L.N., an elderly woman in failing health, had recently moved in with her daughter after her hospitalization for a stroke. The daughter reported to the home care nurse that her mother had minimal appetite, was confused and disoriented, and had developed a blister on her lower back since she had been confined to bed. The nurse noted that L.N. had lost weight since her last visit and that her skin was dry with poor skin turgor. She was wearing an "adult diaper," which was wet. After examining L.N.'s sacrum, the nurse noted a nickel-sized open area, 2 cm in diameter and 1 cm in depth (stage II pressure ulcer), with a 0.5-cm reddened surrounding area with no drainage. L.N. moaned when the nurse palpated the lesion. The nurse also noted reddened areas on L.N.'s elbows and heels.
The nurse provided L.N.'s daughter with instructions for proper skin care, incontinence management, enhanced nutrition, and frequent repositioning to prevent pressure ischemia to the prominent body areas. However, 6 months later L.N.’s pressure ulcer had deteriorated to a class III. She was hospitalized under the care of a plastic surgeon and wound-ostomy care nurse. Surgery was scheduled to débride the sacral wound and close it with a full-thickness skin graft taken from her thigh. L.N. was discharged 8 days later to a long-term care facility with orders for an alternating pressure mattress, position change every 2 hours, supplemental nutrition, and meticulous wound care.
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