Homeless Step Down Pathway Case Study 8

Social History

The patient, T has no partner nor dependents, was homeless and then went to prison. He was released on 22/12/2020 and has been sleeping rough. Smokes- 20-40 cigarettes a day, Alcohol, 8-16 cans of lager daily plus Intravenous Drug User (IVDU) Heroin.

Past and Present Medical History

Chronic Obstructive Pulmonary Disease (COPD),

Schizophrenia, Personality Disorder, Hepatitis C,

Bilateral Femoral Deep Vein Thrombosis and

Infected Right Venous Ulcer for 4 years

Drug History

T is on Thiamine 100mg three times daily, Vitamin B Compound Strong 2 three times daily, Paracetamol 1g 4 times daily when required, Apixaban 5mg twice daily plus Methadone 40mg/40mls daily, and nicotine replacement therapy.

Reason for Admission/Referral:

Step down as a Homeless patient as he was Covid-19 Positive. Nursing management of right infected venous leg ulcer.

Presentation on Admission at Mildmay Mission Hospital

T arrived mobilising independently. He was oriented to time, place and person. Vital signs were stable.

Since admission, T has received services in Mildmay Mission Hospital from the various multi-disciplinary (MDT) members. These including:

Physiotherapy sessions which in most cases declined to participate.

The Housing officer has engaged with him in numerous occasions for housing application.

Dietician input. Weight as at 06/02/2021 was 65.9kg. (TS) weight on the 13/02/2021 was 68.8kg.

T also had the chance to be given Nicotine Vape on request by staff.

Daily wound dressing commenced on the day of admission with the following: -

Wound being irrigated by Prontosan

Urgotul Ag Silver use as primary dressing

Padded with Xupal

Wound then secured with K-Soft and Crepe Bandage.

On admission, the wound was measured as follows;

Right Lateral aspect of the leg =10cmx5cm

Right Medial aspect of the leg =11cmx6cm

Wound as at 09/02/2021 measured as follows;

Right Lateral aspect of the leg=9cmx4cm

Right Medial aspect of the leg=5cmx4cm.

T has been very happy and grateful to the staff at Mildmay as this is the first time in four years that, he has seen a significant improvement of his leg ulcer, he also reported that since his admission at Mildmay he feels that he is treated as a human being.

Written by Kobe Kwateng Staff Nurse