Reference no: EM133848500

Patient scenario:

Mr. Martin, a 79-year-old African American male, lives in a duplex apartment. He has been widowed for 9 years. Over the past 6 months, Mr. Martin has developed multiple leg ulcers on both legs, but predominantly on the left leg. Vesicles, crusts, and eroded areas are noted over the lower half of the left leg, and the tissue around and between the toes on his left foot is sloughing off. At times, the serous draining is heavy enough to wet his trousers leg. There is a foul odor when Mr. M's stockings are removed.

Mr. Martin goes to doctor for assessment and wound care to his legs. On most visits, the elastic stockings have to be soaked off of Mr. M's legs because of the large amounts of crusted serous drainage that sticks to the stockings. Even when his legs are soaked, there are times when the crusted areas of the wound adhere to the stockings, and tissue is pulled off as the stockings are removed. When asked if there is any pain or discomfort when associated with touch to his left leg, Mr. M denies any, but winces and tenses his muscles when his legs are touched. Reinforcement and teaching regarding the importance of elevating his legs when he is sitting down , not crossing his legs, and wearing his elastic stockings at all times when he is out of bed will be done with each nursing visit.

What are your three part nursing diagnostic statements for this patient?