Case Study #2

JULY 01, 2005
Lauren S. Schlesselman, PharmD

PD, a 78-year-old woman, was admitted to a longterm care facility for rehabilitation. She has difficulty ambulating due to a recent ischemic stroke and subsequent left-sided hemiparesis. She has poor nutritional intake due to dysphagia. She occasionally experiences nocturnal urinary incontinence.

On admission, the nurse noted a small 2-cm erythematous region on the left sacral region without apparent skin breakdown. PD complains of itching at the site.

Three months after PD is admitted, the pharmacist conducts his 90-day chart review. The progress notes in PD's chart state that the sacral itching has not improved. The pharmacist asks the nurse if he may observe while she examines the site. The area has progressed to a well-circumscribed ulcer with granulation tissue. There is no eschar present, no odor, and no signs of infection. PD complains of pain in and around the area. The pharmacist appropriately stages the wound as a stage II pressure ulcer.

The pharmacist notices that PD's most recent albumin level was 3.0 g/dL. He makes recommendations to PD's physician that would improve PD's nutritional status. The nurse overhears the discussion and asks what serum concentration of albumin is desired.

What is the desired serum concentration?

Dr. Schlesselman is a clinical pharmacist based in Niantic, Conn.

Click Here For The Answer -----------> [-]

The desired serum concentration of albumin is between 3.5 and 5.5 g/dL. Patients with poor nutritional status, as reflected by low albumin concentrations, are at increased risk of developing pressure ulcers and having a slow recovery rate from them.