NURS 200 vSIM 3 Josephine Morrow Case and Detailed Feedback Log: Venous Stasis Ulcer Diagnosis
with 100% Score Analysis, Clinical Interventions, and Nursing Judgment Documentation
Part 1: The Case – Josephine Morrow
Demographics
Attribute Information
Name Josephine Morrow
Age 72 years
Gender Female
Diagnosis Venous stasis ulcer, right medial malleolus
Setting Medical-surgical unit / Skilled nursing facility
Code Status Full code
Chief Complaint
"Pain and open sore on my right ankle for the past 3 months."
History of Present Illness
Josephine Morrow presents with a chronic, non-healing wound on the inner aspect of her right ankle. The wound began as a small darkened area that
gradually broke open. She reports moderate pain (3-5/10) that improves when she elevates her legs and worsens with prolonged standing or sitting. She
has tried over-the-counter antibiotic ointments and bandages with no improvement. She denies fevers, chills, or foul odor from the wound.
Past Medical History
Chronic venous insufficiency (diagnosed 10 years ago)
Hypertension (well-controlled)
Obesity (BMI 32)
Osteoarthritis, bilateral knees
Past Surgical History
Right knee replacement (2015)
Varicose vein stripping (2005)
Medications
Medication Dose Frequency Indication
Lisinopril 10 mg Daily Hypertension
Acetaminophen 500 mg Every 6 hours PRN Osteoarthritis pain
Multivitamin 1 tablet Daily Nutritional supplement
, Allergies
No known drug allergies (NKDA)
Latex sensitivity (mild rash)
Social History
Lives alone in a ground-floor apartment
Retired teacher
Independent with activities of daily living but struggles with wound care due to limited mobility
No smoking or alcohol use
Eats mostly prepared meals (limited fresh fruits/vegetables)
Physical Examination Findings
System Findings
BP 128/74, HR 82, RR 16, SpO2 98%, Temp 98.2°F
Vital Signs
(36.8°C)
Pain 3/10 at rest, 5/10 after standing 10 minutes
2+ pitting edema to mid-calf, brown hemosiderin
Lower Extremities – Right
staining, warm to touch, dry scaly skin
Lower Extremities – Left Trace edema, no staining, normal color
Pulses Dorsalis pedis +2 bilateral, posterior tibial +2 bilateral
Capillary Refill < 2 seconds bilateral
Sensation Intact to light touch bilateral
4 cm (length) x 3 cm (width) x 0.2 cm (depth), irregular
shape, shallow, moist red granulation tissue (75%),
Wound – Right Medial Malleolus
yellow slough (25%), moderate serosanguineous
drainage, no odor, periwound skin mildly macerated
Ankle-Brachial Index (ABI) Right 0.9, Left 1.0
Diagnostic Data
Test Result Interpretation
Normal – eligible for compression
ABI Right 0.9
(30-40 mmHg)
Wound culture Pending No signs of active infection
Venous duplex Mild to moderate venous
Confirms chronic venous insufficiency
ultrasound reflux, no DVT
Provider Orders
1. Multilayer compression wrap (30-40 mmHg at ankle) – apply daily
2. Wound care: Cleanse with normal saline, apply non-adherent contact layer, foam dressing, then compression
3. Elevate legs above heart for 30 minutes, three times daily
with 100% Score Analysis, Clinical Interventions, and Nursing Judgment Documentation
Part 1: The Case – Josephine Morrow
Demographics
Attribute Information
Name Josephine Morrow
Age 72 years
Gender Female
Diagnosis Venous stasis ulcer, right medial malleolus
Setting Medical-surgical unit / Skilled nursing facility
Code Status Full code
Chief Complaint
"Pain and open sore on my right ankle for the past 3 months."
History of Present Illness
Josephine Morrow presents with a chronic, non-healing wound on the inner aspect of her right ankle. The wound began as a small darkened area that
gradually broke open. She reports moderate pain (3-5/10) that improves when she elevates her legs and worsens with prolonged standing or sitting. She
has tried over-the-counter antibiotic ointments and bandages with no improvement. She denies fevers, chills, or foul odor from the wound.
Past Medical History
Chronic venous insufficiency (diagnosed 10 years ago)
Hypertension (well-controlled)
Obesity (BMI 32)
Osteoarthritis, bilateral knees
Past Surgical History
Right knee replacement (2015)
Varicose vein stripping (2005)
Medications
Medication Dose Frequency Indication
Lisinopril 10 mg Daily Hypertension
Acetaminophen 500 mg Every 6 hours PRN Osteoarthritis pain
Multivitamin 1 tablet Daily Nutritional supplement
, Allergies
No known drug allergies (NKDA)
Latex sensitivity (mild rash)
Social History
Lives alone in a ground-floor apartment
Retired teacher
Independent with activities of daily living but struggles with wound care due to limited mobility
No smoking or alcohol use
Eats mostly prepared meals (limited fresh fruits/vegetables)
Physical Examination Findings
System Findings
BP 128/74, HR 82, RR 16, SpO2 98%, Temp 98.2°F
Vital Signs
(36.8°C)
Pain 3/10 at rest, 5/10 after standing 10 minutes
2+ pitting edema to mid-calf, brown hemosiderin
Lower Extremities – Right
staining, warm to touch, dry scaly skin
Lower Extremities – Left Trace edema, no staining, normal color
Pulses Dorsalis pedis +2 bilateral, posterior tibial +2 bilateral
Capillary Refill < 2 seconds bilateral
Sensation Intact to light touch bilateral
4 cm (length) x 3 cm (width) x 0.2 cm (depth), irregular
shape, shallow, moist red granulation tissue (75%),
Wound – Right Medial Malleolus
yellow slough (25%), moderate serosanguineous
drainage, no odor, periwound skin mildly macerated
Ankle-Brachial Index (ABI) Right 0.9, Left 1.0
Diagnostic Data
Test Result Interpretation
Normal – eligible for compression
ABI Right 0.9
(30-40 mmHg)
Wound culture Pending No signs of active infection
Venous duplex Mild to moderate venous
Confirms chronic venous insufficiency
ultrasound reflux, no DVT
Provider Orders
1. Multilayer compression wrap (30-40 mmHg at ankle) – apply daily
2. Wound care: Cleanse with normal saline, apply non-adherent contact layer, foam dressing, then compression
3. Elevate legs above heart for 30 minutes, three times daily
