Case Study
Home Health Care for Patient With Infected Leg Ulcer
Patient Profile Melody Tennant, 43 years old, has been referred to home care for care of her infected leg wound and intravenous antibiotics. She lives alone in an apartment with her cat in an area of town identified as having a high number of calls to the police. Ms. Tennant worked as a food server but is currently out of work. She is candid with the nurse completing her admission and shares the fact that she has been trying to stop her intravenous drug use for years. Her right lower leg ulcer is the result of injection drugs 6 months ago. The injection site became a “sore” and “just never healed.” Ms. Tennant went to the walk-in clinic when she could no longer stand the pain and her boyfriend noticed her leg was pink and warm to touch. The walk-in clinic physician sent her to the emergency department, where a methicillin-resistant Staphylococcus aureus (MRSA)– infected leg wound was diagnosed.
Subjective Data
• Has a history of being hepatitis B positive (3 years)
• Has varicose veins in both legs; worries that, because of these, the home care nurses will want her to wear support stockings, which she finds “ugly”
• Complains of pain in her right lower leg and asks for “something to take the edge off”
Objective Data Physical Examination
• Peripheral intravenous site (saline lock) in left hand
• Dressing to right lower leg: 10- × 10-cm foam dressing with adhesive edges
• Right lower leg ulcer: 10% pink base, 90% yellow base, irregular flat edges. Wound size is 0.5 cm deep, 7 cm long, 4.4 cm wide. Periwound skin is deep pink, and the diameter of the right lower leg calf is greater than that of the left.
Collaborative Care
• Methadone, 50 mg PO once daily
• Vancomycin, 1 000 mg intravenously BID
• Multivitamin, 1 tablet PO daily
• High-protein diet
Discussion Questions
1. Priority decision: What are the initial priorities for the home health nurse?
2. What other members of the health care team should be involved in the care of Ms. Tennant? What are their roles and responsibilities?
3. Priority decision: What type of patient education program should be implemented? What are the priority teaching goals to promote selfmanagement?
4. What should the nurse consider in the nutrition assessment? How will the nurse address economic considerations related to Ms. Tennant's diet?
5. How can the nurse address Ms. Tennant's coping skills and use community resources to intervene with her mental health and substance use?
6. What types of supplies will Ms. Tennant need? What diagnostics, teaching, and community resources should accompany the use of these supplies?
7. What are the expected long-term outcomes for Ms. Tennant?