A good nursing plan will ensure consistency and continuity of care, which will help minimise the occurrence of decubitus ulcers. There are several nursing interventions that can be implemented by VNs to avoid a prolonged, painful and debilitating recovery for the patient.
Owner participation in wound management is essential, as owners ' understanding of veterinary instructions for bandage care, wound monitoring and medication administration will directly influence healing outcomes and patient welfare.
Background
This case study evaluates the nursing care of a border collie dog called Maddie with a large wound located in a mobile area( the olecranon), which was diagnosed as a decubitus ulcer. It details the many challenges encountered throughout the healing process, including the impact of patient movement and repeated wound infections, which included infection with antibioticresistant bacteria.
The case proved to be particularly challenging due to the position of the pressure sore and the various complications that arose, including the development of new wounds, numerous infections and the treatment protocols used to manage these infections.
The bacterial infections identified in this case were Escherichia coli, Staphylococcus pseudintermedius, Enterococcus faecalis and methicillin-resistant Staphylococcus pseudintermedius( MRSP).
The owners played a pivotal role in maintaining a high standard of wound care and overall wellbeing in the patient during the 6 months of treatment and care required in this case.
Assessment
Maddie had started to struggle with her mobility when she was 6 years old and had been presented to the veterinary surgeon( VS) with intermittent lameness, which had ultimately required medical treatment( Table 2).
Table 2. Maddie ' s medication.
Medication Dose rate Dose given
Meloxicam( Boehringer Ingelheim)
Gabapentin( Pfizer)
Bedinvetmab( Librela, Zoetis)
0.1 mg / kg( 1.5 mg / ml)
1.46 ml once a day
10 – 20 mg / kg 300 mg twice a day
0.5 – 1 mg / kg 15 mg once a month
On this occasion, on 9 March 2023, the owners brought Maddie to the practice due to her‘ not being herself’ over the previous few days. She had been struggling to get up and was eating only when the owner helped her to get up and encouraged her to eat, which was unlike her normal behaviour.
During the physical examination, the VS found muscle wastage over both hindlegs. Proprioception was generally normal, but she was slow to correct her right hindleg on one occasion. She splayed her hindlegs when standing and gradually chose to lie down.
The VS found a subcutaneous swelling caudal to the right elbow and thickening of the bone in that region. The skin was moist and a purulent discharge oozed from a small hole in the skin laterally over the point of the elbow( Figure 1).
Learning outcomes
• Identify a decubitus ulcer
• Review the management of challenging wounds
• Understand the differences between types of dressing materials
Patient signalment
Species Breed Age Sex Weight
Dog Border collie 15 years 7 months Female, neutered 21.4 kg
Figure 1. A small hole in the skin over Maddie ' s elbow.
36 Veterinary Nursing Journal