Nursing Management of Chronic Wound and Asthma: A Care Plan for James Clark NUR4027

Nursing Care Plan for James Clark

1.Potential/Actual Chronic Concern/Problem 1 (PACCP 1): Chronic Non-Healing Wound

A chronic wound can be understood as a wound that does not heal according to the normal physiological process of the human body. The duration required for complete healing of such wounds may vary from three months to years. It generally remains in the inflammatory stage and indicates the risk of potential diseases such as diabetes or cardiovascular diseases (Wcw-Admin-Support, 2024).

In the case study, James has been diagnosed with a superficial chronic wound of 5 by 5 cm. The patient mentioned that he got this injury due to a scratch from a piece of firewood which was mishandled by him. However, the wound has been present from a very long time. Also, James has been travelling to different locations in Australia which may make this wound susceptible to different types of bacterial and fungal infections. The patient has been prescribed metoprolol and hydrochlorothiazide for managing his increasing blood pressure levels (Rolf & Burston, 2019).

2.Potential/Actual Chronic Concern/Problem 2 (PACCP 2) : Asthma

A report by the Australian Institute of Health and Welfare states that approximately 2.8 million Australians are suffering from asthma in 2022. It is responsible for contributing about 2.5% of the total disease burden and 35% of the respiratory disease burden in 2023. In the year 2020-21, there has been 56,600 cases of asthma in the emergency departments of healthcare facilities in Australia. Also, approximately 65% of people diagnosed with asthma are also suffering from other medical conditions, as reported in 2022 (Chronic Respiratory Conditions: Asthma, 2024).

For James medical scenario, it has been observed that he is prescribed with medications namely Salbutamol and Symbicort for effective management of asthma. Symbicort is a corticosteroid while Salbutamol is an antagonist for relaxing the respiratory pathway while experiencing asthma attack (DailyMed - SYMBICORT- Budesonide and Formoterol Fumarate Dihydrate Aerosol, 2024;(Albuterol: Uses, Interactions, Mechanism of Action | DrugBank Online, 2024). In addition to this, since the patient is travelling, he is exposed to different environmental factors such as pollen, dust, etc. which will further alleviate his symptoms of asthma.

3.Patient data underpinning PACCP 1 and PACCP 2 and additional Assessment Techniques/Tools

For chronic non-healing wound, a 5 by 5 cm wound size was observed on the left leg of the patient. A detailed PQRST pain assessment method was used to assess the levels of the pain (Hasnawati et al., 2023).

Provocation: James has been feeling mild persistent pain in the wound but has not specified any specific factors responsible for his pain.

Quality: James mentioned the reason for the pain which was probably due to a scratch from firewood. There are no details regarding the intensity level of pain.

Region/ Radiation: There are no instances in the medical case of James which shows that his pain is radiating to other regions of the body apart from his left leg.

Severity: The patient has not mentioned any incidence of bacterial or fungal infection associated with the wound. However, the elevated blood pressure levels of the patient point towards CVD. This can be further examined to determine the correlation between the chronic wound and CVD.

Time: The patient mentions that this wound has been present for more than a month (Wang, 2024).
For asthma, the medical history of the patient shows usage of Salbutamol and Symbicort. He has been exposed to seasonal pollens and also has exacerbations of asthma since childhood. The peak expiratory flow rate of the patient can be evaluated and all the risky environmental factors for aggravating his asthma can be identified. His current medication plan can be based on his previous treatment interventions to provide him with relief.

4. Goal for Care 1 (G1): To Design a Chronic Wound Care Plan

The specific SMART goal for James is to prepare a chronic wound care plan for prompt healing of the wound and avoid any bacterial or fungal infection. It will be measured by checking the progressive decrease in the size of the wound. It is achievable by using an adequate dressing for increasing the healing of the wound. In addition to this, antibiotics will be prescribed to the patient to avoid any external bacterial or fungal infection. For this, the size of the wound will be checked regularly after 3 days and visible symptoms such as redness and swelling around the wound area will be checked on a daily basis. The dressing of the patient will be changed two times a day and the size of the wound will be checked every 3 days. In addition to this, the wound will be checked for any infections daily. After a period of two weeks, the condition of the wound is re-evaluated and the wound care plan is further extended depending upon findings obtained.

5. Nursing Intervention 1 (NI1) for G1

A TIME framework should be adopted for evaluating the wound and further designing a care plan for it. It involves assessing the Tissue management, Inflammation and Infection control, Moisture balance, and Edge of wound which helps to monitor the healing process for chronic wounds. It will further reduce the risk of infections and reduce the swelling and redness around the wound (Nursing Guidelines?: Wound Assessment and Management, 2024).
The wound dressing of James would initially involve debridement where the tissues are removed with the help of tweezers, etc. Followed by this, the wound is cleaned and dressings such as gauze, hydrogel and hydrocolloid-based dressings can be done to keep the wound moist. Antibiotics in the form of pills or ointments can also be administered to avoid any bacterial infections on the wound (Chronic Wounds: Learn More What Are the Treatment Options for Chronic Wounds?, 2022).

6.Nursing Intervention 2 (NI2) for G1

It is essential to plan an effective balanced diet with appropriate nutrients which promote wound healing. Nutrients such as zinc, iron, vitamin B, protein, vitamin C should be present in adequate amounts in all the meals taken by James (Seth et al., 2024). Also, he could be educated about the chronic condition of his wound and the potential implications related to diabetes or cardiovascular diseases. He can learn the right methodology for wound dressing and should change it at regular intervals to avoid any infection. He should be instructed to report any atypical changes in his wound to the doctor immediately. In this way, James will become aware about the nutritional requirements for promoting healing of the wound. Also, he will be able to change his wound dressings and keep it sterilized to avoid potential infections (Raziyeva et al., 2021).

7.Goal for Care 2 (G2) : To Reduce the Frequency of Asthma Attacks

The specific SMART goal for James is to reduce the frequency of asthma attacks and bring his respiratory rate under the normal range (20 bpm). It will be measured by regularly checking the peak expiratory flow assessment levels and will fall in the range of 400 to 700 L/minute for old-aged people like James (DeVrieze et al., 2023). This can be achieved by ensuring that James strictly adheres to the medications prescribed for managing his asthma. His medication chart will be modified which will be strictly followed for a period of one month so that SMART goal can be achieved. In addition to this, he will be refrained from going to places or coming in contact with factors that can trigger this. Medicinal drugs such as Symbicort and Salbutamol will help in reducing the frequency of asthma attacks and avoid unecessary hospitalisations associated with it. The peak expiratory flow assessment flow assessment levels will be performed on a weekly basis and the impact of the medications namely Salbutamol and Symbicort will also be checked every week. This whole treatment plan will be strictly followed for a month and the medical condition of the patient will be re-evaluated to gain insights on the continuity of the treatment plan.

8.Nursing Intervention 3 (NI3) for G2

There is a need to review the medications prescribed for managing asthma in James. The quantity of the dose along with the frequency can be increased. The patient can be suggested to use Symbicort for preventive purposes and Salbutamol for acute condition of asthma. He can be educated about the methodology of using the inhalers appropriately. Also, he should be instructed to strictly adhere to the schedules for using the inhalers to avoid further asthma exacerbations (Lv et al., 2023).

9.Nursing Intervention 4 (NI4) for G2

James can be asked to reflect upon the factors that are responsible for triggering asthma. He can be educated about the negative impact of the different environmental factors such as pollen, dust, etc. on the increasing frequency of asthma attacks. He can be advised to use masks while he is travelling. In addition to this, he can refrain himself from opening the windows and prefers to stay in air-conditioned environments (Xing et al., 2023).

10.Expected Outcomes

The chronic wound of the patient will show visual signs of healing within 2 weeks. James will ensure that his wound dressings are changed regularly and intake appropriate antibiotics to prevent any infection on the wound. He will understand the role of different nutrients for elevating the healing process and will modify his diet accordingly.

Within a month, the frequency of asthma exacerbations will decrease significantly as James will strictly adhere to asthma management treatment guidelines and also refrain himself from triggering factors. He will know how to correctly use the asthma inhalers and properly follow the schedule for administering the medication (LeMone and Burkes Medical-Surgical Nursing: Critical Thinking for Person-Centred Care, 4th Edition, Educator Resources, 2024.).

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