At BrightStar Care, every client’s story matters. Today, we’re proud to share a recent client case that perfectly demonstrates how skilled nursing care, compassionate support, and continuous attention can transform lives. 💙
Our client, an 88-year-old woman we’ll call Mrs. V., faced a complex and serious challenge. Following a hospital stay for a hip fracture, she was left with limited mobility, ongoing pain, and a high-risk medical condition: a deep Stage 4 sacral pressure ulcer. For those unfamiliar, Stage 4 pressure ulcers are the most severe, involving full-thickness skin loss with extensive tissue damage. They are extremely vulnerable to infection and require highly specialized care to heal.
Adding to the challenge, Mrs. V. also exhibited mild cognitive decline, particularly “sundowning,” which causes increased confusion, agitation, and restlessness in the late afternoon and evening. This made it not only a medical challenge but also a behavioral and emotional one. Ensuring her comfort, safety, and dignity was as critical as the physical healing process.
The Challenges at Hand
Managing a Stage 4 pressure ulcer outside a hospital setting requires meticulous planning, coordination, and 24/7 care. The primary challenges in Mrs. V.’s case included:
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Clinical Complexity – Stage 4 wounds are deep, often necrotic, and prone to infection. They require consistent sterile management, wound monitoring, and specialized therapies to encourage tissue growth and closure.
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Continuous Care Needs – Maintaining strict repositioning schedules, proper nutrition, and hydration is essential to prevent further breakdown and support healing. This cannot be achieved with intermittent care alone.
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Behavioral Management – Mild cognitive decline and sundowning behavior made routine medical care, such as dressing changes and repositioning, potentially stressful. Emotional support and calming strategies were key to ensuring compliance and comfort.
Our Collaborative Approach
At BrightStar Care, we understand that complex cases like Mrs. V.’s require a multi-disciplinary approach. From the moment she joined our care program, we implemented a comprehensive, high-intensity plan designed to address every aspect of her healing journey.
Skilled Nursing Interventions
Our Registered Nurse (RN) team provided weekly on-site visits to:
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Initiate and manage advanced wound care through Negative Pressure Wound Therapy (NPWT), a specialized method that promotes tissue growth, removes excess fluid, and encourages faster healing.
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Perform sterile dressing changes and debridement, ensuring necrotic tissue was removed carefully and monitoring for any signs of infection.
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Coordinate pain management with Mrs. V.’s primary physician, adjusting medications to keep her comfortable during necessary repositioning and wound care.
The RN’s role was crucial—not just for technical medical care, but also for creating a calm and supportive environment that encouraged healing.
24/7 Support from Certified Nursing Assistants (CNAs)
While skilled nursing provided advanced clinical care, continuous support from CNAs ensured that Mrs. V. received round-the-clock attention. Key aspects of their care included:
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Q2H Repositioning Protocol – Strict adherence to repositioning every two hours, around the clock, to reduce pressure on the wound and support tissue recovery.
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Nutritional and Hydration Support – Assistance with meals focusing on high-protein, high-calorie foods, along with careful monitoring of fluid intake to aid tissue regeneration.
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Assistance with Daily Activities – Full support with dressing, bathing, and other daily activities to minimize strain and energy expenditure.
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Cognitive and Emotional Support – Implementation of routine-based care, distraction techniques, and a calm, consistent environment, particularly during late afternoon and evening, to reduce sundowning symptoms and prevent agitation.
The combination of skilled RN care and constant CNA support created a seamless, holistic environment that addressed both the medical and emotional needs of the client.
The Healing Journey
The results of this approach were both inspiring and a testament to the power of coordinated care.
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Week 1–2: The necrotic tissue was successfully removed, and the wound bed became viable and healthy, ready for healing.
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End of Month 2: The wound had significantly reduced in size and was downstaged to a Stage 2 healing ulcer. Pain levels decreased, and the client began showing improved tolerance for sitting periods with assistance.
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Month 3: Complete epithelialization was achieved. The wound fully healed, pain was resolved, appetite improved, mobility increased, and cognitive stability was maintained. Most importantly, there were zero re-hospitalizations during this period.
Mrs. V.’s recovery was not just physical—it was emotional and cognitive as well. By remaining in a familiar environment with continuous support, she maintained her dignity, avoided the stress associated with moving to a higher-level care facility, and regained confidence and comfort in her daily life.
Why This Case Matters
This case is more than just a medical success story—it is a powerful example of how skilled nursing care transforms lives. Some key takeaways include:
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Prevention of Re-hospitalization – Intensive, continuous care prevented infection and avoided costly hospital stays.
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Effective Clinical Outcomes – The combination of RN-led advanced interventions and constant CNA support led to complete wound healing.
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Improved Cognitive and Emotional Well-being – Routine-focused, empathetic care helped manage sundowning symptoms, promoting calm and restful sleep.
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Recovery in a Comfortable Setting – Healing occurred in the client’s home environment, preserving dignity, comfort, and independence.
This success story highlights that complex medical conditions, even those considered high-risk, can be effectively managed outside of hospitals or long-term care facilities with the right mix of expertise, continuous support, and compassion.
Our Commitment to Skilled Nursing
At BrightStar Care, every client’s journey is unique, and every care plan is customized to their specific needs. Skilled nursing is not just about clinical interventions—it’s about creating a complete care ecosystem where medical, emotional, and behavioral needs are addressed simultaneously.
From advanced wound care and pain management to round-the-clock support and emotional reassurance, our team works tirelessly to ensure each client experiences:
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Expert, evidence-based clinical care
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Continuous, personalized attention
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Support for independence and dignity
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A safe and comfortable healing environment
Our teams of RNs and CNAs are trained not just in technical care but also in compassionate engagement, making them invaluable partners in the recovery journey of clients with complex needs.
A Heartfelt Thank You
We want to take a moment to acknowledge the dedication, skill, and compassion of our care team. Every milestone in Mrs. V.’s recovery—every dressing change, every repositioning, every reassuring smile—was made possible by the combined effort of nurses and caregivers committed to excellence. 👏
This client case study reminds us why we do what we do: every client deserves expert care, compassion, and the chance to heal in a safe and supportive environment. 💙
If you or a loved one could benefit from skilled nursing care at home, don’t wait. Our team is here to provide comprehensive, compassionate support tailored to your needs. Reach out today to schedule your free nurse visit at 978-364-7740.
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