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This patient
is showing the sign and symptoms of systemic infection chills, sweating
fatigue, malaise, muscle ache, sensation of heat.
The muscle groups that are most
likely to be affected by this are the flexor hallucis longus, flexor digitorum
longus, and tibialis anterior. All three muscles stretch from the medial
malleolus to the popliteal joint. If the cellulitis were to continue further up
the leg, more muscles would be affected. This infection can damage the
lymphatic drainage system of the affected limb, causing chronic lymph edema.
This patient
is showing the sign and symptoms of systemic infection chills, sweating
fatigue, malaise, muscle ache, sensation of heat.
The muscle groups that are most
likely to be affected by this are the flexor hallucis longus, flexor digitorum
longus, and tibialis anterior. All three muscles stretch from the medial
malleolus to the popliteal joint. If the cellulitis were to continue further up
the leg, more muscles would be affected. This infection can damage the
lymphatic drainage system of the affected limb, causing chronic lymph edema.
The significance of these findings
is that they help guide us in how to care for the patient. IV antibiotics will
need to be started ASAP to combat the infection which is indicated by several
factors: elevated temperature, elevated WBC’s, neuts and bands, wound culture,
cellulitis, and the thick yellow drainage from the wound and unable to bear
weight. Miss G also need CT of left leg and MRI can give the better result with
the other lab work like CMP, CK, ABG, HgbA1C to rule out DKA and also to know
how well her blood sugar is. Miss G need monitoring of the vital sign. Because
when a patient is septic the HR goes up or down. Surgical consult will be
helpful too.
The fact that she cannot bear weight
and reports being in bed for 3 days suggests that she is most likely dehydrated
and suffers from malnutrition as well. An IV should be started for fluids,
possibly a banana bag or LR in order to rehydrate as well as give her body the
proper nutrients to help with wound healing.
This patient needs wound consult
because of open leg wound with left leg redness. The wound should be cleansed
and properly bandaged twice daily, depending upon the amount of drainage that
continues. It’s possible that a wound-vac might be needed as the patient also
suffers from diabetes and has poor circulation. Need to mark the red area in
order to see if the redness is increasing. Leg should be elevated for the
swelling. Calf measurement needs to be done to check if the leg size is
increasing.
Since the patient is complaining of
pain, which is evident by her not leaving her bed for 3 days, She needs around
the clock medicine for pain.
Routine lab draws will need to be
made as well until the infection is under control that way you can ensure that
the infection is not getting worse and monitor the effects it is having on her
body. Since diabetics function and process things differently than normal, a
CBC and CMP would be helpful to monitor organ functions. Also, I would order a
FSBS AC and QHS along with oral diabetic medications depending upon the
HgA1C level and FSBS results. This will not only help wound healing now but it
will help control further issues in the future.
It is also obvious that Ms. G would
greatly benefit from education on diabetes. Although we do not get the
information to know how this started or what her blood sugar levels have been,
it most likely started from a consequence of poorly managed diabetes. Since
diabetics suffer from poor circulation, along with neuropathy, they do not feel
wounds the same way a non-diabetic would. This could have started from
something as simple as a nic from shaving her legs but, left untreated, it
turned into something much worse. A diabetic should always check their feet and
legs thoroughly each night before bed to ensure all skin is intact. Nutrition
should also be something to educate on. Not only is nutrition a huge factor in
managing diabetes, it also plays a vital role in wound healing. The body cannot
heal without the proper nutrients and it is especially difficult if you are a
diabetic. Pt needs podiatrist to have her feet checked and nails cut. Pt needs
education on blood sugar check and how to give insulin and also a nutritionist
to help understand DM.
Another thing to consider, upon
discharge, is whether or not the patient will require home health services.
Stating that she lived alone, no body to help with food and she is in the bed
for three days. This shows the self-neglect of the patient. Assistance may be
required until the leg is fully healed. Pt needs homecare and a program
like Meals on Wheels that deliver meals for her. Other option is skilled
nursing facility. This patient also need emotional support. Powerlessness is a
huge issue with this patient. Her lack of function is the contributing factor.
She is dependent on others. An equal portion is directly related to her
perceived lack of control over decisions. This patient needs a therapeutic
relationship. Nurses should spend one‐on‐one time with her, keep commitments,
provide encouragement, listen attentively, be empathetic. Allow patient to
share her feelings. Encourage participation in self‐care and self‐management activities
so that patient feels less powerless. Giving realistic praise assists the
patient in developing positive feelings and enhances self‐concept. All feelings
are personal and have meaning for the patient. Support groups can serve as a
helpful means to improve interpersonal coping strategies. Counseling with
therapeutic goal setting has been shown to be helpful.