JosephineMorrow,WELL EXPLAINED WITH VERIFIED ANSWERS.

Documentation Assignments 1. Document the findings of a focused skin assessment of Ms. Morrow, including any findings that identify the presence of chronic venous insufficiency. a. During the focused skin assessment, moderate edema (+2) and hyperpigmentation of the skin was bilateral from the knees down. The patient didn’t show any signs of sweating and the skin’s elasticity and color were normal. There was a dressing covering the skin lesion on the lower leg that was changed and the wound assessment for any changes. The patient’s pedal pulses and radial pulses were palpable with a rate of strong 95 beats per minute. 2. Document any abnormal laboratory results that are associated with the presence or status of Ms. Morrow's stasis ulcer. a. The patient had three abnormal laboratory results: HCO3-, Albumin, and Prealbumin. Her HCO3- was 28 when the normal range is 22-26mEq/L, the Albumin was 3.4 when the normal range is 3.5-5.0 g/dL, and the Prealbumin was 14.7 when the normal range is 19-38 mg/dL. 3. Record the results of Ms. Morrow's Braden Scale assessment. a. The results of Ms. Morrow’s Braden Scale assessment was 16 which is very high and is concerning. This puts her at a mild risk for a pressure ulcer. The rest of her skin is intact except for the venous stasis ulcer on her right medial malleolus. 4. Document the characteristics of Ms. Morrow's venous stasis ulcer. a. The venous stasis ulcer is shallow, 1 inch in width, and looks mostly pink to red, with no signs of necrosis or infection. 5. Document the dressing change and irrigation of Ms. Morrow’s wound. a. I first assessed the current dressing and saw that it was clean, dry, and intact. I then removed the dressing and assessed the current status of the ulcer and saw that it was an inch in width, color wise was mostly pink to red and had no signs of necrosis of infection. I then cleaned and irrigated the wound using normal saline and reapplied a new and clean dressing before handing off the patient. 6. In the chart, record patient education on ways to promote venous return. a. The patient was provided with the necessary education to promote venous return and understood all the information given to her. To promote venous return the person should ambulate regularly and if that is not possible then the patient should elevate the legs and wiggle their feet up and down in bed or in a chair. The patient should also be encouraged to use compression stockings which will help alleviate any symptoms and prevent blood clots. Josephine Morrow Guided Reflection Questions Opening Questions How did the simulated experience of Josephine Morrow’s case make you feel? This simulated experience really gave me a good understanding of ulcers and the proper care that is needed for them. I feel confident in my understanding and assessment on ulcers and will know what to do in the future. Talk about what went well in the scenario. The procedure went well since all the procedures that needed to be done were met, the patient understood all that was asked of her, and all needed tasks were complete. Reflecting on Josephine Morrow’s case, were there any actions you would do differently if you were to repeat this scenario? If so, how would your patient care change? If I needed to repeat the case I would do all the same things since all necessary procedures were met and optimal care was met but I would make sure to be more sensitive to hygiene. Scenario Analysis Questions S What priority problem(s) did you identify for Josephine Morrow? I identified that the patient had a venous stasis ulcer on her right medial malleolus and chronic venous insufficiency. The patient is also obese, has impaired mobility, has a past history of COPD and DVT, so she is at a continued risk for skin breakdowns and ulcers. PCC Identify in Josephine Morrow’s health history any factors that predisposed her to having chronic venous insufficiency. COPD, DVT, obesity, and lack of mobility are all factors that will increase her predisposing to venous insufficiency. PCC/S Discuss the assessment findings and diagnostic studies that correlate with chronic venous insufficiency and venous stasis ulceration. Provide the reasons behind these findings. The patient developed a venous stasis ulcer to her right medial malleolus and has brown pigmentation on both lower legs with an +2 edema. Her lab results showed that she had abnormal prealbumin, albumon, and HCO3- levels. S What is the rationale for the daily dose of ASA? The rationale for the daily dose of ASA is to help with circulation. EBP/IWhat is the rationale for compression therapy? Compression therapy is used to improve the signs and symptoms of various venous diseases by providing graduated compression therapy to help control leg swelling and discomfort. The compression socks are designed to provide support to the legs and veins, assist with circulation, and minimize swelling. EBP/IWhat is the rationale for performing a Braden scale assessment on Josephine Morrow? The Braden Scale is used to assess how severe an ulcer is and whether or not it will become a pressure ulcer. An initial Braden Scale assessment will also provide any information on any changes and give an initial assessment on the ulcer. If the Braden Scale begins to change then different measures will be taken. T&C What other interprofessional team members should be involved in Josephine Morrow’s care? Other interprofessional team members that should be involved in Ms. Morrow’s care that can promote quality of life could be physical therapy, cardiac specialist, respiratory specialist, dietitian, and a home care nurse. Concluding Questions Describe how you would apply the knowledge and skills that you acquired in Josephine Morrow’s case to an actual patient care situation. I would apply Maslow’s hierarchy of needs into Ms. Morrow's case, I know that all her needs will be met and the overall outcome will be an improvement in quality of life. I would also make sure that the patient is safe and comfortable at all times to minimize and fall risks. I would make sure to educate the patient to promote better healing and better lifestyle changes. Finally I would include the interprofessional team assigned to the patient and care plan and work with them to give the patient the best care. *The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: