Module Title Wound Management

Module code NURS09106

Banner No B00209786

Tutor Vicky Wilson

Assignment Assignment 2

Word Count 3222

Submission Date 3rd May 2011
Introduction.

The following assignment will take the form of a case study. The subject is a 79-year-old sikh gentleman, who will be known as patient X. Patient X only speaks English as his second language. Patient X has developed a wound on his right hip after being admitted a few days previously, after suffering from a stroke. Patient X has a history of a mild stroke and has slow mobility and uses the aid of a frame to mobilise. Patient X is obese, a heavy smoker and now …show more content…

The tool also includes guidelines for introducing an effective and suitable treatment plan.
The MUST five-step plan involves:
Step 1. The patient’s height and weight are measured to establish a body mass index (BMI) score using the chart in the plan (if it is not possible to obtain height and weight, alternative procedures are given).
Step 2. The amount of unplanned weight loss is noted and scored using tables in the plan.
Step 3. Any underlying illness, such as a psychological condition, is established and a score is given. It will be noted whether there has been, or is likely to be, no nutritional intake for five days or more.
Step 4. The scores from steps 1, 2 and 3 are added together to obtain an overall risk of malnutrition.
Step 5. An appropriate care plan is developed. (Malnutrition – Diagnosis - NHS choices).

Assessing the person’s skin enables you to work out if there are any intrinsic or extrinsic factors that have not yet been detected. The factors you should assess according to Nazarko (2005) are;

• Skin condition. If the person is dehydrated, the skin will appear dry. Is the skin flaking? Is it moist? Is it stretched? Is it leaking fluid? (This can indicate gravitational edema or heart