Please respond to these discussion APA format with a reference
Discussion 1
1. What clinical manifestations are present in Ms. G and what
recommendations would you make for continued treatment? Provide
rationale for your recommendations.
Clinical manifestations for Ms. G. include red, swollen, and painful
left leg which is three inches larger than the right leg. She
has a yellow-red open wound with thick yellow drainage, a fever of
102ºF, chills, and is non-weight bearing. I would recommend
elevating the leg to reduce swelling, she will need to drink plenty of
fluids so that she does not become dehydrated, she will need
antibiotics to deal with the S. aureus infection, and oral
acetaminophen for her fever. She will also need treatment for
her open wound possibly including a wet to dry dressing.
2. Identify the muscle groups likely to be affected by Ms. G’s
condition by referring to “ARC: Anatomy Resource Center.”
Based on the “ARC: Anatomy Resource Center the muscle groups
likely being affected include the Extensor digitorum longus, the
Gastrocnemius, the Soleus, and the Tibialis Anterior.
3. 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.
Subjective data is very important to gather as it tells the health
care team details such as how long they have had an illness or an
injury and what steps they have taken in order to treat it.
Based on the subjective data provided by Ms. G. we know that she lives
alone and has not been eating well lately since she is unable to get
around on her own for the past 3 days. Objective data is also
extremely important as it guides the health care team towards the best
methods of healing the patient. The open wound with yellow
discharge indicates that there is an infection. The fact that
she is a diabetic and has been eating poorly also factors into her not
healing very well. The patient will need to be monitored
closely as her wound and leg heal. She will need wound care and
a course of antibiotics to clear up the infection. She should
also be examined and tested to ensure she has no blood clots, which
could also be an issue due to the large amount of swelling. If
there is a clot, she will need a blood thinning product such as
warfarin or Coumadin, which require regular blood testing to ensure
safe levels. This patient would also benefit from education
about leg, foot, and skin care for diabetics, the importance of
nutrition in healing, and healthy diabetic diets. I would also
set up a consultation with a case manager or social worker since she
lives alone, and may be a candidate for a meals on wheels program or
possibly home health nurse visits. She will also need to follow
up with her primary care physician, and be educated on the importance
of seeing a doctor in a timely fashion for wounds, illnesses, etc.
(CREST, 2005).
4. What factors are present in this situation that could delay wound
healing, and what precautions are required to prevent
delayed wound healing? Explain.
Diabetics who are non-compliant or do not maintain healthy blood
glucose levels and follow a healthy diet are at risk for delayed wound
healing. Diabetics often suffer from poor circulation, which can
also delay healing. It is imperative that she follow a healthy
diet, monitor her blood glucose levels closely, and ensure her glucose
levels are within the proper range using her prescribed
medications. She also needs to drink plenty of water to remain
hydrated which is also important to healing (American Diabetes
Association, 2014).
Reference
American Diabetes Association. (2014). Skin complications. Retrieved
from http://www.diabetes.org/living-with-diabetes/compl…
CREST. (2005). Guidelines on the management of cellulitis in adults.
Retrieved from http://www.acutemed.co.uk/docs/Cellulitis%20guidel…
Discussion 2
Ms. G’s
clinical manifestations include pain, heaviness, and inability to
bear weight on the left lower leg, with redness and swelling. Ms. G
has fever (38.9* C) with lab result of high in WBC and neutrophil
counts and positive staphylococcus aureus on the open wound. These
indicate Ms. G has progressive infection. the recommendation would
be that first intravenous antibiotic therapy treat staph aureus
infection because the IV therapy provide quicker and better into the
bloodstream then oral, second regular cleaning the open wound and
change dressing to provide better chance of healing.
Ms. G’s
condition likely affects her left leg muscle group on soleus muscle
left and gastrocnemius muscle left. Due to the infection at left
lower leg, it likely also affects extensor digitorum longus muscle
left, fibularis longus muscle left, fibularis brevis muscle left,
and flexor hallucis longus muscle left.
Pain, heaviness,
and unable to bear weight on the left lower leg are the significance
of the subjective data. Temperature of 38.9*C, Red from left knee to
ankle, 3 inches greater on left calf than right, and 2cm diameter
yellow-red round open wound with thick yellow drainage above medical
malleolus are the significance of the objective data provided
important information of Ms. G may has a cellulitis. Lab and culture
are need to diagnose cellulitis. High WBC and neutrophils counts,
and positive wound culture of staphylococcus aureus indicate
cellulitis. Ms. G has been applying heating pads to the infected leg
for the last two day, and she has diabetic. Education is necessary
and important to Ms. G. According to American Academy of Dermatology
Association (2018), cellulitis is a common and potentially serious
infection caused by bacteria below the surface of the skin
characterized by redness, warmth, swollen, and pain. Without
treatment, the infection can spread quickly travel to lymph node and
into bloodstream. Early diagnosis and early treatment can avoid
blood poisoning and severe pain. Antibiotics can effectively clear
cellulitis. Appropriate wound clean and care can help the wound
heal. Elevate leg to decrease swelling. heating pad should not be
used to infected leg. this case need to forward to social worker to
help her out because she lives alone and has nobody to help with
meal. To prevent getting cellulitis again, 1, when do any activity,
avoid injuring skin.2. treat wound immediately when injure skin by
washing the wound, applying antibiotic ointment, and covering with a
clean dressing. 3. Keep skin clean and moisturized to prevent cracks
in the skin. Which can let bacteria into the body. 4. Treat medical
condition like diabetes to reduce cellulitis risk.
Ms. G’s diabetes
and associated neuropathy in this situation that could delay wound
healing. Have diabetic under control. Check lower legs every day for
injury and infection because some diabetic patients fail to notice
when they injure a foot, clean and change dressing every day for the
open wound to help wound healing.
Reference:
American Academy
of Dermatology Association. (2018). Cellulitis. Retrieved from https://www.aad.org/public/diseases/rashes/celluli…
Discussion 3
What clinical manifestations are present in Ms. G and what
recommendations would you make for continued treatment? Provide
rationale for your recommendations.
The clinical manifestations that is present in Ms. G’s
condition is left calf greater then right, redness noted from knee to
ankle, yellow drainage noted for wound over medial malleolus. Ms. G is
noted to have temperature of 38.9 degrees C which is 101.4 Fahrenheit.
WBC, neutrophils, and bands are all elevated indicating infection. The
wound culture indicates that the infection in the wound is
Staphylococcus aureus. It is important to find out if the wound is
methicillin resistant staphylococcus aureus prior to beginning
antibiotic therapy.
“Staphylococcus aureus:
Non–penicillinase producing
Penicillin G or V A
cephalosporin, vancomycin,
clindamycin, imipenem
Penicillinase
producing A
penicillinase resistance
penicillin
Vancomycin, cephalosporin,
clindamycin, amoxicillin-clavulanic acid, ticarcillin-clavulanic
acid, ampicillin-sulbactam, piperacillin tazobactam, imipenem,
TMP-SMZ” (Copstead-Kirkhorn (2010) Page 174)
Due to the left calf being 3 inches greater in diameter then the
right leg, it would be imperative to check that leg for pedal pulses
and determine adequate blood flow. It is also important to check the
left leg for a with a venous doppler to make sure there is no deep
vein thrombosis present.
When someone has signs and symptoms of infection they are usually
dehydrated from the fever. It is important to provide this patient
plenty of fluids, so they can maintain hydration.
Identify the muscle groups likely to be affected by Ms. G’s
condition by referring to “ARC: Anatomy Resource Center.”
According to the ARC: Anatomy Resource Center, the muscle groups
that are likely to be affected are: Soleus, Flexor digitorum longus,
Fibularis brevis, flexor hallucis longus, tibialis posterior. (Anatomy
Resource Center. (n.d.).)
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.
For follow up diagnostic testing a duplex ultrasound should be
performed to check for deep vein thrombosis, especially if Ms. G has
been less mobile in the past couple of days due to pain. According to
the Society for Vascular surgery a D-dimer and a duplex ultrasound
would be recommended.
“tests may be recommended
- A blood test known as a D-dimer
- A duplex ultrasound test” (Deep Vein
Thrombosis. (n.d.))
The D-dimer would help determine if there could be a blood clot with
in the body.
Other laboratory testing that should be performed is a lactic acid
level, and blood cultures. These tests will help determine the extent
of the infection, and to make sure the infection did not get into the
blood stream. Ms. G is also a diabetic, so laboratory test that should
be performed is A1c to see if Ms. G is managing her diabetes since
this could influence wound healing.
Ms. G should be educated when to call a doctor should she notice an
infected wound again. She should be taught not to place heat over the
wound, but to use ice to reduce inflammation. Ms. G should get follow
up dietary consult due to her diabetes to make sure she maintains
glucose levels to promote optimal healing.
What factors are present in this situation that could delay wound
healing, and what precautions are required to prevent
delayed wound healing? Explain.
Factors that are present in Ms. G’s situation that could delay
wound healing is her diabetic condition. “Diabetes alters the
host’s ability to resist infection. Phagocytosis is impaired with
hyperglycemia, and detection of the pain of infection may be delayed
because of neuropathies. The invasiveness of the microorganisms is
increased when exposed to hyperglycemic environments. With increased
glucose levels, Candida has been shown to flourish because of
increased resistance to phagocytosis.” (Copstead-Kirkhorn (2010)
Page 164)
Another factor that is present that could delay wound healing is the
fact that Ms. G lives alone and does not have anyone to help make
nutritious meals. Due to pain and infection Ms. G may not feel able to
prepare a nutritious meal thus missing out on protein and other
nutrients that is essential for wound healing. “Protein is a
macronutrient that is critically important during the entire cascade
of the wound healing process” (JAFFE, L., & WU, S. (2017)
page 78) Ms. G is also a diabetic. The nurse should assess blood
glucose levels and A1c to make sure Ms. G’s diabetes are managed
to help promote wound healing.
Ms. G is 160cm which is 5 feet 2 inches and 83.7kg which is
184.5lbs. Ms. G is considered obese (Printable BMI Chart. (n.d.)).
Being obese could drastically affect wound healing. Being obese
affects all the bodies organ systems, in the cascading effect, it can
affect wound healing as well. “Freqtiently, in obese patients
the workload of the heart is increased by the strain of having to
supply oxygenated blood to all tissue. Wound healing is dependent on
the circulatory system to provide oxygen and nutrients to tissue.
Ischemia, the deficiency of blood to tissue, may lead to tissue
necrosis” (Wilson, J. A., & Clark, J. J. (2003) page 119)
Reference
Anatomy Resource Center. (n.d.). Retrieved June 5, 2018, from https://lc.gcumedia.com/bio155l/anatomy-resource-c…
Copstead-Kirkhorn. (2010). Pathophysiology, 4th Edition.
[Pageburstl]. Retrieved from
https://pageburstls.elsevier.com/#/books/978141605…
Deep Vein Thrombosis. (n.d.). Retrieved June 5, 2018, from https://vascular.org/patient-resources/vascular-co…
JAFFE, L., & WU, S. (2017). The Role of Nutrition in Chronic
Wound Care Management: What patients eat affects how they heal.
Podiatry Management, 36(9), 77-84.
Printable BMI Chart. (n.d.). Retrieved June 5, 2018, from https://www.vertex42.com/ExcelTemplates/bmi-chart….
Wilson, J. A., & Clark, J. J. (2003). Obesity: Impediment to
Wound Healing. CRITICAL CARE NURSING QUARTERLY, (2). 119.
Discussion 4
- The clinical manifestations that are present in Ms. G’s
scenario are both the objective and subjective data that was
provided. Ms. G’s complain of pain and the feeling of heaviness in
her leg, not being able to bear weight on her leg, the fact that her
left calf is larger than her right, the redness in her left lower
leg, she is febrile at a temperature of 38.9 degrees C, the
yellowish-red open wound that has drainage, and her laboratory
results an increase WBC count and a positive wound culture are all
clinical manifestations that are present. The recommendations that I
would make for treatment for Ms. G would be to have the wound on her
leg evaluated. Her wound is infected which we know because of its
appearance and her WBC level and she will require antibiotics to
clear up the infection and prevent it from getting
worse.
- According to the ARC: Anatomy Resource
Center (n.d) the muscle groups that would be affected by Ms.
G’s condition are the extensor digitorum longus muscle,
fibularis longus muscle, soleus muscle, gastrocnemius muscle,
tibialis posterior muscle and the extensor hallucis longus muscle.
All of these muscles would be affected on Ms. G’s left
leg.
- Ms. G’s lab results are significant because her
WBC results show that she has an infection. Ms. G would have to have
a follow up appointment to have another CBC drawn to see if her WBC
levels have decreased after treatment. Also, at her follow up
appointment, the physician and health care team would determine how
well her wound has healed and if she needs additional antibiotics or
a different type of dressing. The objective and subjective data
provided shows that Ms. G clearly is in need of education on her
diabetes. Providing her education on proper blood sugar
management, insulin or other medication administration, inspecting
for sores and informing her to seek medical attention sooner rather
than later if she is having problems would be beneficial to Ms.
G. Preventative care needs to focus on good control of
her diabetes, how to prevent getting large sores that could become
infected (proper shoes, assisted devices, clearly away clutter), if
she needs help at home or perhaps needs to move in with a family
member if living alone is getting to be too much for her.
- A factor that is present in Ms. G’s situation that could delay
would healing is the fact that she is a diabetic. Because
of this, her wound is going to take longer to
heal. Diabetes.co.uk (n.d) stated that higher levels of
blood glucose in the blood due to diabetes over time affects a
person’s circulation which is needed for skin
repairs. This causes a diabetic to have slower wound
healing. If a wound goes unhealed and remains open, the
person is more susceptible to gangrene and bacterial and fungal
infections. A precaution that could prevent delayed wound
healing would be to make sure that Ms. G has good control over her
blood sugar levels. Increased stress levels from an injury or
infection such as the one Ms. G has, causes the glucose levels in
the body to increase as well as decrease the number of insulin
receptors that are available (Copstead & Banasik,
2010).
References:
Anatomy Resource Center. (n.d.). Muscular System. Retrieved from https://lc.gcumedia.com/bio155l/anatomy-resource-c…
Copstead, L. C., PhD, RN, & Banasik, J. L., PhD, ARNP. (2010).
Pathophysiology (4th ed.). St Louis, Missouri: Elsevier.
Diabetes.co.uk. (n.d.). Slow Healing of Cuts and Wounds. Retrieved
from https://www.diabetes.co.uk/symptoms/slow-healing-o…
Discussion 5
What clinical manifestations are present in Ms. G and what
recommendations would you make for continued treatment? Provide
rationale for your recommendations.
Ms. G shows various clinical manifestations such as edema indicated
by enlarged left calf diameter, redness and swelling of the left leg
(Erythema), suppuration of thick yellow drainage, also, the
patient’s temperature is also above the normal body temperature,
38.9oC. At this point of medical scenario, it’s
presumed that the patient has not sought out medical attention in the
recent past. Thus, in such a scenario, serious antibiotic treatment is
necessary to fight the infection of Staph aureus. Also, it seems that
the infection is still contained in the affected leg, and probably
worsened by the patient’s diabetes & associated neuropathy. Thus,
there is a need for the recommendation for constant treatment plus
self and family administration care to the victim (Canadian Diabetes
Association, 2008). Finally, it’s crucial to carry out the consistent
cleaning of the wound to avoid infection and accelerate the healing
processing of the wound.
Some recommendations for constant treatment of the patient would
include; optimal glycemic control because infection might cause an
increased glucose level which would reduce the resistance to
infection. Based on Moorman (2012) analysis, another intervention
would be debridement of devitalized muscles, diagnosis of the
Staphylococcus aureus contagion with antibiotics plus bed rest. Also,
testing drug resistance as well as an understanding of the infection
through collecting samples from the wound can be done. This would
avoid the danger of methicillin-resistant Staphylococcus aureus (MRSA)
Identify the muscle groups likely to be affected by Ms. G’s
condition by referring to “ARC: Anatomy Resource Center.”
Flexor hallucis, tibialis anterior and flexor diagitorum longus, are
the muscles possibly affected by Ms. G health condition. The muscles
attach round the medial malleolus.
What is the significance of the subjective and objective data
provided about follow-up diagnostic/laboratory testing, education,
and future preventative care? Provide rationale for your answer.
Both subjective and objective data provided about follow-up
diagnostic testing is significance in some ways. For instance, the
subjective data indicates the unresponsiveness of the leg and pain in
large shows ischemia that can complicate the infection hence worsening
the condition of the wound. This is mainly because of lack of oxygen,
antibiotics, as well as nutrients supply to the tissues of the
affected leg. This can impact future care by demanding tissues
amputation to avoid the spread of infection to the rest of the body
tissues (Alfred, 2012).
Therefore, in this setting, Ms. G needs a practical education
addressing self-care to avoid any likelihood of tissues amputation. On
the other hand, the absence of assistance in feeding indicates the
danger of loss of glucose control. Thus Ms. G, as well as her family
education and preventive care program for home-care, is grounded on
subjective data. Diagnostic testing plus follow-ups are based on the
objective data given because it would show the diagnosis of the disease.
What factors are present in this situation that could delay
wound healing, and what precautions are required to prevent
delayed wound healing? Explain.
Unresponsiveness of the limb and pain may be an indication of
ischemia that can complicate the infection hence worsening the
condition of the wound. This is so because of lack of oxygen as well
as tissues to the wound tissues. Also, patient’s lonely condition
would also aggravate the condition since she is alone and nobody to
take care of her in the painful condition. Regular cleaning of the
wound would increase the general hygienic condition ensuring that the
wound has the best chance of healing. Finally, a regular diet is also
important in the patient condition.
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
Moorman, S. (2012). Patient Education is Critical to Minimizing the
Risk of Recurrence and Long-term Diverticular
Complications. Journal of Christian Nursing, 29
(2), pp. 83-89
Discussion 6
The Clinical manifestation for Ms. G includes:
- A round, yellow-red, 2cm 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 the left 3in more than right.
- Temperature: 38.9
degrees C
- WBC 18.3 x 10¹² / L; 80%
neutrophils, 12% bands
- Wound culture: Staphylococcus
aureus
The Recommendations that I would make would be as follows:
- MRI of the left lower extremity to rule out
osteomyelitis, due to possible wound infection advancing into the
bone.
- If positive for osteomyelitis, Peripheral
Insterted Central Catheter will be needed for long term
antibiotics.
- TCpo2 of the left lower extremity
to assess the small blood vessels in the leg and feet.
- Wound care services, either at a skilled nursing facility of
home health. Wound Care necessary to assess, clean wound and measure
every week and prevent it from deteriorating.
2. Identify the muscle groups
likely to be affected by Ms. G’s condition by referring to “ARC:
Anatomy Resource Center.”
According to the “ARC: Anatomy Resource Center, the group of
muscles more likely to be damaged would be the Gastrocnemius muscle
left, the Flexon Hallucis Longus muscle left, and the Soleus muscle
left (“Anatomy Resource Center”).
3. 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.
It is important to know both subjective and objective data.
Objective data is factual information we get from lab studies, what we
observed, and results from diagnostic studies. In regards to follow up
care it is very important relying on subjective data as well. The
patient might be discharged from the hospital facility and during the
discharge instruction, the patient is encouraged to call the doctor if
they present signs and symptoms of an infection, such as chills,
feeling of lethargy, altered mental status, etc. This represent
subjective data, this is what the patient tell us their symptoms are
to include their feelings, perceptions, and concerns. Objective and
subjective data work hand in hand to reach a diagnosis and treat the disease.
4. What factors are present in
this situation that could delay wound healing, and what precautions
are required to prevent delayed wound healing? Explain.
Factors in this situation that can delay wound healing include:
- Complains of pain and heaviness in her leg.
- Patient is unlikely to move if presenting pain, which can
deteriorate the wound or even develop new pressure ulcers due to
lack of mobility.
- States she cannot bear
weight on her leg and has been in bed for 3 days.
- Patient in bed for 3 days, serious complications can arise due
to lack of circulation.
- Lives alone and has
not had anyone to help her with meals.
- Patient not
eating well, patient needs nutritious meals specially with protein
for wound healing.
Precautions required to prevent wound healing include:
- Prescription for pain medication in order for the patient to
be comfortable
- Home health with physical therapy to
evaluate and treat patient.
- A care giver who can provide
the patient with basic physiological needs, patient can also be
registered to programs such as “meals on
wheels”.
References:
https://lc.gcumedia.com/bio155l/anatomy-resource-c…
Get Answer Over WhatsApp
Order Paper Now
