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Re:Topic 1 Mandatory Discussion Question

1.The clinical manifestations that Ms. G is experiencing are pain and heaviness in her leg, an open round yellow-red wound above medial malleolus with moderate amount thick yellow drainage measuring 2cm diameter and 1cm deep. Her left leg is red from knee to ankle, her left calf measures 3 inches greater then right calf, and her labs reflect elevated WBCs, elevated Neutrophils and elevated Bands. Ms. G also has a temperature of 38.9C (102.02 F) and a positive wound culture of Staphylococcus aureus.

        After reviewing these clinical manifestations, it appears that Ms. G has an infection. Fever along with the red leg swelling and discharge from the wound are all signs and symptoms of an infection.  I would call the primary physician asking for orders for antibiotics and for treatment orders for the wound. I would then give her an antipyretic per standing orders to lower the temperature. And lastly, I would encourage Ms. G to drink plenty of fluids. During fever, fluids are lost through insensible water loss which is from the respiratory tract and sweating. Encouragement for fluid intake is crucial since Ms. G is at risk for dehydration.

2.The muscle groups effected by Ms. G’s condition are: Soleus muscle, gastrocnemius muscle, extensor digitarum longus muscle, extensor hallus longus and fibularis brevis

3.Both the subjective and objective data are very significant in determining an appropriate course of action. It provides essential information to guiding the current treatment. Follow-up lab values for WBC, Neutrophils, and Bands as well as monitoring temperature and wound drainage will all allow for determining if the appropriate antibiotic was chosen and if the infection is being effectively treated. “Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections” (Tong, et al, 2015). “Antibiotic is the primary treatment for this infection” (Tong et al, 2015).  Due to this localized wound infection caused by a bacteria, the neutrophil counts are high because they “are the early responders to an acute bacterial infection and arrive in large numbers very quickly” ( Copstead-Kirkhorn & Banasik, 2014). The follow up labs for the Neutrophil count after the treatment starts will help to determine if the infection is being resolved.

The data of Ms. G’s weight, height, diagnosis of diabetes, in bed for 3 days with no one to help prepare her meals, and applying a heating pad to a red, painful leg are all subjective and objective data that guide the need for education of current condition as well as education for future preventative care. Adults with diabetes hold responsibility for managing of their conditions. Ms. G will need to understand how to best take care of her diabetes. She will be taught that her weight is a contributing factor to being diabetic. “The more fatty tissue you have, the more resistant your cells become to insulin” (Mayo Clinic Staff, 2016), increasing her need for diabetic medications. The need for a proper diet to control her weight will also help control her blood sugar levels. Ms. G will need to learn to examine her feet for wounds. Diabetes causes less blood flood to the feet, and nerves and blood vessels can be damaged causing neuropathy. This loss of sensation can lead to serious foot problems involving the ankle and leg. Ms. G needs encouragement for a life-style-change. A list of resources for assistance with proper diabetic diet, weight management and diabetes support group will help Ms. G learn more about preventive care for her condition. And it must not be forgotten that Ms. G will also need to learn that applying heat to an area that is inflamed and red will exacerbate the redness and could cause localized skin damage leading to more wounds. There is a lot of education that needs to be provided to Ms. G which is based upon the subjective and objective data collected.

4.Diabetes, poor diet and infection are the factors that are present in this situation that could delay wound healing.  Having diabetes causes poor circulation because “narrowed blood vessels lead to decreased blood flow and oxygen to a wound. An elevated blood sugar level decreases the function of red blood cells that carry nutrients to the tissue. This lowers the efficiency of the white blood cells that fight infection. Without sufficient nutrients and oxygen, a wound heals slowly” (Wound Care Center.Org, n.d.). The wound needs to be taken care of immediately which includes being assessed by a wound team and following prescribed wound care treatment.

Precautions to prevent delayed wound healing are for Ms. G to follow a proper diet to ensure she is getting enough protein which is needed for wound healing and not to limit carbohydrates for better blood sugar management. High glucose levels as noted above causes decrease circulation, delaying wound healing. Also, it is essential she follows the prescribed wound treatment orders. If wound bandages are not changed, a build-up of discharge can further exacerbate and delay wound healing. She must complete the course of antibiotics to ensure the bacterial infection is destroyed. And, lastly, with anyone who is diabetic, Ms. G must practice good diabetic management for healthy glycemic control.

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