Mrs. B is admitted to your acute care facility for treatment of multiple pressure ulcers. She has a stage IV pressure ulcer on her R.heel. a stage II on her L hip and another stage III on her sacrum.

Mrs. B is admitted to your acute care facility for treatment of multiple pressure ulcers. She has a stage IV pressure ulcer on her R.heel. a stage II on her L hip and another stage III on her sacrum. The wounds have shown little or no improvement over the last three weeks and the stage II on her L hip developed in the last few days. The area below the R heel wound is cyanotic, and amputation may be required. Her temperature has been consistently running around 100 degrees Fahrenheit. She is on antibiotic treatment for infection in the heel wound.Mrs. B is a long time resident in a long-term care facility due to a diagnosis of progressive Parkinson’s disease. Her weight has dropped by 12 pounds in the past month and by 25 over the past three months. Her appetite is poor. She is a dependent feeder and often will refuse her meals. Mrs. B is unable to walk and can only get into her wheelchair with assistance. The physician has ordered a dietary consult to determine whether a tube feeding is appropriate. A visit to the patient shows an alert, responsive individual. Mrs. B states that “she is eating all she can” and that she is “just not very hungry”. She has previously signed medical papers declining any artificial feeding.