By Sylvia Foley, AJN senior editor
“I survived, although I had been told that I’d eventually die from infection in the wounds.”
In one of this month’s two CE features, “Calciphylaxis: An Unusual Case with an Unusual Outcome,” Tina Wangen and colleagues report on the intriguing story of L.W., a 40-year-old patient who, aside from being female, had no other known risk factors for the disease. Here’s an overview of the article:
Calciphylaxis is most common in patients with end-stage renal disease, and hyperparathyroidism is often present as well. But several cases in patients with normal renal and parathyroid function have been reported; this article describes one such case. The etiology and pathophysiology of calciphylaxis aren’t well understood. There are many risk factors, and the reported median survival time is 2.6 months after diagnosis. The condition is characterized by isolated or multiple lesions that progress to firm, nonulcerated plaques and then to ischemic skin necrosis and ulceration.
In August 2010, a female patient arrived at the hospital with multiple deep, painful necrotic wounds. Given this patient’s presentation on admission, the nurses kept expecting the physicians to initiate end-of-life discussions with her and were surprised when this did not happen. After five days, the patient was diagnosed with calciphylaxis in the unusual presentation of normal renal and parathyroid function, and the team realized that her chances for survival were greater than expected. The nursing staff was crucial in developing and implementing an intensive treatment plan. The patient survived and made a full recovery.
Treatment. The authors describe the various treatment options for calciphylaxis, which are limited. Ms. W. underwent surgical debridement; anti-infection measures that included the use of wet-to-moist dressings, topical antiseptics, and whirlpool baths; hyperbaric oxygen therapy; and extensive physical therapy. Her plan of care also included pain and anxiety management and nutritional support.
A month after her arrival, Ms. W. was well enough to be discharged to a care facility closer to her home. By six months post-discharge, “after 90 hyperbaric oxygen therapy sessions and endless hours of rehabilitation,” Ms. W.’s wounds had healed completely. Diligent, proactive nursing care was essential to achieving that outcome.
For more information and to see before and after photos, read the article, which is free online. And please share your thoughts and experiences with us below.