Case Study: Pneumonia and Pressure Ulcer Prevention in an Elderly MICU Patient
June 6, 2012 Case Study: Pneumonia and Sepsis in an Elderly MICU Patient L.M. is a 75-year-old female who suffers from severe dementia and lives in a SNF. She was diagnosed with lung cancer in 2005 and as a result had a right upper and middle lobectomy. She also has a history of severe emphysema. L.M. has had several pneumonic infections and has an allergy to Pneumovax. She has a recurrent aspiration risk and received a tracheostomy and a PEG tube in January 2012. On Aril 25, 2012, L.M. was found to be increasingly fatigued, somnolent, and had shortness of breath accompanied with tachycardia as witnessed by the staff at the SNF.
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Each category is rated on a scale of 1-4, with the exception of the friction and shear category that is rated on a scale of 1-3. There is a possible score of 23. If a patient has a higher score, they are less susceptible to development of a pressure ulcer and vice versa. In the category of sensory perception, I rated L.M. at a 2 because she only responded to painful stimuli but could not communicate discomfort with the exception of restlessness. I scored her at a 2 in the moisture criteria because she was often diaphoretic because of increased heart rate, increased respirations, and her linens had to be changed once a shift. In terms of activity, she was a 1 because she was confined to a bed both at the hospital and at the SNF she lived in. L.M. was very limited in her mobility and would only make occasional slight changes in her body position; therefore, I assessed her to be a 2. I rated her nutrition at a 2 because she weighed 84 pounds and was on tube feeding that seemed inadequate to meet her nutritional needs. In the last category, friction and shear, I gave her a 1 since she required maximum assistance in moving. She would frequently slide down in her hospital bed and required frequent repositioning. L.M.’s cumulative score was a 10, which is considered a high risk for developing a pressure ulcer. “Prevention of pressure ulcers is a fundamental aspect of intensive care nursing, and quality