Event 2: Right Upper Extremity (RUE) Skin Graft

Mr. Lane, a middle aged man with his right arm in a compression sleeve
Mr. Lane

Mr. Lane has had an infection occur in his right arm along his incision site. He has had two full courses of antibiotics and is infection free. Due to the infection, he has had tissue death and now requires a skin graft to the right upper extremity.

When measuring the right arm pain, he indicates the score of 7 at rest and 10 with movement.

Mr. Lane was readmitted to the urban tertiary care center for the skin graft to his right forearm. The healthy tissue was taken from his thigh; he is being discharged to home.

Medical History

Chief Complaint:

Open area right arm status post-surgical repair 10/8/2013.

History of Present Illness:

2 courses of antibiotic. Tissue death due to infection; outpatient surgery for skin graft.

Pain in right arm 7 at rest and 10 with movement.


Skin graft taken from the right thigh.

Physician Recommendations:

Compression garment fitting by OT for home use; Begin therapy in 4 weeks; No driving

OT Recommendations:

Use of compression sleeve when awake, home exercise program.


  • Atorvastatin 10 mg PO daily
  • Lisinopril 10 mg PO daily
  • Amlodipine 5 mg PO daily
  • NEW Docusate sodium 100 mg PO twice daily
  • NEW Medications changed from Hydrocodone/acetaminophen to Oxycodone/acetaminophen 5/325 mg 1-2 every 6 hours PRN severe pain.


No change.

Work History

Work restrictions

Work restriction: Minimal use of right arm skin graft.


12/5/13 - OT Note

Please see medical record for past medical history. Reason for referral: order for compression garment right upper extremity.


Patient was seen status post skin graft right upper extremity 12/4/13. Measurements were taken for fitting of compression garment for the right upper extremity.

Garment was issued with 20mm Hg compression for edema control and for ulnar nerve protection.

Garment is to be worn during waking hours and may be removed at night for skin care. Patient was instructed in use, wear and care of the garment in conjunction with wound dressings. Patient given a home exercise for gentle ROM of the right arm. Patient is to follow-up with physician for monitoring of garment. No Occupational Therapy services available in his home community and will refer to Physical Therapy for care.

Additional Info

Pharmacy Cost: $360.00, Insurance paid $216.00, Out of pocket $144.00

Compression Garment

Mr. Lane has received an evaluation by an Occupational Therapist at the tertiary care center. He was fit with a compression garment to decrease swelling and to protect the graft right arm. He was instructed in a home exercise program for range of motion.

The garment will help decrease swelling, protect the graft and protect the elbow.

Activity Event

A seated nurse looks to her right while holding a sheaf of papers.
Nurse practitioner

Assume a Role:

You are a nurse practitioner.


One week after discharge from the tertiary care center, Mr. Lane goes to see his local nurse practitioner at the clinic in his hometown.


Mr. Lane did not wear his garment for two days which resulted in an increase swelling in his right arm. He is unable to put the garment on due to the increase in swelling in his arm.

Question: What would you do to help Mr. Lane get back into his garment?

Additional cost; travel barrier
Too slow for resuming wearing of the garment.
Use ace wrap compression to reduce swelling.


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