• Read the case study carefully, then answer the following questions in complete sentences using evidence-based nursing practice.
• May use course materials and U Central as needed to support your answers. Please write in your own words.
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Story: The Case of “Linda’s Pressure Injury”
(Name changed for privacy; drawn from a real, publicly reported patient safety case used in hospital safety trainings)
Background:
Linda, a 72-year-old retired schoolteacher, was admitted to a large community hospital after elective abdominal surgery. She had several risk factors: diabetes, mild malnutrition, and limited mobility post-surgery.
Timeline of Events:
• Day 1–2: Nurses documented that Linda had a Braden score of 14 (mild risk). The care plan included repositioning every 2 hours, but the unit was short-staffed. Turning was inconsistently done, and no pressure-relieving mattress was ordered.
• Day 3: A small red area was noted on her sacrum, but no wound care consult was placed. Documentation was incomplete, and the day shift assumed the night shift would follow up.
• Day 5: The redness turned into a blistered Stage 2 pressure injury. Linda began complaining of pain, but her pain was dismissed as “normal post-op discomfort.”
• Day 7: The wound deteriorated to a Stage 3 ulcer with drainage. Infection set in, requiring IV antibiotics and a longer hospital stay.
• Outcome: Linda was discharged after an additional 12 days with a complex wound requiring home health care. She described feeling ignored and helpless and later became an advocate for pressure injury prevention in hospitals.
• Part A – Questions (Answer All 5)
1. Risk Identification 🔎
Linda’s initial Braden score was 14. (0.5pts)
o What specific risk factors contributed to this score, and why should a score of 14 trigger preventive interventions?
o System Factors 🏥
Staffing shortages were noted during Linda’s hospitalization. (0.5pts)
Limited Mobility Post-Surgery: This directly relates to the Mobility sub-score on the Braden scale. Post-operative pain and recovery restricted her ability to spontaneously shift position, increasing the duration and intensity of pressure and shear on her sacrum.
A Braden score of 14 falls into the category of Mild Risk (or "At Risk," often defined as 15−18, with 13−14 being "Moderate Risk" by some standards, but consistently requires action). A score of 14 should trigger preventive interventions because any score below 18 is considered "at-risk" and, according to evidence-based guidelines from organizations like the National Pressure Injury Advisory Panel (NPIAP) and facility protocols, requires implementing a standardized skin care bundle, which must include:
Repositioning: Implementing a scheduled turning protocol (e.g., every 2 hours).
Support Surfaces: Using a pressure-relieving or pressure-redistributing mattress/overlay (e.g., a low-air-loss mattress) to manage the risk related to her limited mobility.
Nutrition: Initiating a nutrition consultation to address the mild malnutrition.
System Factors 🏥
Staffing shortages were noted during Linda’s hospitalization. (0.5pts)
(Assuming the rest of the question asks how staffing shortages contributed to the injury:)
Staffing shortages contributed directly to Linda's injury by creating a breakdown in the established care plan, which is a major system failure in pressure injury prevention.
Inconsistent Adherence to Repositioning: The case explicitly states that turning was "inconsistently done." Pressure injury prevention hinges on the consistency of the 2-hour turning protocol to ensure sustained pressure is relieved. Staff shortages led to task prioritization where non-immediate tasks, like scheduled turning, were often missed.
Failure of Surveillance and Documentation: Incomplete documentation on Day 3 meant that critical information (the small red area) was not effectively handed off. Short staffing reduces the time nurses have for thorough skin assessments and meticulous charting, leading to a breakdown in communication and follow-up between shifts.
Dismissal of Symptoms: Short-staffed nurses are often overwhelmed, which can lead to cognitive shortcuts and failure to listen actively. Linda's pain complaints were "dismissed as normal post-op discomfort," delaying recognition and intervention for the developing Stage 2 injury.
Sample Answer
Risk Identification 🔎
What specific risk factors contributed to this score, and why should a score of 14 trigger preventive interventions?
Linda's specific risk factors that contributed to her initial Braden Score of 14 were:
Diabetes: Contributes to impaired circulation and peripheral neuropathy, reducing tissue perfusion and sensation, making her skin more vulnerable to ischemia and injury.
Mild Malnutrition: Impairs tissue repair and regeneration due to a deficiency in protein, calories, and micronutrients. Poor nutrition means her skin and tissue lacked the necessary building blocks to withstand or heal from pressure