Activity | MULTIDIMENSIONAL CARE 1 | Rasmussen College System

 

James Lee is a 76-year-old man who fell 4 days ago. He was admitted to the hospital and underwent an open reduction and internal fixation (ORIF) of the right hip. Today is his second postoperative day. He is still bed bound and is unable to roll or pull himself up in bed.

He weighs 210 lb.   Height 74 in    B/P 128/85 mm/hg    HR 80/min   RR 18/min   Sat 97% RA  Temp 98.7 F

Past medical history: Smoker quit 10 years ago.

He has little appetite and says he has been depressed since his wife died last year. While performing your assessment of Mr. Lee, you notice that a large dressing covers the right hip incision. You loosen the dressing and see the staples are intact at the incision site and there is minimal amount of serosanguineous drainage on the bandage. As you turn him in bed, you see a 9cm by 5cm reddened area on his coccyx and a 2cm by 3cm purple bruise-like area on his left heel.

What kind of wounds does Mr. Lee has?

How will you care for each of his wounds?

What factors contributed to each of the wounds and how will you promote healing?

Write two nursing diagnosis and 2 smart goals for this patient.







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