In regards to Ms. G, I would first want a full set of vital signs – her temp is 102 and higher I would want to assess her blood pressure and pulse, in our local hospital we have sepsis protocol and dependent on the other vital signs there may be a plan of care in place. Blood cultures may need to be ordered along with IV fluids and IV antibiotics. In addition, with her being in bed for the last three days and immobile I would want a Doppler study to assess the leg that we know measures larger and is painful with weight bearing, we know there is infection but we also need to assess circulation.
For a plan of care I would assess measurement every shift, elevate the foot and continually reassess vital signs. In regards to her BMI, she is above normal range and for long term care plan I would have dietary consult and have a full assessment in regards to her diet control and long term plan.
The muscle group likely to be affected would be the flexor halluces, flexor digitorum.
The significance of her lab values would be the WBC count being elevated, along with reassessing the wbc and the culture of the open wound I would continue to evaluate the vital signs and obtain cultures when needed. In addition, as we know blood sugar control is essential in wound healing so we would have to have patient on blood sugar checks and most likely a sliding scale for blood sugar management.
The main factors in wound healing are the known staph infection, the known fact of diabetes, and the unknown factors of how educated or how well she manages her diabetes. I would request a wound care consult and most likely put her in a private room with wound care precautions being mindful not to introduce any other issues to the situation. For discharge planning I would ask for case management consult to identify patient needs, education, financial and follow up on wound care possible wound care by home health since she lives at home. It is noted that patient with diabetes are at a higher risk for infections, what may be commonly on the skin when dealing with a diabetic patient it increases the risk of infection setting in, “each year with diabetes increases the risk factor for more infections”. (Preidt, R, 2016).
Preidt, R (2016). Diabetes May Raise Dangerous Staph Infection Risk. Retrieved from http://www.webmd.com/diabetes/news/20160311/diabetes-may-raise-risk-for-dangerous-staph-infection
1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
Ms. G is showing signs of infection:
-positive wound cultures
RECOMMENDATIONS- I would recommend that she be looked at by wound care, primary care, infectious disease, endocrinologist, and a nutritionist. I would recommend wound care, antibiotics, diabetic education. It would be important for these specialties to be on board with the care of Ms. G because you want her to be educated by all the proper physicians and to get the proper care she needs to treat, manage, and prevent this from happening again in the future.
2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
–Tibialis anterior, extensor digitorum longus, soleus, peroneus longus, and gastrocnemius.
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?
The data collected on Ms. G such as the pain she is feeling, heaviness in her foot as the subjective data and the round, yellow red wound with drainage, redness, temp, labs and measurement of her calf are is the objective data. This data is then used to diagnose and treat the issue she has presented in the ER complaining of. Based on the information gathered they can prescribe proper education on diabetes, wound care, antibiotic treatment that will be needed to prevent further issues.
Objective data is used in the assessment to collect information through what is observed. What you see, smell, feel and hear are put together to gather a informative picture of what is being seen. Lab results, actions, behaviors are all used as well in the objective data.
Subjective data is the collection of data through communication with the patient. This is the information the patient gives you that describes what they are feeling, this can include pain, feeling, sensations, how they feel, what they think is going on, and what symptoms they have such as coughing, muscle spasms and or vomiting (Objective Data in Nursing: Definition & Examples – Video & Lesson Transcript | Study.com).
4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing?
–In this situation with Ms. G. is can be difficult for someone with diabetes to have proper healing of wounds. Diabetes can cause poor circulation, neuropathy and increased infection. Some interventions that can aid in improving healing would include eating healthy and balanced meals to insure the proper amount of protein and carbs, this will help to keep glucose levels in range. Checking the wound regularly to make sure it is healing and not getting worse, if it looks to be getting worse seeking medical attention. Also, keeping the blood circulating by exercising. If infections are left untreated and not managed there is increased risk for gangrene and or sepsis. This is the number one reason for limb amputation in diabetic patients (How Diabetes Affects Wound Healing).