Care Planning

The paper will evaluate Mrs. B. a woman aged 79 who was suffering a cerebral vascular accident that led to hemiplegia (Karomed, 2017). For several years the woman was not able to move and depended on his sister for her daily care and movement. Her sister fed Mrs. B, after several years she developed pressure damage on her heels. This made her to known to the district nursing services (Karomed, 2017). However, the pressure ulcers healed, but she developed a grade three pressure ulcer to her sacrum and graded three ulcers to her left buttock.  Mrs. B. was nursed on a emergency mattress suitable for the individual at great danger of emerging pressure ulcers; she used this equipment for fifteen months where the pressure ulcers were healed. But she was exposed to high danger of emerging pressure ulcers. This is due to her condition worsened and pressure ulcers to her sacral region returned (Karomed, 2017). The clinical signs of the infections failed to respond to oral antibiotics and thus required to be admitted for intravenous antibiotic therapy. Care Planning A plan of care is something which simply describes the services as well as support offered. They should be put together and agreed upon by the care receiver through the course of care organization. Agreeing on a plan of care with social and health care professionals’ means that an individual is capable of talking about their situation and how their life is affected (Corecarestandards.co.uk). It also helps in understanding on what individuals want to accomplish in their life and the things that can be done by the subjects upon the right support. The care plan which is agreed upon should be as a result of an interactive process between the subject and the care provider. In some scenarios for example Mrs. B. case, some care plans are developed without involving the subject fully due to their inability to participate. However, efforts are made to consult and communicate with them. Care plans are developed to help the recovery of complications by patients hence enabling them to lead normal lives. Pressure ulcers are examples of these complications as seen below.  Factors to consider in developing a care plan are the primary assessment results of a patient. The medical history of the client is important to know to choose the best management system. According to Guy (2017), an assessment is important as it helps in checking the nutrition status of the patient, mobility, the supply of the blood, signs of systemic infections amongst physiological and social factors. Mrs. B. wound assessment was important to determine, amount and type of exudates, smell as well as the stage of infection regarding grade (Dowsett, Groemann & Harding, 2015). This helps in determining the dressing to be done, amongst other factors. The assessment is thus essential as it presents key issues to be put into consideration while planning a care program. Pressure sores are also denoted to as bed sore or pressure wounds. They are reported to occur in the damage of the skin and the underlying tissues. In extreme cases, the underlying muscles and bones may also get damaged (Reddy, 2014). This disease is said to affect Mrs. B. who was not able to move parts of her body or even the whole body either due to paralysis, illnesses and advanced age. Pressure ulcers are reported to be widely spread, although they have been underestimated health problems. In the United Kingdom, about 4-10 percent of patients admitted in hospitals are reported to develop at least one pressure ulcer (Direct Healthcare). This statistics, however, goes even rises to about 70 percent for the aged individuals with mobility difficulties. Pressure ulcers in some cases present an insignificant problem that may be managed with some modest nursing care. In this cases, the ulcer damages the skin, thereby, leading to a life threatening conditions such as wide spread blood infection and death of body tissues (Patient.info). There are mainly two objectives when it comes to caring of individuals claimed to be at danger of emerging pressure sores. These include prevention of the development of ulcers by use of special equipment and dressings in addition to changing of patient’s position. Also, treatment of the present pressure sores by use of antibiotics, surgery as well as improved nutrition. Conferring to Tamparo (2016), other than the hipbone, several other areas that are reported to be at danger of emerging pressure sores include genitals in men, breasts in women, rims of years, elbows, shoulders, back of the head, ankles, lower back, heels, and toes. The reason for them contracting the disease is due to lack of body fat cover, in addition to the direct connection with the supportive surface like wheelchair and beds. Wheelchair users are claimed to be at great danger of evolving pressure sores at their buttocks, spine, shoulder blades, tailbone and back of their legs and arms. The grading system is used by the health care professionals with the aim of unfolding the severity of pressure ulcers. Grade one ulcer is the said to be the artificial kind of ulcer. The region of the skin infected looks to be bruised. It is seen to be red among the whites while purple or blue to those individuals with skins that are dark coloured. The skin is also said to remain intact, though it may itch or hurt (Therattil, Pastor, & Granick, 2013). In some cases, it also has a spongy and warm feel other than getting hard. In the second category of the pressure ulcer, the epidermis, as well as dermis, get damaged leading to the loss of the skin. The ulcer thus appears as a blister or an open wound. In the third category, pressure ulcers lead to loss of skin leading to the damaging of the underlying tissues (Jiang et al., 2014). Muscles and bones may not be damaged even though the ulcer seems as a profound hollow wound. Grade four sore of pressure is the severe utmost kind of sore. The membrane looks injured, and the nearby tissues begin to deceased. The essential muscles and bones get damaged, hence leading to a life threatening infection. The pressure ulcer may be produced by pressure, friction, shave or either a mixture of all. The cost of treatment, however, depends on its severity. It is estimated to cost up to about 4 percent of its healthcare expenditure (Bhattacharya & Mishra, 2015). Other risks factors include cardiovascular disease, diabetes mellitus, and paralysis of the limbs, malignancy, and heart failure among others. In adults, pressure ulcers are said to occur in bony areas such as sacrum (Coleman et al., 2013). The pressure ulcer patients should thus receive an initial and ongoing assessment which includes; person’s general physical condition and ulcers should be assessed together since they are closely related, previous damage by similar condition, photographs to accompany the assessment, psychological as well as social factors among others. In the management of grade three ulcers, patients should be referred to a specialized service. Healing is, however, not a fast process. So long as the patient has enough pressure distribution, appropriate management of the wound and good nutrition, the ulcer is said to heal in most of the cases (Langer & Fink, 2014). Management also involves the repositioning of the patient, treatment of the coexisting condition that may delay the healing process and also the management of the wound using the advanced wound dressings among other technologies as seen in Mrs. B case. Individualized care planning is said to aim at putting people on an equal footing with health and the social care experts, moving into doing with from doing to. The care planning is said to follow a health and a collective care assessment of the requirements and is said to consume more time other than being more comprehensive. According to Oleske (2014), my client’s health care planning process, information on how the condition affected his life was collected including the support that the needed to decide on the best method of managing his condition. Providing Mrs. B with the test results information enabled her to reflect as well as helping in preparing her for the more answers during the probing process (Parker, 2017). The care plan, thus, included the results of the brief discussion between Mrs. B including the lists of the actions agreed. He, therefore, owned the plan and kept a copy of it in which he had a choice on who was to have a look at the plan and who should not. For instance, older adults with diabetes, arthritis, and heart disease are always detailed and contain information on their medication and emergencies as well as the information on their health and well-being (Coulter, et al., 2013). From the care planning, my role was to enable my client to live independently, be able to control their lives as far as he could, enjoy the best life quality as he could and also take part in the society on an equal level. This is in addition to keeping much self-worth and respect as possible. Since the sacral region is at high risk of further skin breakdown and infection, a lot of care was taken to avoid contamination of the wound from urine and faecal matter. My choice was a hydrophilic dressing on the wound since the area was complicated to dress (Chu & Tsai, 2016). In doing so, a zinc oxide paste was the one used as it helped in absorbing adequate amounts of exudates. Evaluation of the progress of healing was done in four weeks to determine whether there is an improvement or not. Despite this, the weekly assessment was important to discover early complications that necessitate changing of the treatment plan (Emedicine.medscape.com). Administration of the antibiotics to the patient to avoid infections from bacteria was also done. This was an important care practice to avoid development of secondary infections. An antiseptic cream may, however, be applied on the ulcer to kill the present bacteria causing infections. Proper nutrition was adopted according to Thomas (2014), to ensure an improved rate of healing. Dietary supplements that included vitamin C, zinc and proteins were used. An individualized care plan was important as a care plan was developed following a discussion between the client and the care provider. Individualized care plan offers flexibility in the care provision as different individuals have different preferences (Mariani et al., 2017). In standardized care plan, a guideline is available which states on how a patient with a certain illness like the stage three of the pressure ulcers should be treated (Health Catalyst). The standardized plan may not offer solutions to new developments in comparison to individualized care. Again, the patient was elderly and was diabetic. The care planning program had to take into consideration of these other two factors. Management of the blood sugar level in the body was also a concern while ensuring that the patient was able to move. The movement was important in ensuring that the contact area to the supporting surface was often changing to prevent the eruption of another pressure ulcer in other parts of the body. Conferring to Reid, Ayello & Alavi (2016), the patient had a reduced appetite due to medication which led the importance of further consultation with a doctor. Standardized care thus difficult to adopt as the condition of the patient differs from one individual to another. The process of treatment and disease management was, however, successful due to the application of multidisciplinary approach in the patient’s treatment. This was dressing of the wound combined with nutrition and management of diabetes which is a disease claimed to be a risk factor that may lead to pressure ulcers (Langer & Fink, 2014). Physiotherapy was also another discipline that was applied in the management of the two conditions. This enabled the repositioning of the patient to allow pressure distribution in other body parts and thus avoiding direct pressure on the ulcer wounds. In conclusion, care planning is important for management of diseases and Mr. B. should actively participate in their development. This makes them own the plans hence ensuring routine follow up. Individualized care planning is the best in comparison to standardized care plan since it offers flexibility and thus becoming friendly to the clients. Grade three pressure sacrum ulcer is an advanced stage of pressure ulcer that needs professionalized care treatment. In so doing, as a nursing professional active participation in developing a care plan and implementing it was important. Hydrophilic dressings for the wound were important in ensuring the wound was not wet for a quick recovery. The paste offered a good option as it was easy to apply. Supplements, on the other hand, provided the nutrients required by the patient for management of both diabetes and grade three sacrum ulcers. Before developing a care plan, a prior assessment is important as it helps to know the issue affecting Mrs. B  regarding her nutrition status, stage of the wound, type and amounts of exudate if present, other infections among other several considerations.

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