Critical Thinking Questions
Ans. The clinical manifestation present in Ms. G are redness of the left leg (Erythema) which is spreading from knee to ankle. The increased diameter of the left calf signifies edema. Thick yellow drainage and increased temperature of 38.9 degrees Celsius are also clinical manifestations. There is also elevated WBC count of 18.3 * 1012 /L and neutrophil count which is a clear sign of progresssive infection. Wound culture is also positive for Staphylococcus aureus.
- What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
The recommendations for continued treatment of Ms. G is that since she is diabetic, optimum glycemic control is required because the presence of infection may lead to increase in glucose level. Another intervention is to remove damaged tissues and treatment of infection by Staphylococcus aureus with antibiotics and bed rest (Moorman, 2012). Antibiotic therapy will help to fight against infection by S.aureus. Another important recomendation is to establish whether the infection is affecting only the limb or is life threatening. It is also important to test for drug resistance and sensitivity of the infection by collecting a specimen from the wound. This would avoid the risk of (MRSA) methicillin-resistant staphylococcus aureus (Albert, 2012). It is also recommended to clean wound regularly.
- Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
- Ans. The muscle groups likely to be affected by Ms. G’s condition are the flexor hallucis longus, flexor digitorum longus, and the tibialis anterior muscles which attach around the medial malleolus.
- 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 of Ms. G shows heaviness of the limb and pain. This signifies ischemia, which may complicate the infection and lead to poor or no healing of the wound. This occurs because of decrease in supply of oxygen, nutrients and antibiotics to the tissue of the limb. It may affect future care by necessitating amputation or debridement of devitalized tissue to prevent the spread of the infection to the rest of the body. In this context, the patient requires substantive education on self-care to prevent possibility of amputation. Lack of help to feed her meals signifies that the patient is at a risk of loss of control of glucose levels. This lead to the recommendation that family of the patient should be educated about the care and feeding routine of Ms. G. The objective data such as calf measurement, temperature and wound characteristics helped to decide on the follow-up and diagnostic since it will demonstrate the prognosis 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.
- Ans. Diabetes could delay wound healing in this situation due to poor oxygenation of tissues. Hypoxia can intensify the early inflammatory reaction which will in turn extend injury by escalating the levels of oxygen radicals (Woo, Ayello, & Sibbald, 2007). Hyperglycemia or high blood sugar can also increase oxidative stress when the production of Reactive oxygen species (ROS) exceeds the anti-oxidant capacity. In diabetic wounds, bactericidal capacity of the immune system also decreases. It also leads to improper functioning of fibroblasts and epidermal cells. These defects are responsible for inadequate bacterial clearance and it can increase infection by S.aureus.
- Thus, Ms. G would have to maintain her blood glucose levels so that wound healing can occur at a faster rate.
Albert, N. (2012). Fluid Management Strategies in Heart Failure. Critical Care Nurse,32(2), 20-32.
Moorman, S. (2012). Patient Education is Critical to Minimizing the Risk of Recurrence and Long-term Diverticular Complications. Journal of Christian Nursing, 29(2), 83-89.
Woo, K., Ayello, E. A., & Sibbald, R. G. (2007). The edge effect: current therapeutic options to advance the wound edge. Adv Skin Wound Care, 20, 90-117.