Site icon New

MCQ – 88219

amit18289

Question

A 38-year-old man comes to the physician for a follow-up examination. He was treated for a urinary tract infection with trimethoprim-sulfamethoxazole 2 months ago. He is paraplegic as a result of a burst lumbar fracture that occurred after a fall 5 years ago. He has hypertension and type 2 diabetes mellitus. Current medications include enalapril and metformin. He performs clean intermittent catheterization daily. He has smoked one pack of cigarettes daily for 19 years. His temperature is 37.1°C (98.8°F), pulse is 95/min, respirations are 14/min, and blood pressure is 120/80 mm Hg. He appears malnourished. Examination shows palpable pedal pulse. Multiple dilated tortuous veins are present over both lower extremities. There is a 2-cm wound surrounded by partial-thickness loss of skin and a pink wound bed over the right calcaneum. Neurologic examination shows paraparesis. His hemoglobin A1c is 6.5%, and fingerstick blood glucose concentration is 134 mg/dL. Which of the following is most likely to have prevented this patient’s wound?
A. Compression stockings
B.

Cessation of smoking
C.

Optimising blood sugar control
D.

Frequent position changes
Show Answer

Correct Answer � D

Explanation

Answer: D. Frequent position changes

The presence of partial-thickness skin loss calcaneal wound with a pink wound bed in a paraplegic individual is suggestive of a stage II pressure ulcer.

Frequent position changes

Bedfast or chairfast individuals such as this patient are at risk for the development of pressure ulcers. To prevent this condition, at-risk patients should undergo position changes at least every 2 hours to reduce the duration and magnitude of pressure over vulnerable areas of the body such as the heels, ischial tuberosities, and other bony prominences. Further prophylaxis includes optimizing the patient’s nutritional status, obtaining sufficient glycemic control, and educating the patient regarding frequent mobilization and control of infection.

Treatment for a stage II decubitus ulcer includes pressure relief of the affected areas, wound treatment with removal of dead tissue and hydrocolloid dressings, and skin care. Newer methods of treatment, including electrical stimulation, negative pressure wound therapy, and hyperbaric oxygen therapy, can also be considered.

Exit mobile version