Week Eight Journal
Mrs. C. C. was a sixty-seven-year-old Caucasian woman who presented to the office with bruises on her left forearm and right hand. She had a history of diabetes, hypertension, atrial fibrillation, peripheral vascular disease, and arthritis. Upon completion of her history and physical exam, large dark purplish irregular patches were noted on the left dorsal portion of bilateral forearms. The areas did not blanch and appeared to be isolated areas to bilateral forearms. There were no other signs of bleeding noted or verbalized per Mrs. C. C. She stated that she could not remember injuring herself, but stated she might have bumped her left forearm a couple of days ago. She was taking oral anticoagulant Coumadin daily. …show more content…
This cellular level changes can impair healing and can be exaggerated in individuals with risk factors aforementioned. Consequences of purpura in the elderly population can lead to healing alterations. When elderly patients have purpura, there can be alterations in the proliferation of cells that can lead to delayed wound healing and recovery (Sgonc & Gruber, 2013). Therefore, Mrs. C. C. may have these bruises on the skin for a longer time. Also, being post-menopausal her levels of estrogen have declined, and this can lead to reduced "extracellular matrix deposition" and inflammatory responses (Sgonc & Gruber. 2013, p. 163). These mechanisms can lead to a delayed healing process.
Care Plan
Assessment
The assessment of Mrs. C. C. would need to begin with a complete history and physical exam that includes a visual exam of her entire body/skin. The step would need to include a complete history of the present illness to detail the mechanisms of injury, history of other related injuries, and identify any other signs of bleeding. Coagulation trends would need to be reviewed. Diagnosis
Thrombocytopenic Purpura
Treatment
Supportive
Mrs. C. C. was a sixty-seven-year-old Caucasian woman who presented to the office with bruises on her left forearm and right hand. She had a history of diabetes, hypertension, atrial fibrillation, peripheral vascular disease, and arthritis. Upon completion of her history and physical exam, large dark purplish irregular patches were noted on the left dorsal portion of bilateral forearms. The areas did not blanch and appeared to be isolated areas to bilateral forearms. There were no other signs of bleeding noted or verbalized per Mrs. C. C. She stated that she could not remember injuring herself, but stated she might have bumped her left forearm a couple of days ago. She was taking oral anticoagulant Coumadin daily. …show more content…
This cellular level changes can impair healing and can be exaggerated in individuals with risk factors aforementioned. Consequences of purpura in the elderly population can lead to healing alterations. When elderly patients have purpura, there can be alterations in the proliferation of cells that can lead to delayed wound healing and recovery (Sgonc & Gruber, 2013). Therefore, Mrs. C. C. may have these bruises on the skin for a longer time. Also, being post-menopausal her levels of estrogen have declined, and this can lead to reduced "extracellular matrix deposition" and inflammatory responses (Sgonc & Gruber. 2013, p. 163). These mechanisms can lead to a delayed healing process.
Care Plan
Assessment
The assessment of Mrs. C. C. would need to begin with a complete history and physical exam that includes a visual exam of her entire body/skin. The step would need to include a complete history of the present illness to detail the mechanisms of injury, history of other related injuries, and identify any other signs of bleeding. Coagulation trends would need to be reviewed. Diagnosis
Thrombocytopenic Purpura
Treatment
Supportive