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A case study, calciphylaxis: an exercise in human caring.

Article Excerpt
On a quarterly basis, staff members of the adult medical-surgical division at Inova Fairfax Hospital (Falls Church, VA) present a patient case study at a nursing grand rounds. Presenting gives the staff nurse an opportunity to grow professionally as he or she prepares and delivers a portion of the discussion. In October 2007, a group of four nurses told Abby's story and reminded an audience of their peers why they entered nursing.

Abby's Story

Prior to spring 2007, Abby was an independent 36-year-old leading an ordinary life. She had no reason to think she would not be going home when she entered the emergency room in March with painful wounds to her legs. Not a stranger to the health care system, Abby already had a significant medical history that included end-stage renal disease (ESRD), systemic lupus, portal vein thrombosis, and thrombotic thrombocytopenia purpura. At the time of hospital admission, she was taking various medications routinely, including prednisone, erythropoietin (Epogen [R]), lactulose, acetaminophen (Tylenol [R]), calcium acetate (PhosLo[R]), sevelamer hydrochloride (Renagel[R]), and warfarin (Coumadin[R]). In addition to the complaint of painful wounds that would not heal, she also described increasing weakness that, in combination with the pain to her legs, was decreasing her ability to ambulate and care for herself.

After many consultations, Abby first was diagnosed with warfarin-induced necrosis. She had been taking warfarin for 10 years due to her portal vein thrombosis, but the medication had been discontinued for a short time and then restarted. According to Abby, the lesions began to appear shortly after she resumed the medication. Based upon this initial assessment, the warfarin was discontinued and Abby was prescribed a low-molecular-weight heparin. Additionally, a biopsy of her...

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