Carefully read the case study below and respond to all related questions in your initial post. Provide support from a minimum of two scholarly sources:

Janice Pressley is an 84-year-old Black woman residing in a long-term care (LTC) facility. She has been immobile since undergoing an open reduction and internal fixation of the left hip following a fall. Mrs. Pressley had lost 9 pounds since the fall one week ago. The AGPCNP notices a darkened circular area to the left heel and redness to the coccyx upon return to the LTC facility.  

ROS: The family denies fever, chills, nausea, vomiting, diarrhea, excessive bleeding or bruising, weight gain. The medical record shows a 9-pound weight loss since the fall. The family reports poor appetite, constipation, impaired memory, and occasional shortness of breath. Patient cries out and yells during repositioning or movement of left leg.

Social History: Retired music teacher and pianist. A widow for six years. Denies tobacco or illicit drug use. Reports she used to drink brandy at bedtime.  She has two daughters; one lives locally, and the other lives in Jacksonville, FL. Before her memory deteriorated, she used to teach private piano lessons.   

PMH: Alzheimer’s with dementia, constipation, HTN, and HF. 

PSH: Open reduction, internal fixation of left hip, total right knee replacement, cholecystectomy, bilateral cataract surgery  

Allergies: No known drug allergies.    

Current Medications: MVI daily, enoxaparin 40 mg SC daily, donepezil 10 mg at bedtime, metoprolol succinate 25 mg daily, furosemide 40 mg daily, ramipril 2.5 mg daily, lubiprostone 24 mcg daily w/food, hydrocodone 5 every six hours as needed for moderate to severe pain, acetaminophen 500 mg every 4-6 hours as needed for pain

Vital Signs: Temperature:  98.1 – Pulse: 78- Respiration: 20 – BP: 146/86 – Weight: 92 pounds – Pain: The patient cannot rate pain on a scale, but she continually yells out when repositioned or the left leg is touched.

Labs: WBC 8.2; H&H: 9.0/27; Platelets: 201; Sodium 130; Potassium 3.9; BUN 9; Creatinine 1.1; Albumin 2.3 

Physical Examination: General: Frail older Black woman. Head: NC/AT. Neck: Supple. Carotid pulses 2+ bilaterally. Cardiovascular: Regular rate and rhythm. Lungs: Thorax symmetrical. Lungs diminished.  Abdomen: flat, soft, non-tender, non-distended, and no HSM. Hypoactive bowel sounds in all four quadrants. No guarding or rebound tenderness. Musculoskeletal: Moves all extremities with decreased ROM left hip. Extremities: Non-pitting edema to the left lower extremity. Pedal pulses 1+ bilaterally.  Skin: left hip incision open to air, well-approximated. No drainage, minimal redness to incision. Turgor is non-elastic. Nails are without clubbing or cyanosis. No rashes. Skin color is uniform, even toned with pink undertones except for the left heel and coccyx.  The darkened area to the heel measures 6 cm in diameter. The redness to the coccyx measures 3×5 cm, with a break in skin noted.

Answer the following questions for the initial post: 

• What risk factors does Mrs. Pressley have for developing pressure ulcers?
• Explain the probable cause of the darkened circular area to the left heel and redness to the coccyx.
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• The Wound Healing Society uses the mnemonic TIME to describe impaired wound healing. Using the TIME mnemonic, what assessments should the AGPCNP perform for Mrs. Pressley’s heel and coccyx wounds?
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• Describe the likely stages of the wounds above.
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• What treatment strategies could the AGPCNP order to treat pressure ulcers (stages I-IV)? Be sure to include both pharmacological and non-pharmacological treatment strategies.
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• What laboratory and diagnostic tests should the AGPCNP order for a patient with impaired skin integrity?
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• What other disciplines could the AGPCNP consult with to manage Mrs. Pressley’s wounds? Please provide a rationale for each.
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• What education could AGPCNP provide to help educate the nurses in this LTC facility on preventing pressure ulcers?