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Wound healing

Viera Vojtková
Language: English
Country: Slovakia
Typology: health care professionals
Text:
Mr. Leo is 78 years old and has been living together in one household with his partner for more than 40 years. Their children moved for work to another city. He has been taking care of his farm his whole life. He weights 116 kg. Because of the heart insufficiency he moves very slowly and gets easily breathless. His legs swell a lot. The skin on his legs is very flaky with wounds that practically do not heal. Leo has been working hard for all his life. He took care of his fields and his farm animals, but in the past years he had less and less strength and gradually had to leave his work. He decided to rent his fields to another farmer and sold his animals. Leo can still drive a car and can manage shopping with his partner. Wounds on his knees have not been healing properly for a few months and it is very difficult for him to see his doctor every third day for retying. Leo’s doctor prescribed him, in addition to tying, also compressive treatment. He recommended Leo nursing at home and seeing the doctor only when needed. Leo is exhausted by this situation and he is afraid that in the case of not healing or worsening the wounds he would have to go to the hospital or the amputation will be needed. The doctor explained to him that it can be prevented by precious treatment of wounds and by banding the knees. For his whole life Leo has been thinking of work more than of healthy lifestyle so this situation is new to him. A nurse comes for an interview and Leo tells her all of these. Leo is helpless and he is afraid of what is going to happen. The nurse reads the prescription from the doctor, how to clean the wounds or retie them and what medication is needed. When she is familiar with the situation they start to create a nursing plan. Leo needs help with the hygiene of legs, with retying, banding and providing medication and tools. The nurse agrees with Leo that she will order and provide the things needed in his name and she also takes care of the financial side of the order, because Leo is afraid that it all will be expensive. Subsequently they agree visits 3 times per week for the retying needed. Leo has a lot of questions about possible progress of his state and he is afraid of the course of healing. Right after the first visit of the nurse he feels relief that he is not alone for the situation anymore, because his partner does not know how to help him with this. During the next visit the nurse precisely explains the whole course of cleaning the wound and of tying and she also explains to him how banding is working and why it helps to heal boils of knees. She explains and describes to him everything she does and why it is important. She explains effect of the compressing, removing of the dead skin, cleaning and of the foam containing uric acid and also of the cream she putts on the wounds. She describes layers of tying and its importance. The nurse also warns him that the treatment requires its time and that the first improvements he will notice can come in 1-2 weeks. The regular visits and answers to Leo’s questions, but also regularity and professionalism of the nurse, give Leo the feeling that everything possible is happening for his healing. OBJECTIVES: Alleviate fear, eliminate the feeling of helplessness, prevention from deteriorating skin problems deriving from chronic vascular disease, wound healing, prevention of infections and complications, elimination of pain. MEANS AND STRATEGY: Regular and preventive change of the bandages and establishment of the class 3 compresses in the home environment, securing the availability of the necessary health care material, regular continuous relieving and clarifying interviews, motivation to continuous and uninterrupted treatment, creating space for finding resources for assisting healing in Leo’s past: fortitude and perseverance he had at work. CONCLUSIONS: Healing of Leo’s wounds takes long time and the success comes erratically. Leo needs plenty of continuous support as well as professional health care. The flaws in the lay home care or underestimation of the compression therapy interruptions lead in the past to worsening of his conditions. Consistency and continuity brought improvements. Leo has no more wounds. Nurse helps him continuously to follow the preventive skin care and compression therapy.


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