Sherman Yoder Part 2.docx - Worksheets to Prepare for...

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Worksheets to Prepare for Simulation Cases Module – Gerontology vSim Scenario (Patient) – Sherman “Red” Yoder Part 2 Part 1: Plan of Care Concept Map (adapted from vSim template) Simulation Patient Overview Client summary: presentation, medical history and background, physical assessment findings, medications, diagnostics brief summary of pathophysiology and rationale for clinical manifestations Red Yoder is an 80-year-old male with a pressure ulcer on his right great toe that developed about five weeks ago. His current medical problems include type 2 diabetes. He has been treated at home with an oral antibiotic and wet to damp saline dressings daily. The home health agency nurse has been checking the wound twice a week. Dr. Baker has admitted him with possible wound infection and has written preliminary orders. He has just arrived with his daughter-in-law, Judy, and they are waiting in room 2. The lab technician has been by to draw labs, obtain wound culture, and insert an IV. Complications that contribute to the increased risk of foot problems and infections include the following: Neuropathy: Sensory neuropathy leads to loss of pain and pressure sensation, and autonomic neuropathy leads to increased dryness and fissuring of the skin (secondary to decreases sweating). Motor neuropathy results in muscular atrophy, which may lead to changes in the shape of the foot Peripheral vascular disease: Poor circulation of the lower extremities contributes to poor wound healing and the development of gangrene Immunocompromised: Hyperglycemia impairs the ability of specialized leukocytes to destroy bacteria. Therefore, in poorly controlled diabetes, there is a lowered resistance to certain infections The typical sequence of events in the development of a diabetic foot ulcer begins with a soft tissue injury of the foot, formation of a fissure between the toes or in an area of dry skin, or formation of a callus (Hinkle & Cheever, 2018). Patients with an insensitive foot do not feel injuries, which may be thermal (e.g., from using heating pads, walking barefoot on hot concrete, testing bathwater with the foot), chemical (e.g., burning the foot while using caustic agents on calluses, corns, or bunions), or traumatic (e.g., injuring skin while cutting nails, walking with an undetected foreign object in the shoe, or wearing ill-fitting shoes and socks) (Hinkle & Cheever, 2018).

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