move their ankles and an appropriate compression system should be selected that will help the patients to wear their own footwear and remain active as far as possible. 


Nutrition has a significant  role to prevent and treatment of the venous leg ulcer. Patient’s wieght might be an issue as malnutrition causes delay and complications in the process of healing of the wounds (Partsch, 2014). Consumption of healthy and balanced diet followed by maintenance of suitable weight helps in the reduction in the risk of development of several conditions that inclines a person towards ulcers as well as encourage in the process of healing in the patients who are suffering from such wounds. 

Aseptic technique 

Bacteria and other such microorganisms are fond everywhere and some of them are good for people whole others cause severe harm to the body. These harmful microorganisms are known as pathogens. In order to protect the patients from such harmful microbes, pathogens and bacteria while carrying out certain medical procedures, the medical experts- doctors, nurses and others use aseptic technique. Aseptic technique means using certain practices and procedures in order to prevent the patients from the contamination of pathogens. It involves application of most strict rules and minimizing the risk of infection. The health care providers use this particular technique in the operation theatres, outpatient care centers, clinics as well as in other healthcare settings (Gillespie et al., 2014). 

Use of Aseptic technique

In order to prevent the spread of pathogens into the wounds of the patients, the healthcare experts use the aseptic technique while they are handling the equipments needed in the surgical process, insertion of chest tube, urinary catheter, central intravenous (IV) or arterial lines as well as various drainage equipments. The medica practioners also use aseptic technique while they are performing dialysis, surgical techniques and assessing and dressing the wounds of the patients (Lo et al., 2014). 

3. Pressure Ulcers 

Pressure ulcers are also known as decubitus ulcers, pressure sores.  Bedsores are now referred as pressure injuries or localized damage that are caused to the skin and to the surrounding tissue that occurs over a area that consists of bones. This is mainly caused due to application of pressure along with friction in that particular area of the body of the patient. The most common areas of where these ulcers occur over the skin that overlies the areas of heels, sacrum, coccyx and the hips of the patient’s body (Demarré et al., 2015). Other areas of the body where these ulcers are quite visible are in the elbows and back part of the shoulders.  These ulcers occur due to the application of pressure that are applied to the soft tissues that further results in partial or complete obstruction in the flow of blood in the body of the patients . 

Treatment of Pressure Ulcers

The prominent treatment options for pressure ulcers generally include change in the position of the patient regularly or use of special mattresses in order to reduce or relive the pressure. The patients can also be provided with dressings to help in the process of healing. In certain cases, surgery of the part of the body is also required.

Changing position

Movement and changing of the position regularly helps in relieving the pressure on the ulcers that have already developed as well as helps in the prevention in the development of new ulcers. After the assessment of the risk factors in a patient of the development of the ulcers, a schedule of repositioning is developed (Levine et al., 2013) This schedule will state how often the patient needs to be repositioned. 

Mattresses and Cushions 

The patient who is having high chances of developing pressure ulcers or is having a minor ulcer specially designed static foam or dynamic mattress is recommended for use. The patient with more serious ulcer requires a movable mattress or bed system like those mattresses that are connected to a pump and delivers constant flow of air into it. There are foam and pressure redistributing cushions that help in distributing the pressure f the body of the patient.


Special dressing processes are used in the protection of the pressure ulcers and speeds up the recovery process in the patients. These dressings include- alginate dressings and hydrocolloid dressings. The dressing equipments of alginate dressings are made from seaweeds and contains high amount of calcium and sodium for the speedy healing. The hydrocolloid dressings  has a special gel technique to encourages the new cell growth in the parts of the body that has been affected with ulcers while it keeps the surrounding skin dry and healthy. Other dressing types include the use of foams, films, gel fibers or hydro fibers, gels and antimicrobial or antibiotic dressings (GarcíaFernández et al., 2014). 


 The patient, Daisy Warthen was having second category of skin tear in which the chances of loss of tissue is moiré than 25 percent. The patient was also having a venous leg ulcer in the ankle of her lefty leg measuring 2x1.5 centimeters approximately. The patient had later developed pressure ulcers on her hips, which can be treated with the help of continuous movement and repositioning the patient, with the help of specially designed mattresses and cushions as well as with special dressings.