With reference to appropriate guidelines and evidence, critically analyse the issues raised by Peter’s decision.

Essay question 1: Diabetes and renal failure

Meera Gupta is a 78 year old lady who lives at home with her husband. Before her acute admission to hospital with a myocardial infarction (MI) Meera had experienced a decline in her mobility and had noticed she was slightly more breathless than usual, resulting in a decline in her ability to conduct daily activities. Meera suffered a myocardial infarction (MI) at home, requiring Primary Percutaneous Coronary Intervention and stent insertion. Due to problems achieving radial access, the PPCI was conducted through a femoral artery approach. As a result Meera suffered a haematoma covering roughly half the front surface of her upper leg stemming from the entry site in the groin. The access site had been managed with manual compression post sheath removal.
As the haematoma was so large, she was referred to a vascular surgeon for advice about its management. The surgeon chose to aseptically remove the haematoma under local anaesthetic which left a very large open wound that needed to be dressed daily. The wound was very large and wasn’t healing well, the tissue viability nurse was asked for advice about wound management. Meera also began to get embarrassed about the wound and became withdrawn often refusing to see her visitors.