Case Scenario: 

Question Case Scenario: Mr. George McFarlane is a 53-year-old Caucasian male, admitted to the hospital after seeing his General Practitioner (GP) for an infected Left (L) toe, caused by a blister/ lesion, possibly from ill-fitting shoes. When Mr. McFarlane realized there was a lesion present, he initially did not consider it serious and did not seek medical treatment straight away. After a week, the smell disturbed him and he sought advice from his General Practitioner (GP) who prescribed oral antibiotics and stressed the importance of cleansing and changing the dressing on his wound regularly. Due to Mr. McFarlane’s job which required being on the road for long hours at a time, these regular dressing changes did not occur. Subsequently, due to irregular dressing changes, Mr. McFarlane’s Methicillin-resistant Staphylococcus Aureus (MRSA) positive status, and Type II diabetes, the lesion failed to heal and became larger and deeper. Mr. McFarlane returned to his GP five (5) weeks later. The GP immediately referred him to a specialist wound clinic. Investigations included a full blood count (FBC). The white blood cell (WBC) count was 17x 10⁹/L, predominantly neutrophils. The erythrocyte sedimentation rate (ESR) was 75mm/hr. An x-ray showed changes consistent with osteomyelitis. Mr. George McFarlane was admitted to the hospital for surgical debridement of his wound. A large amount of tissue was excised from his left foot, which resulted in the amputation of all 5 toes. The wound was packed and placed on a suction wound dressing (negative-pressure wound therapy), to minimize the exudate at the wound surface and promote healing by granulation. Post-operatively, he initially did well. However, on the seventh day after surgery, he developed pyrexia and his diabetic control deteriorated. His left foot had swollen above the bandaging. The dressing was removed and there was tissue engorgement and cellulitis surrounding the wound and evidence of necrosis.  Medical history Mr. McFarlane has a Past Medical History (PMH): • Type ll Diabetes needing close management • Osteoarthritis in L) Knee • Peripheral Vascular Disease (PVD) • Chronic Obstructive Pulmonary Disease (COPD) • Methicillin-resistant Staphylococcus Aureus (MRSA) positive • peripheral neuropathy Social History (SHx): • Second marriage • Occupation – Long Haul truck driver • ETOH (Alcohol) usage on a regular basis • Smoker, averages 15/20 cigarettes per day • Often consumes take away/ fast food diet as away from home regularly.  1. Discuss how Mr. McFarlane’s chronic illnesses could impact wound healing and the cause of his wound. Include, in your answer, how the pathophysiology of Type II Diabetes, Peripheral Vascular Disease, and peripheral neuropathy could delay/ hinder wound healing. 2. a. Explain the differences between a simple, complex, and surgical wound. In your response, consider the complications of healing with each type of wound. bWhich wounds may need debridement?  c. How has the historical development of contemporary wound management strategies changed over time? Discuss the reason why some wounds are left undisturbed for a longer period of time.  3. What support networks related to wound management strategies could you suggest to assist and ease the difficulties for the client as well as family members, after discharge home? In your answer consider areas such as a holistic assessment and approach, and research what government health bodies are available to assist with financial assistance. Supply the Web Link for the government health bodies in your answer.  4. Discuss appropriate pain management strategies for your client, Mr. McFarlane. a. Who, within the multidisciplinary team, could provide you with assistance with planning a pain management strategy? b. How could you relieve pressure from Mr. McFarlane’s foot for comfort and what equipment is available to relieve the pressure? Include, in your discussion, appropriate pain management for Mr. McFarlane and time frames to be considered prior to attend to the wound assessment and dressing. c. Discuss the role of the pain management team and the requirement to liaise with your RN/ Team leader as outlined in the Enrolled Nurse standards for practice.  5. Discuss the following wounds or questions and provide a brief description of treatment for each. Malignant wound Burn Fistula Sinuses Visceral wound What wounds may require skin grafts and why? 6. What education should be provided to Mr. McFarlane and his family in relation to his wound? Your answer should be specific to Mr. McFarlane. Consider in your answer: Modes of transmission of infection, and what types of pathogens can cause infection. Strategies for the prevention of the development of other wounds. Wound care post-discharge including evaluation of the condition of the wound and where to seek assistance if the wound deteriorates. Possible psychological impacts of a chronic wound.  References required  Health Science Science Nursing NURS HLTENN001 Share QuestionEmailCopy link Comments (0)