Nursing Case Study Assignment

Overview of the patient’s condition

The patient in the current case is Dr. Russel Dicken and he is an active VET doctor aged 91 years. Now recently he complained about wound infection, swelling, pain in right ankle and foot, right ankle edema. This has affected the patient's mobility and has led to the development of leg ulcers in the following. The pain score of the patient was recorded at 6 out of 10 which are higher than the medium pain. It has been identified that pain is continuous and the bleedings through ulcers and wounds are continuous which a major health issue is. Now there were arterial doppler tests conducted for the patients but nothing significant was detected in this test. Understanding past medical history of the patient it can be said that the patient has had Hypertension, PVD, left total hip replacement, right knee replacement, Atrial flutter, Atrial fibrillation, anxiety, depression, MRSA infection, wound infection, Ischemic wound disease, ulcers on leg and basal cell carcinoma glaucoma. The temperature record was 3.8 Fahrenheit, the BP was recorded at 130/60, Respiration was accounted at 18 and pulse was noted to be 80. The payment currently has medications that include Alphagen, Doxycycline, Ibuprofen/Codeine, Laxame, Nebivolol, Lyrica, Perindopril, Pradaxa. The diet followed by the patient is soft and thin in nature, the planet currently is assisted by 2 to mobilize and lives with his wife as well as has no smoking habits. The patient also has no allergy to any kind of food and medication. The wound is currently treated through 2nd day dressing. The type of wound identified in the patient is - serious, color is stated to be red and yellow, and heavy exudates surrounding skin is fragile, dry and scaly has been identified.

Describing the pathophysiology

Cellulitis is a common bacterial infection that causes swelling of bones and muscles and the skin becomes red. It is an acute case of bacterial infection that causes inflammation of the deep dermis and the  subcutaneous tissue which surrounds the dermis.  The following health problem is identified by the erythema, warmth, edema, and tenderness to palpation caused by the cytokine and neutrophil present (Raff & Kroshinsky, 2016).  Now in order to respond to such problems in pathophysiology there will be a requirement of applying cytokines and neutrophils over the skin region that are affected this leads to the epidermal response. This response includes the creation of antimicrobial peptides and polifiltration. It normally brings happiness in the lower legs which can be seen in the current case.  In order to understand the pathophysiology of cellulitis and leg ulcers it is important to understand the causes that leads to occurrence of Arterial Leg ulcers. It is seen that Arterial Leg ulcer is caused by decrease in arterial blood flow and tissue perfusion. It is important to understand that in his scenario there are three methodologies of pathophysiology that are involved and this include extramural strangulation, mural thickening or accretion and intramural restriction of blood flow (Weng et al. 2017). It is seen that normally foot ulcers occur majorly in diabetic patients although in the current case the patient is not diabetic and the ulcer is not caused due to the diabetic components. It is important to understand that all of these following pathophysiology measures help in  better the overall treatment provokes and acts as the bedrock of the medical treatment provided to the painter. It is critical to comprehend that in his situation there are three systems of pathophysiology that are included and this incorporate extramural strangulation, wall painting thickening or accumulation and intramural limitation of blood stream. It is seen that typically foot ulcers happen significantly in diabetic patients in spite of the fact that in the current case the patient isn't diabetic and the ulcer isn't caused because of the diabetic parts (Mihara et al. 2014). Understanding that these following pathophysiology measures help in better the general treatment incites and goes about as the bedrock of the clinical treatment given to the patient. It is to understand that an ideal management plan is determined for the pain suffered from leg ulcers with the help of early strategic and coordinated approach so that an appropriate medical process for treatment is followed in the operations of the firm.

Identifying and analyzing two nursing care priorities

Acknowledging the kind of issues that are being faced by the concerned 91 year old patient  as well as applying the reasoning cycle the two major nursing care priorities has been identified in this section of the study. Upon analysing the current patient situation the health issues and its related data the two actions upon which priority is required to be established have been identified which are as follows:

  • Wound Management due to recurrent leg ulcers

One of the major care priorities that is required to be taken in the current situation is to inculcate into an effective wound management plan for the cellulitis that is occurring upon the recurrence of the leg ulcers of the said patient. In order to control the bacterial infection it is important that a wound management plan is followed that would significantly control the recurrence of the leg ulcers and prevent the patient from suffering the associated issues of bacterial infection that develops as a result of the ulcers (Oh et al. 2014). Therefore by prioritizing care upon the effective management of wounds would result in better health outcomes of the said patient.

  • Pain management

Another major action that is required to be focused upon as per the reasoning cycle model is regarding the significant pain that is being faced by the 91 year old patient. Since from the patient observation phase as well cues collection stage of the model it could be observed that the pain score of the patient had been 6 out of score table 1-10 which is quite higher than the normal score rate (Stevens & Bryant, 2016). The pain issues of the patient should be prioritized by inclusion of a proper pain assessment and management plan.

Explaining of how health education on the selected priorities will be planned

Owing to the elderly age of the concerned patient it has become significantly important that the process of health education is planned taking into consideration the age factor. For the selected care priorities one of the convenient measures that could be taken for the health education of the elderly patient is communication . since providing any kind of training as a part of a health education strategy would not work as the patient is too old to carry out any kind of activities by himself (Strazzula et al. 2015). Therefore Health education via communication is the only way possible b y which the elderly patient could be educated about the care priorities. The patient has to be educated  regarding the wound management issues that require proper treatment and management only then the 91 year old patient would  be able to raise awareness regarding hides regular dressing as from the observation it could be observed that the patient at this age has been quite responsive. Therefore if he learns to communicate about the necessity of its wound being dressed regular the recurrence of leg ulcers could stop. In addition to this by relevant communicative methods the patient is required to be educated about the pain that he feels due to his pressure areas and wounds (Dalal et al. 2017). By communicating to the patient the reason behind the pain and the manner in which it is a priority one would be able to assess the moment he has to raise the alarm before the pain exceeds.

Explaining the pharmacokinetics of two medications that the patient takes

From the initial assessment of the patient it could be observed that the 91 year old patient has been on a number of medications. In this section of the study the two major medication whose pharmacokinetics would be discussed are as follows:


It is a racemic mixture of two isomers whose pharmacokinetic feature varies according to the phenotype of the metabolizer. The medication is majorly used to treat hypertension that is high blood pressure from which the patient has been suffering which is evident from the past medical history of the patient.. The overall absorption of the medicine is quite similar to that of an oral solution (Chlebicki & Oh, 2014). The plasma concentration is observed to reach 2 from 0.5 after a dosage of 15 mg in case the metabolizer is observed to be extensive. The kinetic profile of the drug is observed not to be interrupted in case of no food intake. It is a drug that is high protein bound approximately 98% to albumin and its half life concentration is observed to vary from 10 hours to 31 hours (Bruun et al. 2016).


It is a tetracycline drug that is usually taken to treat the bacterial infection which from the patient's initial assessment has been observed to suffer from. It is an antimicrobial drug that inhibits the protein synthesis by suppressing the growth of bacteria or by keeping them in a stationary phase of growth (Quirke et al. 2017).

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Bruun, T., Oppegaard, O., Kittang, B. R., Mylvaganam, H., Langeland, N., & Skrede, S. (2016, January). Etiology of cellulitis and clinical prediction of streptococcal disease: a prospective study. In Open forum infectious diseases (Vol. 3, No. 1, p. ofv181). Oxford University Press.

Chlebicki, M. P., & Oh, C. C. (2014). Recurrent cellulitis: risk factors, etiology, pathogenesis and treatment. Current infectious disease reports, 16(9), 422.

Dalal, A., Eskin?Schwartz, M., Mimouni, D., Ray, S., Days, W., Hodak, E., ... & Paul, M. (2017). Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database of Systematic Reviews, (6).

Mihara, M., Hara, H., Furniss, D., Narushima, M., Iida, T., Kikuchi, K., ... & Murai, N. (2014). Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema. British Journal of Surgery, 101(11), 1391-1396.

Oh, C. C., Ko, H. C. H., Lee, H. Y., Safdar, N., Maki, D. G., & Chlebicki, M. P. (2014). Antibiotic prophylaxis for preventing recurrent cellulitis: a systematic review and meta-analysis. Journal of Infection, 69(1), 26-34.

Quirke, M., Ayoub, F., McCabe, A., Boland, F., Smith, B., O'Sullivan, R., & Wakai, A. (2017). Risk factors for nonpurulent leg cellulitis: a systematic review and meta?analysis. British Journal of Dermatology, 177(2), 382-394.

Raff, A. B., & Kroshinsky, D. (2016). Cellulitis: a review. Jama, 316(3), 325-337.

Stevens, D. L., & Bryant, A. E. (2016). Impetigo, erysipelas and cellulitis. In Streptococcus Pyogenes: Basic Biology to Clinical Manifestations [Internet]. University of Oklahoma Health Sciences Center.

Strazzula, L., Cotliar, J., Fox, L. P., Hughey, L., Shinkai, K., Gee, S. N., & Kroshinsky, D. (2015). Inpatient dermatology consultation aids diagnosis of cellulitis among hospitalized patients: a multi-institutional analysis. Journal of the American Academy of Dermatology, 73(1), 70-75.

Weng, Q. Y., Raff, A. B., Cohen, J. M., Gunasekera, N., Okhovat, J. P., Vedak, P., ... & Mostaghimi, A. (2017). Costs and consequences associated with misdiagnosed lower extremity cellulitis. JAMA dermatology, 153(2), 141-146.

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