The case scenario provided will be used to answer the discussion questions that

Question

The case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

Complains of pain and heaviness in her leg.

States she cannot bear weight on her leg and has been in bed for 3 days.

Lives alone and has not had anyone to help her with meals.

Objective Data

Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage

Left leg red from knee to ankle

Calf measurement on left 3 in > than right

Temperature: 38.9 degrees C

Height: 160 cm; Weight: 83.7 kg

Laboratory Results

WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands

Wound culture: Staphylococcus aureus

Critical Thinking Questions

What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.

Identify the muscle groups likely to be affected by Ms. G's condition by referring to "ARC: Anatomy Resource Center."

What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain

Explanation / Answer

1. ANS: The clinical manifestation present in Ms. G are redness of the left leg (Erythema), edema signified by increased diameter of the left calf, suppuration of thick yellow drainage, and increased temperature of 38.9 degrees Celsius. The inflammation is also spreading from the ankle-knee and presently the calf region. There is systemic manifestation of fever and elevated white blood cell count. There is hence need for recommendation for continued treatment and administration of self and family care for the patient (Canadian Diabetes Association, 2008).

The recommendations for continued treatment of Ms. G would include: optimum glycemic control since the presence of infection may lead to increased glucose level which based on the rationale that it decreases the resistance to infection. Another intervention is debridement of devitalized tissues, treatment of the staphylococcus aureus infection with antibiotics and bed rest (Moorman, 2012). Another important approach is to determine whether the infection is limb threatening or life threatening. Another recommendation is to test for drug resistance and sensitivity of the infection through collecting a specimen from the wound. This would evade the risk of (MRSA) methicillin-resistant staphylococcus aureus (Albert, 2012).

2. ANS: The muscle groups likely to be affected by Ms.G’s condition are the flexor hallucis longus, flexor digitorum longus, and the tibialis anterior muscles which attach around the medial malleolus.

3. ANS: Subjective data shows numbness/ chilling of the limb and pain at rest signifies ischemia, which may complicate the infection and lead to poor or no healing of the wound. This is due to lack of supply of oxygen, nutrients and antibiotics to the tissue of the limb. It may affect future care by necessitating amputation or debridement of devitalized tissue to prevent the spread of the infection to the rest of the body (Alfred, 2012). In this context, the patient requires substantive education on self-care to prevent possibility of amputation. Lack of help in feeding signifies risk of loss of control of glucose levels,   hence patient’s and her family education and preventative care program for subsequent or home care is based on subjective data. Follow-up and diagnostic testing is based on the objective data provided since it will demonstrate the prognosis of the disease.

References:

Albert, N. (2012). Fluid Management Strategies in Heart Failure. Critical Care Nurse,32 (2):pp.20-32.

Canadian Diabetes Association (2008). Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes, 8 (32), 28-46.

Please remind this: Answering to many questions is against to chegg rule, So iam answering question 1, 2 and3.

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