Maree Smith is an 18-year-old girl who became a paraplegic after a car accident when she was 16 years old. She and some friends were 'joy riding' in a stolen car which crashed into a tree. The driver was killed, the other passengers had minor injuries but she was thrown out of the car because she was not wearing a seat belt.  Before the accident Maree played netball and enjoyed an active social life. She had planned to become a chef. After the accident Maree was in hospital and rehabilitation for 6 months and then returned home where she now lives with her parents and two younger brothers who attend the local high school. The house has been modified to facilitate independence (wet shower area with seating, ramps, use of slide board for transferring) which has meant that Maree has a high level of independence. Maree does not have any previous medical or surgical history and is not taking any medications. Maree's family find it difficult to deal with her behaviour at times – she often appears angry, criticises her mother's cooking and brothers' behaviour constantly, complains about the smallest of things. At first the family were sympathetic because of the situation (Maree becoming a paraplegic) but now her behaviour can be very disruptive, rude and uncalled for. Maree's mother has suggested family counselling but Maree refuses to attend. Recently, Maree spilt a cup of boiling noodles onto her lap resulting in a burn injury. Unfortunately, she was home alone when this occured and no first aid was administered. Maree did not tell anyone about the accident initially and it was only a few days later when the blisters burst and there was staining on her clothing that Maree confessed to what had happened.  Maree's mother applied Jelonet and a non-adherent dressing (from the first aid kit) to the area. About a week later, Maree's mother took her to the local GP because the area had increased exudate, pain and odour.  The GP recommended using Flamazine (silver sulfadiazine) cream with a non-adherent pad daily. A week later, Maree refused to attend the GP clinic and was subsequently referred to the community nursing service for management.

Consider Maree's situation and discuss her management plan.  Your discussion should include:

• skin and wound assessment (using MEASURE or other acceptable wound assessment tool) (this may be presented in table format);
• Establishing an aetiology for the wound (using assessment information and clinical history); 
• Identifying factors which might affect healing in Maree's case; 
• Establishes both short and long-term goals of therapy; 
• A suitable dressing regimen (cleansing; primary and/or secondary; fixation; skin care; frequency of care); 
• Providing a rationale for your choice of dressing(s)(please ensure that you comment on the suitability of the past and current dressing regime); 
• A discussion of alternative dressing options or therapies that highlights both appropriate and inappropriate dressings for this wound (2 appropriate alternative dressings and 2 inappropriate dressings); and 
• Identifies three (3) other factors that should be taken into consideration in the overall management plan for Maree. 

Please note ensure that your assignment is presented as an essay with subheadings and not a series of dot points or tables with limited discussion. Word limit (2500 words)

INRODUCTION

This document is about a case study involving an 18-year-old female client called Maree Smith. Maree is paraplegic following a motor car accident that occurred when she was 16 years old. She resides with her family after spending six months of rehabilitation in the hospital following the accident. The family house has been modified to accommodate Maree who had an active social life and engaged in sports activities prior to the accident. The modifications are aimed at improving her independence.  Maree has however been noted to have behaviour issues that are weighing on her family members. She constantly complains, is always angry and criticizes her mom's culinary skills. She has declined to attend family counselling and sustained burn injury after pouring hot noodle soup on her lap. The wound remained unattended because Maree did not reveal the incident to her family members, she however changed her mind and confessed after the blisters burst. Her mother applied jelonet and non-adherent dressing but an increase in exudate and pain led to her deciding to take Maree to the GP who prescribed flamazine and non-adherent pad. Maree had to be referred to the community nursing service after refusing to attend clinic sessions at the GP a week post treatment commencement. This document will use the MEASURE mnemonic to assess Maree's wound, the aetiology of the wound will be established, factors that may affect Maree's wound healing, short and long-term goals of the wound shall be established, a suitable wound regimen and rationale for suitability, alternative dressing regimens and two inappropriate dressings and lastly, three factors that should be taken into consideration in Maree's overall management plan.

Skin and wound assessment (using MEASURE or other acceptable wound assessment tool) (this may be presented in table format);

Measure: 

It is important to measure the length, width, depth and area of the wound (Keast DH et al, 2004) 

Exudate:

The quantity and quality of exudates should also be noted. According to the information provided, blisters on Maree's wound burst and was noted to be staining her clothes and later, an increase in exudate was noted after commencement of treatment.

Appearance:

The wound bed including tissue type and amount needs to be examined. Wound bed on Maree's left thigh is red and covered by about 40% yellow slough/fibrin tissue and the wound on the right inner thigh is covered by about 30% slough. 

Suffering

The pain type and level need to be known. Maree is paraplegic and therefore does not feel any pain. However, partial thickness wounds are known to be painful due to exposure of sensory nerve endings in the superficial dermis (Cleland, 2012). The pain can be assessed using appropriate pain assessment tool such the visual analogue scale (Keast et al., 2004).

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