Questions

The subjective data provided by Ms. G included complaints of “…pain and heaviness in her (left) leg” and the inability to bear weigh on her leg and that she has been in bed for 3 days. Ms. G also states that she has been applying heat to the left leg for the last 48 hours, but her leg is more painful and she is” chilling”. In addition, Ms. G stated that she is a Diabetic and does not have anyone to help her with her meals and that she lives alone.

The objective data obtained from the assessment revealed that Ms. G is a 23-year-old diabetic who is 5’3 and 184 lbs. Ms. G’s left lower leg is red from the ankle to the knee and the left calf measurement is 3 inches larger than her right calf. Ms. G also has a round open wound with a moderate amount of thick yellow drainage that is 2cm in diameter and 1 cm deep located above the medial malleolus. From the description provided in this scenario, the patient has cellulitis (Mayo Clinic, 2019). The lab results are: WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands. The wound culture report indicated: Staphylococcus aureus was present in the wound. According to the Mayo clinic (2019), “The incidence of a more serious staphylococcus infection called methicillin-resistant Staphylococcus aureus (MRSA) is increasing” (Para, 6). Perhaps the patient also needs to be evaluated for this, as well.

My recommendations are as follows: After checking for allergies, the patient will require a course of antibiotic treatment, NSAIDS for pain, APAP to reduce fever and education concerning wound care. The patient should be educated concerning cellulitis, diabetes, blood sugar monitoring, medications, wound care, diabetic foot hygiene and inspection, proper heat application, diet and professional home health care. Increased protein, foot and ankle hygiene and wound care will facilitate wound healing. Education provided by this writer and reinforced by home healthcare staff concerning disease processes will help the patient to better understand how to manage her diabetes and cellulitis (Mayo Clinic, 2019).  

According to the ARC: Anatomy Resource Center (n.d.) the bony prominence, the medial malleolus is located on the inner aspect of the ankle.  The potential groups of muscles that could be affected include, but are not limited to, the left Abductor Hallucis muscle, the Gastrocnemius, Soleus, Tibialis Anterior and the Extensor Digitorum Longus.

The significance of the subjective and objective data provided about follow-up diagnostic/laboratory testing, education, and future preventative care involves education concerning proper care and follow up with wound care. The patient should be taught to report any increasing signs and symptoms of infection to her physician. The patient should be taught the importance of diagnostic/ lab testing and preventative care. Furthermore, the patient should be taught how to apply heat safely and the importance of implementing suggested care from her physicians and home care staff. Moreover, the patient should be educated concerning monitoring her blood sugar, taking her medications, foot care hygiene, wearing proper foot wear and the inspection of her feet daily.

The factors that are present that could delay wound healing, and the precautions that are required to prevent delayed wound healing involve a diabetic patient with cellulitis who is living alone and stayed in bed for 3 days due to pain. Her wound culture indicated that Staphylococcus Aureus was present in the wound. There are a multitude of issues that all point to further education for this patient. The precautions needed are appropriate handling of the wound, elevation of the left leg, hygiene, blood sugar monitoring, medications and the importance of taking all antibiotics prescribed to her, diet, increased protein essential for wound healing and daily foot inspection (Grand canyon University, 2013). If the patient understood more about all aspects of her care she would be enabled to participate more fully in her care.

References

ARC: Anatomy Resource Center. (n.d.). Muscular System in Grand Canyon University ARC: Anatomy Resource Center.  Retrieved from https://lc.gcumedia.com/bio155l/anatomy-resource-center/v2.1/#/main

Grand Canyon University. (2013). NRS410 Lecture 1.Introduction to pathophysiology and nursing management of disease. Cell Structure , Infalamation and innmune system. Retrieved fromhttps://lc-ugrad3.gcu.edu/learningPlatform/user/users.html?operation=home&token=7iDqO7mKYHjzXbS%2bWFIznME7xLNavXJeUIkiTPCqFkm%2bTLQVeqi4QCwAxfNHd01vWR5On60EMHEnAScw%2fgtDjQ%3d%3d&classId=1695951#/learningPlatform/loudBooks/loudbooks.html?viewPage=past&operation=innerPage&topicMaterialId=145e45e2-0efc-4ff9-85ca-7fab0aa81183&contentId=64be1e20-3e70-4fd0-929f-d70532cdd950&

Mayo Clinic. (2019) Cellulitis.  Retrieved from https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762

5-Great post! That is amazing to hear how the medical fields has advanced so much to the point that they are now able to test the organism to test and see which antibiotic would work best for it. I am sure her diabetic history would need to be considered as well for her treatment and would need to be taken into consideration. Post care would need to be considered and patient education would be ideal for prevention for her as well. 

6-Great post and recommendations. You are right, a DVT came to my mind first thing due to the swelling, so a doppler would be necessary. Although I do like wounds, I am not a wound care nurse and would need a consult. Her diabetes would need to be addressed. Hopefully after this incident she would be educated more about the health of her diabetes and how important it is to keep it under control. 

 

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