Pathophysiology discussion response 1

Please respond to these discussion APA format with a reference

Discussion 1

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

Clinical manifestations for Ms. G. include red, swollen, and painful left leg which is three inches larger than the right leg. She has a yellow-red open wound with thick yellow drainage, a fever of 102ºF, chills, and is non-weight bearing. I would recommend elevating the leg to reduce swelling, she will need to drink plenty of fluids so that she does not become dehydrated, she will need antibiotics to deal with the S. aureus infection, and oral acetaminophen for her fever. She will also need treatment for her open wound possibly including a wet to dry dressing.

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

Based on the “ARC: Anatomy Resource Center the muscle groups likely being affected include the Extensor digitorum longus, the Gastrocnemius, the Soleus, and the Tibialis Anterior.

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? Provide rationale for your answer.

Subjective data is very important to gather as it tells the health care team details such as how long they have had an illness or an injury and what steps they have taken in order to treat it. Based on the subjective data provided by Ms. G. we know that she lives alone and has not been eating well lately since she is unable to get around on her own for the past 3 days. Objective data is also extremely important as it guides the health care team towards the best methods of healing the patient. The open wound with yellow discharge indicates that there is an infection. The fact that she is a diabetic and has been eating poorly also factors into her not healing very well. The patient will need to be monitored closely as her wound and leg heal. She will need wound care and a course of antibiotics to clear up the infection. She should also be examined and tested to ensure she has no blood clots, which could also be an issue due to the large amount of swelling. If there is a clot, she will need a blood thinning product such as warfarin or Coumadin, which require regular blood testing to ensure safe levels. This patient would also benefit from education about leg, foot, and skin care for diabetics, the importance of nutrition in healing, and healthy diabetic diets. I would also set up a consultation with a case manager or social worker since she lives alone, and may be a candidate for a meals on wheels program or possibly home health nurse visits. She will also need to follow up with her primary care physician, and be educated on the importance of seeing a doctor in a timely fashion for wounds, illnesses, etc. (CREST, 2005).

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 who are non-compliant or do not maintain healthy blood glucose levels and follow a healthy diet are at risk for delayed wound healing. Diabetics often suffer from poor circulation, which can also delay healing. It is imperative that she follow a healthy diet, monitor her blood glucose levels closely, and ensure her glucose levels are within the proper range using her prescribed medications. She also needs to drink plenty of water to remain hydrated which is also important to healing (American Diabetes Association, 2014).

Reference

American Diabetes Association. (2014). Skin complications. Retrieved from http://www.diabetes.org/living-with-diabetes/compl…

CREST. (2005). Guidelines on the management of cellulitis in adults. Retrieved from http://www.acutemed.co.uk/docs/Cellulitis%20guidel…

Discussion 2

Ms. G’s clinical manifestations include pain, heaviness, and inability to bear weight on the left lower leg, with redness and swelling. Ms. G has fever (38.9* C) with lab result of high in WBC and neutrophil counts and positive staphylococcus aureus on the open wound. These indicate Ms. G has progressive infection. the recommendation would be that first intravenous antibiotic therapy treat staph aureus infection because the IV therapy provide quicker and better into the bloodstream then oral, second regular cleaning the open wound and change dressing to provide better chance of healing.

Ms. G’s condition likely affects her left leg muscle group on soleus muscle left and gastrocnemius muscle left. Due to the infection at left lower leg, it likely also affects extensor digitorum longus muscle left, fibularis longus muscle left, fibularis brevis muscle left, and flexor hallucis longus muscle left.

Pain, heaviness, and unable to bear weight on the left lower leg are the significance of the subjective data. Temperature of 38.9*C, Red from left knee to ankle, 3 inches greater on left calf than right, and 2cm diameter yellow-red round open wound with thick yellow drainage above medical malleolus are the significance of the objective data provided important information of Ms. G may has a cellulitis. Lab and culture are need to diagnose cellulitis. High WBC and neutrophils counts, and positive wound culture of staphylococcus aureus indicate cellulitis. Ms. G has been applying heating pads to the infected leg for the last two day, and she has diabetic. Education is necessary and important to Ms. G. According to American Academy of Dermatology Association (2018), cellulitis is a common and potentially serious infection caused by bacteria below the surface of the skin characterized by redness, warmth, swollen, and pain. Without treatment, the infection can spread quickly travel to lymph node and into bloodstream. Early diagnosis and early treatment can avoid blood poisoning and severe pain. Antibiotics can effectively clear cellulitis. Appropriate wound clean and care can help the wound heal. Elevate leg to decrease swelling. heating pad should not be used to infected leg. this case need to forward to social worker to help her out because she lives alone and has nobody to help with meal. To prevent getting cellulitis again, 1, when do any activity, avoid injuring skin.2. treat wound immediately when injure skin by washing the wound, applying antibiotic ointment, and covering with a clean dressing. 3. Keep skin clean and moisturized to prevent cracks in the skin. Which can let bacteria into the body. 4. Treat medical condition like diabetes to reduce cellulitis risk.

Ms. G’s diabetes and associated neuropathy in this situation that could delay wound healing. Have diabetic under control. Check lower legs every day for injury and infection because some diabetic patients fail to notice when they injure a foot, clean and change dressing every day for the open wound to help wound healing.

Reference:

American Academy of Dermatology Association. (2018). Cellulitis. Retrieved from https://www.aad.org/public/diseases/rashes/celluli…

Discussion 3

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

The clinical manifestations that is present in Ms. G’s condition is left calf greater then right, redness noted from knee to ankle, yellow drainage noted for wound over medial malleolus. Ms. G is noted to have temperature of 38.9 degrees C which is 101.4 Fahrenheit. WBC, neutrophils, and bands are all elevated indicating infection. The wound culture indicates that the infection in the wound is Staphylococcus aureus. It is important to find out if the wound is methicillin resistant staphylococcus aureus prior to beginning antibiotic therapy.

“Staphylococcus aureus:

Non–penicillinase producing Penicillin G or V A cephalosporin, vancomycin,

clindamycin, imipenem

Penicillinase producing A penicillinase resistance penicillin Vancomycin, cephalosporin,

clindamycin, amoxicillin-clavulanic acid, ticarcillin-clavulanic acid, ampicillin-sulbactam, piperacillin tazobactam, imipenem, TMP-SMZ” (Copstead-Kirkhorn (2010) Page 174)

Due to the left calf being 3 inches greater in diameter then the right leg, it would be imperative to check that leg for pedal pulses and determine adequate blood flow. It is also important to check the left leg for a with a venous doppler to make sure there is no deep vein thrombosis present.

When someone has signs and symptoms of infection they are usually dehydrated from the fever. It is important to provide this patient plenty of fluids, so they can maintain hydration.

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

According to the ARC: Anatomy Resource Center, the muscle groups that are likely to be affected are: Soleus, Flexor digitorum longus, Fibularis brevis, flexor hallucis longus, tibialis posterior. (Anatomy Resource Center. (n.d.).)

What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.

For follow up diagnostic testing a duplex ultrasound should be performed to check for deep vein thrombosis, especially if Ms. G has been less mobile in the past couple of days due to pain. According to the Society for Vascular surgery a D-dimer and a duplex ultrasound would be recommended.

“tests may be recommended

• A blood test known as a D-dimer
• A duplex ultrasound test” (Deep Vein Thrombosis. (n.d.))

The D-dimer would help determine if there could be a blood clot with in the body.

Other laboratory testing that should be performed is a lactic acid level, and blood cultures. These tests will help determine the extent of the infection, and to make sure the infection did not get into the blood stream. Ms. G is also a diabetic, so laboratory test that should be performed is A1c to see if Ms. G is managing her diabetes since this could influence wound healing.

Ms. G should be educated when to call a doctor should she notice an infected wound again. She should be taught not to place heat over the wound, but to use ice to reduce inflammation. Ms. G should get follow up dietary consult due to her diabetes to make sure she maintains glucose levels to promote optimal healing.

What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Factors that are present in Ms. G’s situation that could delay wound healing is her diabetic condition. “Diabetes alters the host’s ability to resist infection. Phagocytosis is impaired with hyperglycemia, and detection of the pain of infection may be delayed because of neuropathies. The invasiveness of the microorganisms is increased when exposed to hyperglycemic environments. With increased glucose levels, Candida has been shown to flourish because of increased resistance to phagocytosis.” (Copstead-Kirkhorn (2010) Page 164)

Another factor that is present that could delay wound healing is the fact that Ms. G lives alone and does not have anyone to help make nutritious meals. Due to pain and infection Ms. G may not feel able to prepare a nutritious meal thus missing out on protein and other nutrients that is essential for wound healing. “Protein is a macronutrient that is critically important during the entire cascade of the wound healing process” (JAFFE, L., & WU, S. (2017) page 78) Ms. G is also a diabetic. The nurse should assess blood glucose levels and A1c to make sure Ms. G’s diabetes are managed to help promote wound healing.

Ms. G is 160cm which is 5 feet 2 inches and 83.7kg which is 184.5lbs. Ms. G is considered obese (Printable BMI Chart. (n.d.)). Being obese could drastically affect wound healing. Being obese affects all the bodies organ systems, in the cascading effect, it can affect wound healing as well. “Freqtiently, in obese patients the workload of the heart is increased by the strain of having to supply oxygenated blood to all tissue. Wound healing is dependent on the circulatory system to provide oxygen and nutrients to tissue. Ischemia, the deficiency of blood to tissue, may lead to tissue necrosis” (Wilson, J. A., & Clark, J. J. (2003) page 119)

Reference

Anatomy Resource Center. (n.d.). Retrieved June 5, 2018, from https://lc.gcumedia.com/bio155l/anatomy-resource-c…

Copstead-Kirkhorn. (2010). Pathophysiology, 4th Edition. [Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978141605…

Deep Vein Thrombosis. (n.d.). Retrieved June 5, 2018, from https://vascular.org/patient-resources/vascular-co…

JAFFE, L., & WU, S. (2017). The Role of Nutrition in Chronic Wound Care Management: What patients eat affects how they heal. Podiatry Management, 36(9), 77-84.

Printable BMI Chart. (n.d.). Retrieved June 5, 2018, from https://www.vertex42.com/ExcelTemplates/bmi-chart….

Wilson, J. A., & Clark, J. J. (2003). Obesity: Impediment to Wound Healing. CRITICAL CARE NURSING QUARTERLY, (2). 119.

Discussion 4

1. The clinical manifestations that are present in Ms. G’s scenario are both the objective and subjective data that was provided. Ms. G’s complain of pain and the feeling of heaviness in her leg, not being able to bear weight on her leg, the fact that her left calf is larger than her right, the redness in her left lower leg, she is febrile at a temperature of 38.9 degrees C, the yellowish-red open wound that has drainage, and her laboratory results an increase WBC count and a positive wound culture are all clinical manifestations that are present. The recommendations that I would make for treatment for Ms. G would be to have the wound on her leg evaluated. Her wound is infected which we know because of its appearance and her WBC level and she will require antibiotics to clear up the infection and prevent it from getting worse.
2. According to the ARC: Anatomy Resource Center (n.d) the muscle groups that would be affected by Ms. G’s condition are the extensor digitorum longus muscle, fibularis longus muscle, soleus muscle, gastrocnemius muscle, tibialis posterior muscle and the extensor hallucis longus muscle. All of these muscles would be affected on Ms. G’s left leg.
3. Ms. G’s lab results are significant because her WBC results show that she has an infection. Ms. G would have to have a follow up appointment to have another CBC drawn to see if her WBC levels have decreased after treatment. Also, at her follow up appointment, the physician and health care team would determine how well her wound has healed and if she needs additional antibiotics or a different type of dressing. The objective and subjective data provided shows that Ms. G clearly is in need of education on her diabetes. Providing her education on proper blood sugar management, insulin or other medication administration, inspecting for sores and informing her to seek medical attention sooner rather than later if she is having problems would be beneficial to Ms. G. Preventative care needs to focus on good control of her diabetes, how to prevent getting large sores that could become infected (proper shoes, assisted devices, clearly away clutter), if she needs help at home or perhaps needs to move in with a family member if living alone is getting to be too much for her.
4. A factor that is present in Ms. G’s situation that could delay would healing is the fact that she is a diabetic. Because of this, her wound is going to take longer to heal. Diabetes.co.uk (n.d) stated that higher levels of blood glucose in the blood due to diabetes over time affects a person’s circulation which is needed for skin repairs. This causes a diabetic to have slower wound healing. If a wound goes unhealed and remains open, the person is more susceptible to gangrene and bacterial and fungal infections. A precaution that could prevent delayed wound healing would be to make sure that Ms. G has good control over her blood sugar levels. Increased stress levels from an injury or infection such as the one Ms. G has, causes the glucose levels in the body to increase as well as decrease the number of insulin receptors that are available (Copstead & Banasik, 2010).

References:

Anatomy Resource Center. (n.d.). Muscular System. Retrieved from https://lc.gcumedia.com/bio155l/anatomy-resource-c…

Copstead, L. C., PhD, RN, & Banasik, J. L., PhD, ARNP. (2010). Pathophysiology (4th ed.). St Louis, Missouri: Elsevier.

Diabetes.co.uk. (n.d.). Slow Healing of Cuts and Wounds. Retrieved from https://www.diabetes.co.uk/symptoms/slow-healing-o…

Discussion 5

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

Ms. G shows various clinical manifestations such as edema indicated by enlarged left calf diameter, redness and swelling of the left leg (Erythema), suppuration of thick yellow drainage, also, the patient’s temperature is also above the normal body temperature, 38.9^oC. At this point of medical scenario, it’s presumed that the patient has not sought out medical attention in the recent past. Thus, in such a scenario, serious antibiotic treatment is necessary to fight the infection of Staph aureus. Also, it seems that the infection is still contained in the affected leg, and probably worsened by the patient’s diabetes & associated neuropathy. Thus, there is a need for the recommendation for constant treatment plus self and family administration care to the victim (Canadian Diabetes Association, 2008). Finally, it’s crucial to carry out the consistent cleaning of the wound to avoid infection and accelerate the healing processing of the wound.

Some recommendations for constant treatment of the patient would include; optimal glycemic control because infection might cause an increased glucose level which would reduce the resistance to infection. Based on Moorman (2012) analysis, another intervention would be debridement of devitalized muscles, diagnosis of the Staphylococcus aureus contagion with antibiotics plus bed rest. Also, testing drug resistance as well as an understanding of the infection through collecting samples from the wound can be done. This would avoid the danger of methicillin-resistant Staphylococcus aureus (MRSA)

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

Flexor hallucis, tibialis anterior and flexor diagitorum longus, are the muscles possibly affected by Ms. G health condition. The muscles attach round the medial malleolus.

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.

Both subjective and objective data provided about follow-up diagnostic testing is significance in some ways. For instance, the subjective data indicates the unresponsiveness of the leg and pain in large shows ischemia that can complicate the infection hence worsening the condition of the wound. This is mainly because of lack of oxygen, antibiotics, as well as nutrients supply to the tissues of the affected leg. This can impact future care by demanding tissues amputation to avoid the spread of infection to the rest of the body tissues (Alfred, 2012).

Therefore, in this setting, Ms. G needs a practical education addressing self-care to avoid any likelihood of tissues amputation. On the other hand, the absence of assistance in feeding indicates the danger of loss of glucose control. Thus Ms. G, as well as her family education and preventive care program for home-care, is grounded on subjective data. Diagnostic testing plus follow-ups are based on the objective data given because it would show the diagnosis of the disease.

What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Unresponsiveness of the limb and pain may be an indication of ischemia that can complicate the infection hence worsening the condition of the wound. This is so because of lack of oxygen as well as tissues to the wound tissues. Also, patient’s lonely condition would also aggravate the condition since she is alone and nobody to take care of her in the painful condition. Regular cleaning of the wound would increase the general hygienic condition ensuring that the wound has the best chance of healing. Finally, a regular diet is also important in the patient condition.

References

Albert, N. (2012). Fluid Management Strategies in Heart Failure. Critical Care Nurse,32

(2): pp.20-32.

Canadian Diabetes Association (2008). Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes, 8 (32), 28-46

Moorman, S. (2012). Patient Education is Critical to Minimizing the Risk of Recurrence and Long-term Diverticular Complications. Journal of Christian Nursing, 29 (2), pp. 83-89

Discussion 6

The Clinical manifestation for Ms. G includes:

• A round, yellow-red, 2cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage.
• Left leg red from knee to ankle
• Calf measurement on the left 3in more than right.
• Temperature: 38.9 degrees C
• WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
• Wound culture: Staphylococcus aureus

The Recommendations that I would make would be as follows:

• MRI of the left lower extremity to rule out osteomyelitis, due to possible wound infection advancing into the bone.
  • If positive for osteomyelitis, Peripheral Insterted Central Catheter will be needed for long term antibiotics.
• TCpo2 of the left lower extremity to assess the small blood vessels in the leg and feet.
• Wound care services, either at a skilled nursing facility of home health. Wound Care necessary to assess, clean wound and measure every week and prevent it from deteriorating.

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

According to the “ARC: Anatomy Resource Center, the group of muscles more likely to be damaged would be the Gastrocnemius muscle left, the Flexon Hallucis Longus muscle left, and the Soleus muscle left (“Anatomy Resource Center”).

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? Provide rationale for your answer.

It is important to know both subjective and objective data. Objective data is factual information we get from lab studies, what we observed, and results from diagnostic studies. In regards to follow up care it is very important relying on subjective data as well. The patient might be discharged from the hospital facility and during the discharge instruction, the patient is encouraged to call the doctor if they present signs and symptoms of an infection, such as chills, feeling of lethargy, altered mental status, etc. This represent subjective data, this is what the patient tell us their symptoms are to include their feelings, perceptions, and concerns. Objective and subjective data work hand in hand to reach a diagnosis and treat the disease.

4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

Factors in this situation that can delay wound healing include:

• Complains of pain and heaviness in her leg.
  • Patient is unlikely to move if presenting pain, which can deteriorate the wound or even develop new pressure ulcers due to lack of mobility.
• States she cannot bear weight on her leg and has been in bed for 3 days.
  • Patient in bed for 3 days, serious complications can arise due to lack of circulation.
• Lives alone and has not had anyone to help her with meals.
  • Patient not eating well, patient needs nutritious meals specially with protein for wound healing.

Precautions required to prevent wound healing include:

• Prescription for pain medication in order for the patient to be comfortable
• Home health with physical therapy to evaluate and treat patient.
• A care giver who can provide the patient with basic physiological needs, patient can also be registered to programs such as “meals on wheels”.

References:

https://lc.gcumedia.com/bio155l/anatomy-resource-c…