“It isn’t fair. I’ve worked so hard all my life, I don’t deserve this,” thought Mrs. Ross as she looked down at her right leg where a large wound gaped open. Two weeks ago, she had a femoral-popliteal bypass, which got infected. The wound was opened up and was healing slowly by secondary intention. It was painful, raw, and frightening. She put a hand on her chest and raised the head of the bed higher so she could catch her breath and stare out the window. Nursing Assessment Including Client Story
Mrs. Ross is a previous landowner and farmer’s wife with extensive acreage. Her husband died 2 years ago, and the land was sold. She lives alone in the farmhouse and has help coming in two times a week. As she grew older, she isolated herself in her home and rarely went out. She has had multiple health problems. In her 30s, she attempted suicide and was rescued. She speaks rapidly and seems unable to hold still. Ten years ago, she was diagnosed with chronic obstructive pulmonary disease, but she continued to smoke two packs of cigarettes a day. Five years ago, she was diagnosed with heart failure, yet still she continued to smoke. Two years ago, she developed disabling pain in her right foot and leg. She stopped smoking and worked hard to get healthy.
Her right foot turned almost black, she could no longer walk, and she agreed to have a femoral-popliteal bypass. After surgery, when the infection set in the leg, she was very angry and sputtered at everyone. She was transferred to the long-term care section of the hospital. Vital signs are: BP 96/62; pulse: 99 to 122 beats per minute and irregular; respirations: 20 breaths per minute. Heart sounds are irregular and distant; peripheral pulses are very weak; dorsalis pedis pulse is present in both legs but weak; lung sounds include wheezes and coarse crackles throughout; and oxygen saturation is 88% to 90%, on oxygen at 3 L. A wound vac is attached to the wound to help close the large opening. Mrs. Ross has not been out of bed for 4 days. She is eating minimally.