This case involves an elderly woman who was admitted to the hospital in order to undergo a procedure to remove her kidney following a cancer diagnosis and attempted tumor cryoablation. The surgery went well, and there were no complications noted, however due to the patient’s advanced age and poor health her recovery time was extensive. Following her surgery, she remained in the same hospital in which she underwent surgery for a period of several weeks. During that time, the patient developed stage IV bedsores, which caused a life-threatening systemic infection. The patient recovered, however she required an extended hospital stay and suffered permanent injuries as a result of the sores and subsequent infection.
Question(s) For Expert Witness
- 1. Do you treat and monitor surgical post-operative patients?
- 2. How often do you see patients with bedsores?
- 3. What measures should be taken to prevent patients from developing bed sores?
Expert Witness Response E-008120
I regularly treat and monitor surgical patients in a post-operative setting. I am the clinical nurse manager of a large orthopedic, urology, and cardiac step down unit at our facility. We see quite a few bedsores and follow a protocol for prevention, staging of current pressure ulcers, and treating the wounds. In addition, I have had numerous patients who have had Nephrectomies. I am the President of my State Board of Nursing and have been since 2012. I would need to know the exact length of stay, whether the patient was turned, if the could patient turn herself, if the patient or family refuse turning, what her nutritional status was, her weight, as well as any co-morbidities. Length of stay for my patients who have had a nephrectomy is generally 4-5 days without complications. A stage 4 pressure ulcer is full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. This type of ulcer can include undermining and tunneling. The depth of a stage IV pressure ulcer varies by anatomical location. Stage IV ulcers can extend into muscle and supporting structures (e.g., fascia, tendon, or joint capsule) making osteomyelitis possible. Exposed bone and tendon is visible or directly palpable in Stage IV ulcers.
Expert Witness Response E-000437
I treat and monitor post-operative patients several times a week. In addition, I have managed patients with bedsores routinely for over 40 years, and have lectured regionally and nationally on this topic. Patients first need to be identified as to the potential risk they have for developing a bedsore. Then, a plan of care is developed for prevention. In addition to the routine nursing care of turning, keeping the patient clean and dry, and prevent prolonged contact with objects, additional measures for prevention include pressure reduction mattresses, increased mobility, adequate hydration, adequate nutrition, and management of bowel and bladder incontinence. If the patient does develop impaired skin integrity, the nurse should implement a skin care program that includes further preventive measures as well as treatment to prevent further deterioration of the damaged area.