Q1: When visiting Farhan to change his dressing you notice over granulating tissue. What action do you take?
2. Reassess the wound.
I would examine the wound more closely to see about changing to another type of dressing. Over granulation can be accompanied by signs of infection – so I’d check for those and probably change to an antimicrobial foam dressing, maybe applying antimicrobial or silver nitrate ointment first. This will resist infection and aid healing.
Q2: Farhan does not always understand what is happening to him during a consultation. How do you approach this?
2. Adapt your communication to explain to Farhan carefully and appropriately what is happening.
It’s important to avoid using medical jargon with Fahran, so I would speak using simple language and avoiding complex terms. I would use words he may easily understand and speak at a slower pace than usual. I’d also try to put him at ease by being friendly and kind, as if I were speaking to an older child. I’d also check that he had understood anything I said by asking him questions after anything I’d explained.
Q3: People who live in assisted living can be discharged home at any time?
2. Wrong, each patient needs to be treated as an individual. Needs change and you need to establish the cause for admission in the first place.
Fahran’s response to the surgery needs to be considered. For example, he may be agitated afterwards and attempt to remove the dressing. So he may need to remain in hospital longer than other patients, so that nurses can keep a closer eye on him and hopefully prevent him disturbing the dressing or moving around too much post operatively. It’s possible that in the supported living accommodation where’s he’s been staying, that staff have left him to sit for long periods without activity, which may have exacerbated or caused the condition. So it would be important to review his activity levels in the long term (once recovered) to ensure that Fahran doesn’t experience a repeated case of pilonidal sinus. Communication with the home and the staff would be needed, along with an action plan too prevent worsening or a repeat case.
