Nsg. Dx: Impaired Skin Integrity

Doctor’s Diagnosis: Pressure Ulcer Stage III

Nurse’s Diagnosis: Impaired skin integrity related to immobility as manifested by presence of bedsores in the upper and lower extremities

Diagnosis of a certain disease differs when you are a nurse or a doctor. A nurse’s diagnosis is more meticulous and detailed compared to doctors. It just goes to show that nurses are very detailed and particular when it comes to these but diagnosis is not my reason for this post.

One same, old day during my duty at one of the hospitals in Bulacan (Philippines), assigned at the emergency room, while waiting for some patients to come but there is none. After long hours of wait, I even fell asleep at one corner, there came a man carrying an old lady within the age range of 60-70, She is half-conscious, and we immediately let her lie at the ER bed to have her Vital Signs checked and to be physically assessed.

Upon assessment, the patient’s body built is not proportionate to age and lifestyle (underweight), has signs of distress, not oriented with the three spheres (time, date and place), blind, immobile, the client is unkempt (poor personal hygiene), edematous, has presence of bedsores in upper and lower extremities, abdomen and back, has history of hypertension. The patient was brought to the hospital because of worse “wounds” (Chief complaint should be as verbalized by the client right?)

Being the student nurse on duty, I got her Vital Signs, I was with my group mate, I let her check the patient’s Blood pressure while I am getting the cardiac and respiratory rate but she was making face and trying to tell me that she can’t do it and so I took charge. The patient is agitated but I felt she was more of scared. Since she was blind, w let her know that she was in the hospital, I held her hand but when I let go, she wouldn’t. I can really smell the obnoxious odor of the patient (due to the sores and poor hygiene) but I didn’t bother.

I further assessed the patient but I think one of the relative said “Natignan niyo na siya diba? Tama Na! Hirap na yung matanda… Ngayon lang makakapagpahinga yan eh.” (You have already examined the lady right? Please leave her alone, she’s having a hard time and it’s only now that she will have a rest…) and so respecting the relative’s wish, I stopped and then I and my group mate leave the ER.

At the lobby, we had a conversation that goes this way:

Me: In the future and if ever I will be in the situation like that, I won’t let my mom or grandmother experience that.

Group mate: My grandmother was bedridden but she doesn’t have and never had bedsores until she died. They just took for granted the old lady.

Me: How can the old lady rest? The fact that she is in a hospital, Hello? They are the one’s to be blamed for the current health status of the patient. What kind of family are they? Just now? When the situation got worse?

Group mate: Oh well, that’s life.

Sometimes, or most of the time, I become tactless of what I say when I am pissed off especially when there are people being taken for granted, stepped on, not treated equally and rightfully.

Few minutes I talked to my group mate again.

Me: Sh*t! The relatives were just by our side. I think they heard me.

Group mate: Definitely, but it’s ok.

Me: Yeah, it’s OK so that they’ll know their mistake and will not take for granted the same person who herself take good care and raised them well.

Our conversation is much better if it’s in Filipino but I translated it for the benefit of the many.

Guilty as I am charged for being tactless, I should stand my act (yes, I know I am the heroine here but I shouldn’t have done it in that manner. The end doesn’t justify the means right?)

Going back to the patient, an Intravenous Line is inserted to her hand, she was admitted and brought to the OR (Operating Room) for a debridement (Surgical scraping of the dead cells for faster healing of the wound) Poor old woman, for she will again endure pain though she will be on anesthesia.

I don’t know if there’s any self-worth left to the patient. I don’t know if she still wants to live for that matter. People surrounds me and do stuffs with me that I don’t even know. I can’t even see but I can clearly feel makes me wish I was just deceased.

Old age scares me, its degenerative process and all but that’s the way of life. We were born, we grow older, and then die (lucky if you didn’t catch disease and just die due to old age). I just hope I won’t be like that because I myself won’t let the shoes of the old lady happen to my family. I promised that to my group mate.

P.S:

The attending physician made it clear to the relatives that it is not just a “wound” but it is Pressure Ulcer meaning a wound that got worse— because of negligence (well, I was the one who added this.) For added information about Pressure Ulcer, click here.

God has given us a (human) BODY to take care of in this world— if not; good thing there is a SOUL. The question is, are you taking care of it?

Posted by: Dianne Peña | 05-20-2008 | 11:05 PM
Posted in: Rhapsodies