NSG 223 Unit 8 conflicting priority resolution example

Walk to Stay Strong or Rest the Foot to Heal It: Both Cases Argued at Full Strength, Then Resolved for One Man's Sixth Hospital Day

Student Name

Department of Nursing, Herzing University

NSG 223: Medical-Surgical Nursing II

Instructor Name

March 5, 2026

Walk to Stay Strong or Rest the Foot to Heal It: Both Cases Argued at Full Strength, Then Resolved for One Man's Sixth Hospital Day

The Conflict in One Sentence

On day 6, the composite dialysis patient's deconditioning argues for walking several times a day, while his healing forefoot wound argues for keeping weight off it, and the same nursing hours and the same patient energy have to serve both.

The Case for Putting Mobility First

At home he managed a short walk to the corner store and drove himself to dialysis three times a week. Since admission he has walked on only four occasions, mostly less than 30 m. Hospitalization-associated disability, the loss of the ability to carry out daily activities that a person could manage before admission, is common in older adults and often does not recover after discharge (Covinsky et al., 2011). In an observational study of older hospitalized adults, patients who could walk when admitted nonetheless spent the great majority of hospital hours in bed (Brown et al., 2009). For this man, losing the ability to walk to his car would mean losing independent access to dialysis, which is his lifeline. Immobility also raises the risk of clots in the leg veins, pressure injury over the heels and sacrum, and weakening of the breathing muscles, and his kidney failure and diabetes already add to each of these risks. Every day in bed has a cost that grows.

The Case for Putting the Wound First

The wound on the ball of his right foot is the reason he is here, and it formed because repeated pressure on a foot without sensation broke down the skin and let infection reach bone. The surgery removed infected bone, and the remaining tissue must now heal under a foot that still cannot feel pressure. International guidance on diabetes-related foot ulcers puts offloading, keeping pressure off the ulcer, at the center of healing, and notes that people with neuropathy often exceed safe loading without realizing it (Bus et al., 2024). Every extra step, even in a heel-bearing shoe, carries a chance of pressure on the forefoot, especially when he is tired, turning, or getting up at night. A wound that breaks down now could mean another operation or a larger amputation, and he has already been told that the goal is to save the front of his foot.

The Resolution

Neither side is chosen outright. The resolution is to set a daily walking dose small enough to protect the wound and large enough to protect his independence, and to add activity that does not load the forefoot.

Walking: three short walks a day, each up to 30 m, only in the heel-bearing shoe, only with physical therapy or a nurse, only after the dressing has been checked, and never at night. A wheelchair is used for longer distances, such as to dialysis. Non-weight-bearing activity: seated leg exercises, sit-to-stand practice using the left leg and arms, and upper-body exercises twice daily, which keep strength without loading the right forefoot. Protection: heel off-loading in bed, turning every two hours, compression devices, and a urinal at night so he has no reason to walk unaccompanied.

How the resolution will be judged: wound edges and drainage at each dressing change; his ability to stand from a chair without help, tested each morning; and whether the walks actually happen, recorded in the shift note.

What He Said

The plan was discussed with him before it was written. He said, "If I can't get to my car, I can't get to dialysis, and then what?" He also said, "I didn't feel the first sore at all. I don't trust my foot." Both statements are recorded because they show he holds both sides of the conflict himself. He agreed to the three short walks and asked for the seated exercises to be written on a card by his bed so he could do them between visits. His agreement matters: a plan he did not accept would be followed only when a nurse was present, and the night-time risk of an unaccompanied walk would remain.

What Would Change the Balance

Any sign of wound breakdown, such as new drainage, redness spreading at the edges, or a blister under the shoe, would shift the balance to strict non-weight-bearing and seated activity only. A decline in his ability to stand from a chair would shift it toward more supervised walking, discussed with the surgical team. The plan is reviewed with him daily, because he is the one who knows how much the loss of walking would cost him. The course text describes the same balance between healing and deconditioning in patients recovering from lower-extremity surgery (Hinkle et al., 2022). The patient is a composite.

References

Brown, C. J., Redden, D. T., Flood, K. L., & Allman, R. M. (2009). The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society, 57(9), 1660-1665. https://doi.org/10.1111/j.1532-5415.2009.02393.x

Bus, S. A., Armstrong, D. G., Crews, R. T., Gooday, C., Jarl, G., Kirketerp-Moller, K., Viswanathan, V., & Lazzarini, P. A. (2024). Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes/Metabolism Research and Reviews, 40(3), Article e3647. https://doi.org/10.1002/dmrr.3647

Covinsky, K. E., Pierluissi, E., & Johnston, C. B. (2011). Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure." JAMA, 306(16), 1782-1793. https://doi.org/10.1001/jama.2011.1556

Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.