Clinical Confessions Discussion Question

Clinical Confessions Discussion Question

Please respond with a paragraph to the following post, add citations and references:

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

The patient presents with an open left leg wound above her medial malleolus with moderate amount of purulent drainage. She has redness that appears from knee to ankle that indicates cellulitis. Cellulitis can present with redness, swelling, warmth, tenderness, pain and skin dimpling (Kleinman, 2015). Patient also has temp of 102F (38.9C) with chills. Lab work indicates infection present with wound culture showing Staphylococcus aureus. Recommendations for treatment of cellulitis would include oral antibiotics, rest, elevation of extremity and over the counter pain relievers such as Advil or Motrin. If left untreated, cellulitis can turn into sepsis and bacteria can spread into the bloodstream. Cleansing the leg with normal saline and keeping the area clean and dry would be important. Could also use an antimicrobial on open wound and cover with dressing to prevent any further complications.

Kleinman, R., (2015). Cellulitis and diabetes – What are the risks? Diabetes Health and Wellness. Retrieved from https://www.adwdiabetes.com/articles/cellulitis-and-diabetes-what-are-the-risks February 25, 2019

2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to Anatomy Resource Center.”

The muscle groups affected by Ms. G’s condition includes the following:gastrocnemius, fibularis longus, anterior and posterior tibialis, soleus, flexor & extensor hallucis brevis, fibularis brevis and flexor & extensor digitorum longus (Anatomy Resource Center).

Reference:

The Muscular System (n.d.). Anatomy Resource Center. Retrieved from https://lc.gcumedia.com/bio155l/anatomy-resource-center/v2.1/pdfs/muscular-system-updated.pdf

3. 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.

Subjective data regarding pain, inability to bear weight and immobility led to lab testing and a wound culture. The objective data that we gather by observation are the patient’s wound measurements, symptoms of leg infection, temperature, height and weight. Gathering this information will allow the nurse to assess the patient’s knowledge regarding their disease state. This information can help the nurse develop a diagnosis and treatment plan for the patient to follow. The patient will need to know how to determine if the wound is improving or getting worse. Also, the patient needs to understand if the cellulitis is improving. Educating the patient on her diabetes, cellulitis and signs and symptoms of infection can help the patient understand the importance of managing her glucose levels and diabetes. Diabetes can also lead to wound complications and delayed wound healing. The patient should follow up with her primary care physician and be sure to complete the course of antibiotics recommended.

Reference:

Carter, L. (n.d.). The Difference Between Subjective and Objective Data. Retrieved from https://study.com/academy/lesson/subjective-data-in-nursing-definition-and-examples.html

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 with high blood sugars can have nerve damage and or neuropathy. This causes poor circulation and difficulty getting blood to the area for wound healing to occur. High blood sugars can also affect the immune system and delay oxygen, nutrients and cells that are involved in wound healing to repair tissues. Diabetics with continually high blood sugars have narrow arteries and veins that prevent blood flow to the lower extremities. Some precautions for this patient would be to manage glucose levels, weight control, don’t smoke, nutrition, get plenty of exercise, know the signs and symptoms of infection and manage wound care daily. The patient should also be aware of good skin care, inspecting feet daily, and wearing proper fitting shoes. Adequate levels of protein, carbohydrates and supplements are also needed to speed up wound healing in a diabetic patient.

Reference:

Collins, N., Sloan, C., (2013). Diabetic Wound Healing Through Nutrition and Glycemic Control. Today’s Wound Clinic, Vol. 7 Issue 2. Retrieved from https://www.todayswoundclinic.com/articles/diabetic-wound-healing-through-nutrition-and-glycemic-control February 25, 2019