Understanding Impaired Skin Integrity And Nutritional Imbalance: A Case Study

Causes and Effects of Nutritional Imbalance

Mr. A (the name has been changed due to confidentiality), a 68 year old man was admitted to the healthcare emergency department after having severe lower abdominal pain, which was mild from last few days. The pain occurred while he was having his dinner and the severity of the pain was such that he fell on the ground and injured his head. His daughter called the ambulance and henceforth he was admitted to the hospital emergency department. His daughter revealed that his father was suffering from gastroenteritis from last 3 years and used to suffer from mild pains in past as well. However, this time the pain was so severe that he was unable to move. His daughter revealed that Mr. A does not lead a healthy lifestyle and his dietary habits include oily and less fibrous foods, red meat and high carbohydrate containing food and so on. Further, it was also revealed that Mr. A consumes excess amount of alcohol and he even smokes 10 to 12 cigarettes a day. Mr. A is not very happy in his personal life and after the death of his wife; he becomes agitated while meeting new people. After communicating to Mr. A it was found that he is not comfortable to talk to the nursing staff or physicians and was looking for his daughter for everything he needed.

Nutritional imbalance is the uneven amount of nutrients that are important for our body to function properly and divide in a healthy way. There are several macro and micronutrients present in food products that every individual should consume on daily basis. On the other hand, several food products can create complications in human body and therefore it should be neglected. However, unhealthy life style, physical and emotional condition of individual and aging sometimes creates nutritional imbalance in human body that can lead to severe health conditions. He developed hypertension, stress, depression and therefore his digestion was effected. These health conditions has also induced impaired skin Integrity and therefore, he has developed few untreated wounds on his back legs and stomach. Impaired skin integrity is a tissue damage that cannot be treated by the defense system of the body as lack of nutrition and metal trauma induces this condition (Paganin & Rabelo, 2013). Therefore, from the case study of Mr. A, it is well understood that the interventions taken for him should target these impaired skin condition, wounds and nutritional imbalance in the nursing care plan.

Factors Delaying Wound Healing

In the case of Mr. A, wounds are one of the results of his unhealthy dietary and stressful metal condition. Wound healing is one of the critical biological process that requires restoration of tissue integrity. This is divided into four steps such as hemostasis, inflammation, proliferation and tissue remodeling. However, these steps are dependent on different physiological conditions such as stress, dietary condition, and mental health and so on. High level of depression, anxiety and stress can delay the healing process four times than normal. On the other hand, aging can also be a factor for impaired skin healing or integrity. While aging, supply of cutaneous nerves and blood vessels are decreased and gentle thinning of tissues occurred. Aging also decreases the ability to create collagen therefore leading to impaired skin healing during wounds.

Several factors are responsible for delay in wound healing, such as infection, nutritional imbalance, tissue necrosis, hypertension and aggression, temperature and aging. Bacterial contamination, environmental stressors and pollution can create physiological condition that delays wound healing procedure. Nutritional factor was one of the biggest reason for Mr. A’s impaired wound healing conditions as he was not following healthy lifestyle. Stress, hypertension was another reason for delayed wound healing in his aging skin. Protein and vitamin deficiency, Tissue necrosis, relatively low tissue temperature and excessive tension on wound edges can lead to delayed wound healing and leading to impaired skin integrity (Wahab et al., 2014).

The clinical characteristics of wound is inclusive of different measurements of the wound including the wound bed status, measurement of the wound, peri-wound skin measurement and the type of wound exudate. Wound is the healthy granulation tissue, which is the sign of healing wound. This wound bed is the indicator of healing wound as unhealthy wound bed is red in color and bleeds on contact. On the other hand, pink wound bed is healthy and indicates faster healing process. Measurement of wound is also an integral part of wound treatment as measurement allows the clinician to use appropriate intervention to treat the wound (Gadekar et al., 2012). The basic method of wound measurement is using 12:00-6:00 clock method that measures the length of the wound. After collecting the measurements, it was found that the wound at the back of Mr. A was 3.6 centimeter in length, 5.8 centimeter in breadth and the depth was 2.8 centimeter. 2 cm tunneling was also found in the depth of the wound. The tissue around the wound was full of exudates and red in color. The wound exudates was full of pus and blood and dressing was important to make the wound heal faster (Uzun, Anand & Shah, 2013).

Characteristics and Management of Wounds

The treatment for Mr. A was inclusive of care plans to treat his wounds. Wound management plan along with the interventions to treat his gastroenteritis was included in the care plan. As the patient was admitted in the emergency condition with severe pain in his lower abdomen therefore, pain management is the prime objective for the clinicians in case of Mr. A. further, wound management and nutritional balance will be focused.

Type of tissue	Description	Management
Necrotic tissue	This tissue is present near the wound bed and is black in color. it can be soft or hard	Managing this tissue can be done by allowing autolysis.
Peri wound tissue	Fragile and translucent. These tissues are ink in color and present on the perimeter of the wound	This is present to promote new tissue growth
Granulating tissue	Healthy granule tissue is red in color present in the leg wound of Mr. a, and unhealthy tissue is dark in color present on the back wound of the patient.	Management strategy includes allowing angiogenesis and progression of healing.
Slough	Viscous and yellow wound bed. Wet and dry on the surface.	Management process includes autolysis and removal of debris.

The wound management plan will be implemented once the pain management for patient is over. The progress of wound management plan will be recorded on weekly basis and interventions will be modified according to the status of the wound. Follow up will be taken on daily basis and one nursing staff will be given the responsibility to monitor the wounds daily.

Conclusion

In the conclusion, it can be said that, Mr. A is having several critical health conditions that requires a lot of concentration and dedication. The first intervention will be to manage his gastroenteritis related pain and after that, physicians will focus on his wound management. The assignment includes characteristics of the wound including its measurements and further the wound management plan has also been shared. In the second part of the assignment, nursing care plan has been shared. 

Diagnosis or potential diagnosis	Goal	Strategies and/or interventions	Rationale	Relevant primary healthcare service	Contemporary therapies	Evaluation
Lower abdominal pain in patient (Actual)	To reduce the abdominal pain in Mr. A	1. To assess the pain characteristic including severity, onset, duration and quality of pain. 2. finding a comfortable way to control the pain 3. apply the most appropriate pain management strategy	1. understanding the degree of pain is necessary to apply proper medication and treatment 2. According to the preference of the patient, pharmacological or non-pharmacological interventions can be taken. 3. as Mr. A is suffering from impaired skin integrity therefore clinicians should consider his medical conditions while choosing interventions (Barr et al., 2013)	Pain management experts and primary nurses.	Mind body therapy and nutritional supplementary therapy will be sued to contemporary approach for pain relief (Nahin et al., 2016)	feedback taken from primary nurses will be converted into the pain score for evaluation
Impaired skin healing and wounds (Actual)	To fasten the healing process and minimize the occurrence of new wounds	1. Wound assessment will be done. It will include mound measurement, peri-wound measurement. 2. reduce situations that induces wounds generation 3. Help patient to understand the type of food or situation that leads to wound.	1. It is important to assess the wound to understand its treatment 2. it is important to reduce the stress that leads to induce hormonal imbalance in the body 3. helping patients will make the clinicians understand the lifestyle that leads to wounds in Mr. A. (Montero et al., 2012)	Wound care specialist and nursing staff	Other complementary intervention includes cleaning and dressing the wound, making the patient aware of pros and cons of the healthy dietary habits and so on (McAleer & Irvine, 2013).	It is important as successful implementation can provide the patient a healthy quality of life
Nutritional imbalance (Actual)	To compensate the nutritional imbalance in Mr. A	1. record the nutritional imbalance and dietary preference 2. make a nutritional plan for the patient that includes macro and micro-nutritional balanced diet	1. it is important to understand the nutritional intake of the patient to assess the amount he need further 2. this will help the patient to fulfill his nutritional intake (Popkin, Adair & NG, 2012)	Nutritionists Dieticians and primary nursing staff	Providing the patient with vitamins and minerals to compensate for the dietary lack. can be a contemporary intervention (Chaix et al., 2014).	Assessment will be done based on the health recovery conditions. Evaluation will be done on weekly basis.
Poor self-hygiene needs (actual)	Considering the age of Mr. A, and his mental conditions it is evident that his hygiene level is not so good and he is not able to understand the importance of his daily hygienic requirements	1. understand the daily hygienic conditions that Mr. A follows	1. It is important as understanding the daily hygiene routine of Mr.  will help doctors to understand his hygiene needs (Bakker et al., 2014)	Primary care nurse	Providing the patient with community support can also provide contemporary intervention (Bakker et al., 2014)	This will help to enhance the quality of life of the patient.
Hypertension and anxiety (actual)	Considering the mental health of the patient it is important to understand his mental state that lead him to choose addiction as a way out	1. his mental status will be understood with the help of his daughter and a psychiatrist	It is important to understand the metal condition of the patient as wound healing process can be delayed because of the stressed and depressed mental health condition.	Primary nursing staff, psychiatrists	Providing counselling to the patient about healthy lifestyle and dietary habits can be used as contemporary intervention	It will help to enhance the quality of life
Infection due to unhealed wound (Potential)	As the patient has unhealed wound on his body, hence there is a chance of infection in near future.	1. The wound measurement will be taken and depth and tunneling will also be measured. The wound exudate will be examined	1. it is important to assess the current status of the wound 2. the exudate or pus isolated from the wound will help to understand the microbial load of the wound that can create infection (Langer et al., 2015)	Microbiologist Primary nursing staff	Dressing and cleaning the wound area can be used as contemporary interventions for wound management (Zhao et al., 2013)	It will help to accelerate the wound healing process.
Disturbed sleep pattern (potential)	To promote regular sleep habits in patient	1. assess the sleep pattern of the patient and provide proper environment to provide healthy sleep	This will help to identify the factor that inhibit sleep and will help to inhibit the factors	Primary nurse	Pharmacological intervention may aid to healthy sleeping and therefore it should be taken as contemporary intervention	It will help to remove depression and anxiety form the patient’s life and will help him to focus on his dietary and nutritional requirements
Risk of social isolation (Potential)	As the stress and depression level is increasing in the patient, the risk of social isolation has been increased and therefore intervention should be applied for this	1. assess the social connection of the patient and analyze the reason of social isolation 2. encourage him to connect to new people	1. it is important as it will help to assess the behavioral issue and negative feelings of patient 2. participating in social program will help him to divert (Dam et al., 2016)	Nurse and community service	Stress management and psycho-education can be used as contemporary intervention (Beinart et al., 2012)	It will help to relief the stress and depression of the patient
Diabetes (potential)	As the nutritional imbalance is increasing in patient, hormonal imbalance can occur that can lead to diabetic conditions	1. blood sample of the patient will be taken to assess the diabetic tests	It is important as assessment of diabetic condition can help to understand the internal reasons of delayed wound healing procedure (O’Hagan, De Vito & Boreham, 2013).	Lab assistant, microbiologist and nursing staff	No such contemporary intervention is needed	It will help to restrict the dietary preferences of the patient

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