Graduate Certificate in Wound Management
WMTLLU806A: Assess and manage patients with lower leg ulceration
related to circulatory insufficiency
Case Study
Warning – Uncontrolled when printed! The current version of this document is kept on the William Light Institute website.
Authorised by: Academic Director Smartfutures Pty Ltd ABN 31 127 177 637 T/A The William Light Institute
Document Owner: Academic Director Smartfutures Pty Ltd ABN 31 127 177 637 T/A The William Light Institute Current Version: 23/06/2016
Page 1 of 4
Mrs Robina is a 78 year old female who is refereed to your wound management outpatient clinic by
her local doctor for assessment of a wound on her right leg. She first presented to her local doctor
two weeks ago but the wound has failed to heal.
Past Medical History:
 She describes her health as good. She takes no medication
 She developed varicose veins in both her legs after her third pregnancy. She had stripping and
ligation of veins in her legs 40 years ago however the varicose veins have returned.
 Her legs have been getting swollen in the evening for approximately the last 5 years. This has
increased over the last 8 months with increased swelling throughout the day.
 She complains of leg pain when standing for long periods of time. This is relieved when she sits
down and puts her leg up.
 She does not remember ever having a wound on her leg which did not heal.
 She has never smoked.
Patient demographics:
 Height 170cm
 Weight 82kg
Social history:
Mrs Robina lives at home with her husband. She is actively involved as a volunteer in her local
community including serving at the community shop one afternoon per week.
Her husband has chronic illnesses including heart disease and arthritis which restrict his mobility.
Mrs Robina is responsible for the shopping and food preparation and all household chores. She
drives a car and regularly is required to transport her husband to medical appointments. They have
three adult children, with one living locally with two young children.
Recently the wound on her leg has made prolonged standing difficult so she has had to limit her level
of activity including reducing her hours of community service which she is disappointed about.
Nutrition
Mrs Robina states that she aims for a healthy balanced diet and cooks meat, grain and vegetable
based dishes for herself and her husband. She states that as she has gotten older that she finds that
her appetite for meat has decreased and has found herself eating smaller portions than her
husband. She tries to eat three meals a day, however finds that a small snack at lunch time is
sufficient on most days.Graduate Certificate in Wound Management
WMTLLU806A: Assess and manage patients with lower leg ulceration
related to circulatory insufficiency
Case Study
Warning – Uncontrolled when printed! The current version of this document is kept on the William Light Institute website.
Authorised by: Academic Director Smartfutures Pty Ltd ABN 31 127 177 637 T/A The William Light Institute
Document Owner: Academic Director Smartfutures Pty Ltd ABN 31 127 177 637 T/A The William Light Institute Current Version: 23/06/2016
Page 2 of 4
Wound History
She says that the wound occurred when she knocked her leg on a piece of wood in the garden a
couple of month ago. Initially it was a small laceration, approximately 4 cm long which she covered
with a bandage. During the ensuring period it has increased in size and started to produce large
amounts of exudate. She says the exudate is sometimes offensive and soaks through her clothing
frequently during the day especially when she is working at the shop.
She saw her local doctor two weeks previously and was advised to cover the wound with gauze and
a crepe bandage and has recommended changing it every day. Upon review the wound had failed to
improve so referral for further opinion was indicated.
She says the wound is not painful but her legs feel heavy and ache at the end of the day.
Assessment and Physical Examination
Mrs Robina arrives unaccompanied to the wound management clinic. She is alert and mobile but
walks unaided with a moderately pronounced limp. She admits feeling ‘generally unwell’ for the
last few days. Vital signs are as follow:
 Blood Pressure 130/95
 Heart Rate 86
 Temperature 38.4C
Physical Examination revealed the following:
 There is mild oedema to the lower leg and the skin is dry and scaly with some reddish brown
pigmentation over the ankle region extending to the lower leg. There is some indentation of the
skin in the area where the crepe bandage had been wrapped around.
 There is evidence of varicose veins over the calf and thigh on the right leg.
 The wound is over the medial aspect of the lower leg it is covered with a gauze dressing and a
bandage. Some of the dressing has adhered to the wound bed.
 There is evidence of serous exudate on the gauze which has soaked through the bandage, and
the bandages are slightly malodorous.
 There is some erythema to the skin surrounding the immediate peri-wound area. The
surrounding skin is also dry and scaly and the texture of the skin changes from soft to a more
firm texture around mid to distal calf.
 Capillary refill time is less than 2 seconds.
 Dorsalis pedis pulse is able to be palpated. Posterior tibial not assessed due to the location of the
wound.
 The ankle brachial pressure index is 0.96 in the right leg, with DP and PT pressures greater than
120 mmHg.Graduate Certificate in Wound Management
WMTLLU806A: Assess and manage patients with lower leg ulceration
related to circulatory insufficiency
Case Study
Warning – Uncontrolled when printed! The current version of this document is kept on the William Light Institute website.
Authorised by: Academic Director Smartfutures Pty Ltd ABN 31 127 177 637 T/A The William Light Institute
Document Owner: Academic Director Smartfutures Pty Ltd ABN 31 127 177 637 T/A The William Light Institute Current Version: 23/06/2016
Page 3 of 4
Blood Results
The following blood results represent her biochemical and cellular markers on presentation to the
wound management clinic.
Pathology Result Normal Range
C-Reactive Protein 50 <5.0mg/L
White Cell Count 10.8 4.0 – 11.0×109/L
Neutrophil Count 7.4 1.8 – 7.5×109/L
Monocytes Count 0.8 0.2-0.8.0×109/L
Haemoglobin (Hb) 128 115-155 g/L
Platelet Count 210 150-450×109/L
Sodium (Na) 141 137-145 mmol/L
Potassium (K+) 3.3 3.5 – 4.9 mmol/L
Chloride 99 100-109 mmol/L
Albumin 29 34-48 g/L
Urea 7.1 2.7-8.0 mmol/L
Creatinine 98 50-100 umol/L
Total Protein 64 65-85 g/L
Microbiology
A wound swab performed by the GP has returned a positive culture for Staphylcoccus aureus (gram
positive) and E.coli (gram negative), with no antibiotic resistances identified.
Venous duplex Doppler scan:
Results from a recent venous duplex ultrasound of the right leg have revealed a previously
ablated greater saphenous vein (GSV) which remains non-patent. There is evidence of
retrograde flow (venous incompetence) of the short saphenous vein (SSV) and there is also
evidence of venous incompetence of the femoral veins (deep venous disease). There is a small
amount of non-occlusive thrombus detected in the distal popliteal vein. The scans were able to
be compared with older imaging of the right leg and reveal that the deep venous disease is a
new finding.

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