| Abstrakt: |
Background: Many patients with End Stage Renal Disease (ESRD) will use warfarin either temporarily or long-term at some stage in their treatment journey and some will develop painful skin lesions that we must be able to differentiate as warfarin induced skin necrosis (WISN) or calciphylaxis. Both present alike clinically but have different aetiology's, pathophysiology and management. Case description: I present the case of Fred, a 70 year old man approaching the need for peritoneal dialysis (PD). During my nursing assessment at his pre PD catheter insertion review he reports painful lesions on his legs -- he has been on warfarin for many years for a mechanical aortic valve. Does Fred have WISN or calciphylaxis? Discussion: This presentation will describe the causes, underlying pathophysiology, diagnosis and management of WISN and calciphylaxis and will discuss these conditions as they relate to Fred's case. The following questions will be addressed in this presentation -- Is WISN an acute issue seen within days of starting warfarin or can it develop with long term use? Can someone with WISN keep using warfarin? Fred has only begun his journey with ESRD, could this be calciphylaxis in a pre-dialysis patient or is it seen mainly in the long term dialysis patient? Conclusion: It is important for nurses to understand the differences between WISN and calciphylaxis so that a correct diagnosis is made and the appropriate management implemented. [ABSTRACT FROM AUTHOR] |
