Clinical Report 1
Regions Hospital Outpatient Wound Clinic
640 Jackson St., St. Paul, MN 55101
Evaluator: Jan Chevrette, RN, BSN, CWOCN
Evaluation Period: 12-21-04 to 9-2-05
Patient: Rick C., 64 year-old male, quadriplegic and wheelchair dependent since MVA at age 18 years
| Initial Evaluation Findings on 12-21-04: | Findings on 9-2-05: | Exit Findings on 2-10-06: |
| Braden Score: 10 | Braden Score: 13 | Braden Score: 13 |
| Sleep Surface: Hi-Lo residential electric bed with low air loss mattress overlay | Sleep Surface: Comfortex Rest-Q mattress | Sleep Surface: Hi-Lo residential electric bed with Comfortex Rest-Q mattress. |
| Current Diet: Infrequent small meals & protein supplements, diminished appetite. | Current Diet: Protein supplements, normal appetite | Current Diet: Frequent small meals & protein supplements, normal appetite. |
| Wt: 158.8# | Wt: 175.4# | Wt: 196# |
| HGB: 12.0 g/dl. (L) | HGB: 9.9 g/dl. (L) | HGB: 11.8 g/dl |
| Albumin: 2.5 g/dl (L) | Albumin: 3.7 g/dl (L) | Albumin: 3.9 g/dl |
| Sed Rate: >140 mm/hr (H) | Sed Rate: >100 mm/hr (H) | Sed Rate: 38 mm/hr (H) |
| C-reactive protein: 23.5 mg/dl (H) | C-reactive protein: 5.7 mg/dl (H) | C-reactive protein: 1.4 mg/dl (H) |
Bed surface:
Initially, the patient was on total bed rest on a low air loss overlay which he found to be 1) uncomfortable due to firmness 2) contributed to neck and shoulder pain 3) required frequent repositioning for comfort 4) was noisy and interfered with sleep and 5) did not contribute to the decrease in ulcer size on the sacrum, (L) trochanter, and (R) ischeal tuberosity.
**Patient was placed on the Comfortex Rest-Q mattress on 12-17-04 and reported the following observations: 1) decreased pain in shoulders and back 2) frequent repositioning was no longer necessary 3) foam mattress did not absorb body heat 4) slept more soundly with fewer awake periods 5) no noise and most importantly 6) ulcers improved.
Summary of Ulcer Characteristics
| (L) trochanter | 12-21-04 | 9-2-05 | 2-10-06 |
| size | 7.8 x 5 x 2 cm deep | 5.5 x 3 x 0.8 cm deep | Healed |
| base | Exposed bone, access to joint space some viable tissue | Viable, no bone exposed unable to access joint space | |
| margins | rolled | epithelializing | |
| undermining | 3.2 cm at 10 o’cl | none | |
| Sacrum | |||
| size | 3.5 x 2.3 cm x 2.5 cm deep | 2.5 x 1.7 x 1 cm deep | 1.5 x 0.2 cm at skin level |
| base | viable | viable/granular | granular |
| margins | Viable, stalled, indurated | Epithelializing, scarred | Epithelializing, scarred |
| undermining | 2.9 at 9 0’cl | 2.2 at 9 o’cl | none |
| (R) ischeal tuberosity | |||
| size | 6.2 x 4.2 cm x 2.1 cm deep | 2.5 x 0.7 x 0.5 cm deep | Healed |
| base | Exposed bone, some viable tissue | granular | |
| margins | Rolled | epithelializing | |
| undermining | 1.9 cm at 9 o’cl | none |
Conclusions from the Comfortex Rest-Q Evaluation:
- Patient perceived many benefits from the Comfortex mattress listed above.
- Comfortex mattress is appropriate for patients with a wide variety of health care needs and does not have to be discontinued when improvement goals have been met.
- All ulcers improved on the patient with many barriers to healing.