Expectation of wound healing For EACH wound,

Expectation of wound healing For EACH wound, explain at least two (2) factors in the case study with rationales that may impact on the healing process. Wounds At least two (2) factors for each wound with rationale Malignant wound Venous ulcer Admission Mrs. Mariam Gold is an 88-year-old lady who has been admitted to hospital for palliative management. Miriam’s husband and her children are not coping at home, and she has been in a lot of pain due to her malignant wound to her left L) groin. The malignant wound has purulent discharge and strong offensive odour. Miriam requires pain relief before attending dressing and incontinent aid change and hygiene care. Mrs. Gold also has a chronic venous ulcer to her right R) lower leg. Presenting Problems Fluid overload (dialysis ceased due to the palliative approach) Aspiration pneumonia Past Medical History COPD CABGs AF (normally on Warfarin) IBS End stage renal failure (ESRF) on dialysis Metastatic cervical Ca Varicose veins On examination CNS: Drowsy and vague CVS: BP 103/62, PR 72bpm irregular. Peripheral oedema to both lower limbs Respiratory: SpO2 92% RA, RR 22, increased WOB GIT: Mildly thickened fluids only, not tolerating diet. Faecally incontinent with incontinent aid in situ at all time GUT: Urinarily incontinent with incontinent aid in situ Integumentary: Malignant wound to L) groin and Venous ulcer to R) LL (see pictures). Sacral and bilateral heels skin reddened but intact. Full nursing care (FNC) required MSK: RIB, may hoist into recliner at times Social: Lives at home with her frail 90-year-old husband with two daughters living nearby. Mariam and her family do not wish for further active treatment.

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