Evidence Based Practice 1
Running Head: EVIDENCE BASED PRACTICE PAPER NURSING: CASE 3
Evidence Based Practice Nursing: Case 3
[Author Name]
[Institute Name]
Introduction
Evidence Based Practice (EBP) Nursing is a problem solving approach to clinical practice that integrates the best available evidence, nursing skills and preferences of individual, families and communities. The purpose of this evidence-based practice paper is to determine the likely causes of leg ulcer in elderly age and best nursing practices for its treatment.
Discussion:
The case 3 is a wound care case study in which Mr. S. is having ulcer on left leg. He has a history of hypertension and chronic obstructive airway disease. An ulcer on the lower leg is very painful and is developed in association with poorly controlled High Blood Pressure. He has been looked after by a wound care nurse for the past two months who adopted four-layer compression-bandage therapy for healing of the wound but ulcer seems to be more widespread. Mr. S. also complains of severe pain during dressing changes.
Additionally, he has had a poor appetite and is underweight. He has been in the nursing home since her wife’s death (8 years). The children live far and could not come to see him weekly. The nursing home staff says that Mr. S. has been very reserved and uninterested in his physical appearance and personal hygiene since his daughter moved far.
Here the nursing practice problem seems to be the lack of symptom management and accurate treatment of ulcer. The treatment of the cause is far more important than the choice of dressing. The patient’s history is hypertension that is interrelated with the ulcer (Agren et al: 1999).
PICO:
In geriatric patients suffering from hypertension, does ulcer or chronic wound formation can be cured by controlled treatment of hypertension?
Literature Search:
In Google I searched for the NIH articles where I looked for the articles published in last five years. It opened another window “PMC” where I searched for words “leg ulcer” and “Hypertension”. A long list of articles opened and this was the best searched article relevant to the topic. The journal name is “Clinical Intervention in Aging: Dove Press” and the article is, “Wound care in the geriatric client” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697592/ ). This article was selected because it provided sufficient information regarding the clinical practices related to leg ulcer in older age. It provided us with the major factors that cause ulcer; hypertension is one of those factors.
Evidence:
The research was conducted to address the assessment tools and techniques, appropriate classification systems, dressing choices and treatment modalities. It also discussed about some wound care products as they relate to chronic wound care. The study was conducted by Steve Gist, Iris Tio-Matos, […], and Michael Beebe. In this article different case studies were presented in order to illustrate decision making process involved in relation to caring different kinds of wounds. Case studies of patients suffering from different kinds of ulcers are presented to demonstrate the factors causing ulcer and their proper treatment.
The study examined different kinds of ulcers caused by different chronic diseases like diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency). In this case the patient is having venous ulcer that is caused by venous hypertension. Moreover, venous ulcers are classically located over the medial malleolus and Mr. S. is also having ulcer on the left leg on medial malleolus. Special dressings have been developed for different kinds of ulcers and therefore the proper dressing causes the ulcer to be healed.
The authors conclude their study by stating that ulcer in majority of the elderly people can be healed if treated assertively and accurately. The symptom management improves the overall outcome for the elderly patients whether healing or palliation is the goal. Wound care in older people can be maximized by a multidisciplinary approach by drawing on each team member’s expertise.
Summary:
The aim of this paper is to discover the major cause of leg ulcer and best possible nursing practices fir its treatment in older age. Though the four-layered compression therapy utilized by the wound care nurse is ideal for healing and treatment of the leg ulcer but the factors that cause also need to be controlled (Argen et al: 1999). Aged people suffering from chronic diseases like hypertension in this cause are likely to have leg ulcer. Perhaps, uncontrolled high blood pressure or its improper treatment results in the development of leg ulcer that is really painful (Mekkes et al: 2003).
References
Gist S., Tio-Matos I., [...], and Beebe M. (2009). Wound Care in the Geriatric Client. Clinical Intervention in Aging: Dove Medical Press Limited. 4: 269-287.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697592/
Agren, M. S., Eaglstein, W. H., Ferguson, M. W., Harding, K. G., Moore, K., Saarialho-Kere, U. K., & Schultz, G. S. (1999). Causes and effects of the chronic inflammation in venous leg ulcers. Acta dermato-venereologica. Supplementum, 210, 3-17.
Mekkes, J. R., Loots, M. A. M., Van Der Wal, A. C., & Bos, J. D. (2003). Causes, investigation and treatment of leg ulceration. British journal of dermatology, 148(3), 388-401.