What clinical manifestations are present in Ms. G?
Ms. G presents Pain, heaviness, chilling, unable to bear weight on her left leg, round, yellow-red wound with yellow drainage, elevated white count, neutrophils, bands, wound culture with Staphylococcus aureus.
Ms. G is a young female (23y/o) with diabetes that weighs 184.3 pounds and measures 5 feet 2 inches tall. Based on Ms. G’s weight and height she is obese. She has been home applying heat to her leg for the past 48 hours. The heating pad could have caused damage to the tissue possibly already infected causing further damage. Obesity has also been identified as being one of the risk factors in the development of lower extremity cellulitis (Antimicrobe, 2014).
The pain, heaviness, and chilling are all indicators that her body might be fighting infection. The open wound observed with erythema, swelling, and thick yellow exudate is also indicative of infection. According to Antimicrobe cellulitis is an acute infection of the skin that involves the subcutaneous tissues. It is manifested by: swelling, erythema, tenderness, warmth, and fever (Antimicrobe, 2014).
Ms. G has a low grade fever of 102.2. According To Your Health website a patient with a fever between 100 degrees Fahrenheit and 102.2 degrees Fahrenheit is beneficial by assisting the body in repelling the microbes or invader from the body (To Your Health, 2012).
White blood cells help fight infection (leukocytes). Elevated WBC is due to infections that are mostly related to bacteria. Neutrophils are the first cells to respond and arrive at the site where inflammation occurs. Neutrophils conventional units are between 45%-73%. Neutrophils increase with an acute infections, trauma, surgery, and leukemia to name a few (Brunner, 2008). Ms. G’s, neutrophils are just slightly elevated at 80%.
The body’s immune system responds by the inflammatory response which is started by the response of tissue injury or invading organisms.
Normal band count is between 2-6%. Bands are immature white blood cells. When the body is under significant attack by bacteria or virus and immature cells might be released early into the circulation to fight infection. Ms. G has 12% band count which is also indicative of infection.
What recommendations would you make for continued treatment?
Cooling measures plus Tylenol should be started to reduce fever and pain. Provide wound care on a daily basis and practicing proper skin hygiene. Making sure that patient has their lower extremity elevated to reduce edema. Advise to pump her feet on a regular basis to promote circulation. Provide patient with a diabetic diet while in the hospital. An antibiotic treatment will need to be started. Accu checks with a sliding scale should be implemented. Provide diabetic education before the patient is discharged.
Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
The ARC: Anatomy Resource Center (n.d.), identifies that the muscle groups affected would be the soleus, tibialis, anterior extensor, digitorum longus, and the gastrocnemius.
What is the significance of subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care?
Objective date is collected by physical examination, including observation, palpation, percussion, and auscultation, and by laboratory analysis and other studies to eliminate possible diagnosis pertaining to the patient’s signs and symptoms.
Subjective data is a collection of data that has been provided by the patient or family. The subjective data is retrieved from the description of an event rather than from a physical assessment.
What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delay wound healing?
A diabetic patient takes longer for their wound to heal but the wound can rapidly get worse, so it requires close monitoring. If the patient has an elevated blood sugar it will cause the arteries to stiffen and cause narrowing of the blood vessels. Narrowed blood vessels than lead to decreased blood flow and oxygen to the wound. The patient having an elevated blood sugar also decreases the function of red blood cells that are able to fight infection. Ms. G lives alone has not been able to walk for three days and has not had proper nutrition based on her current weight and current situation making the wound to get worse. Without the proper and sufficient nutrition and oxygen the wound will heal very slowly.
Antimicrobe. (2014). Cellulitis. Retrieved from http://www.antimicrobe.org/e1.asp#t1
ARC: Anatomy Resource Center. (n.d.). Explore the human body. Retrieved from http://conhs.gcumedia.com/bio155/anatomy/arcBio155v2.swf
Brunner, L. (2008). Brunner & Suddarth’s textbook of medical-surgical nursing (11th ed.).Philadelphia: Lippincott Williams & Wilkins.
To Your Health. (2012). The facts about fevers. Retrieved from http://www.toyourhealth.com/mpacms/tyh/article.php?id=1521