A 64-year-old woman with a past medical history of morbid obesity, type II diabetes mellitus, recurrent urinary tract infections, and depression was a resident of a long-term care facility (a skilled nursing facility) due to multiple chronic illnesses. At baseline, she used a wheelchair for mobility and required some assistance with activities of daily living (ADLs).
During an unassisted transfer from her wheelchair to her bed she slipped and fell. She immediately complained of hip pain and was transferred to an acute care hospital. She was found to have a left hip fracture as a result of the fall and underwent an uncomplicated surgical repair. She was ultimately readmitted to the original skilled nursing facility with severely limited mobility secondary to the surgery. At the time of readmission, she was essentially bedbound, unable to transfer to a chair or her wheelchair.
A few weeks later, she continued to remain bedbound with little progress in her functional status. One morning when the nurse was delivering her morning medications, the patient was found to be confused and combative where previously she had been alert, oriented, and always very pleasant. She was febrile to 102°F and had a blood pressure of 110/70 mm Hg, which was lower than her usual. Because of concerns for an acute infection, she was transferred to an acute care hospital.
At the hospital, a full examination revealed a very deep pressure ulcer in her sacrum (stage IV full thickness ulcer), which had developed at the long-term care facility after her hip fracture. Unfortunately, likely secondary to an infection of the pressure ulcer, she developed septic shock and died 3 days later despite maximal efforts.
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