1. Patient Assessment
1.1. Physical factors
1.1.1. Fast food diet
1.1.1.1. Impact: May lead to lack of nutrients being absorbed by bloodstream and supplied to wound sites to help timely healing
1.1.1.1.1. Goals of treatment: Encourage and inform Doris a healthy meal delivery service so she is recieving adequate nutrition and lower BMI
1.1.2. History of Hypertension, CCF, COPD
1.1.2.1. Impact: reducing blood supply to wound sites and reduced oxygen intake and therefore reduced oxygen to wound site which affects healing
1.1.2.1.1. Goals of treatment: Encourage lifestyle changes by reducing fast food diet, lack of exercise, smoking to improve symptoms and conditions contributing to poor health and prolonging of wound healing
1.1.3. BMI of 27.5 overweight
1.1.3.1. Impact: Put pressure on her right heel ulcer when upright and sacral wound when sitting and she's reported sitting is uncomfortable
1.1.3.1.1. Goals of treatment: Encourage and inform her to return to bowls and incorporate light exercise into her routine for optimum recovery
1.1.4. Heavy smoker
1.1.4.1. Impact: History of COPD and contributing to high respiratory rate, low blood oxygen saturation
1.1.4.1.1. Goals of treatment: Inform Doris the impacts smoking is having on her health and promote all the reasons to consider quitting
1.2. Psychosocial factors
1.2.1. Doris lives alone - widow of 8 years, she sees her adult children and cares for her grandchildren twice a week, she doesn't have in home support or care
1.2.1.1. Impact: Hinder or prolong healing as her children who are supposed to help with wound dressing may not be there when necessary to change wound dressings
1.2.1.1.1. Goals of treatment: Involve her children in her healing plan to stick to the wound dressing changes so she feels supported and can heal as quickly as possible without further complications or infection
1.2.2. Anxiety surrounding wounds
1.2.2.1. Impact: Mental health decline and stop her from participating in things outside of her home and with family, friends and in her community
1.2.2.1.1. Goals of treatment: Encourage Doris to continue to engage in small activities and ssocisl intersction to prove to herself she can still do things while her wounds are healing and this will improve her confidence and ease anxiety
1.2.3. Limiting her contact with friends, no longer participating in monthly community lawn bowls
1.2.3.1. Impact: Loss of connection and social interaction can lower immune response and quality of life impacting mental health and possibly contribute to her anxiety
1.2.3.1.1. Goals of treatment: Encourage Doris to contact friends via phone when she can't see them to ensure she's not losing her social connections and sense of belonging
2. Wound Assessment
2.1. Sacral Wound
2.1.1. Stage 2; healing towards stage 1
2.1.2. Pressure Ulcer
2.1.3. Pink wound bed no slough, has blood flow and is viable
2.1.4. Localised pinkness indicates healing, no signs of infection at wound site
2.1.5. Small amount of serous exudate
2.1.6. Surrounding skin is mildly macerated
2.2. Right Heel Wound
2.2.1. Stage 2
2.2.1.1. Anti-microbrial dressing
2.2.2. Neuropathic Foot Ulcer from diabetes
2.2.2.1. Wear medical grade footwear to prevent future ulcers occurring
2.2.3. Mixed red and yellow wound bed, partially viable, contains granulation and slough tissues
2.2.3.1. Remove non-viable tissue
2.2.4. Localised inflammation and redness signals no infection yet
2.2.5. Haemaserous exudate
2.2.6. Demarcated edges
2.2.7. Surrounding skin is intensely maceracted
2.2.7.1. Avoid soaking feet