COMMENT SUSAN

 I NEED A POSITIVE ARGUMENT BASED IN THIS POST..BETWEEN 100-120 WORDS

he case scenario provided will be used to answer the discussion questions that follow.

Case Scenario

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.

Subjective Data

• Complains of pain and heaviness in her leg.
• States she cannot bear weight on her leg and has been in bed for 3 days.
• Lives alone and has not had anyone to help her with meals.

Objective Data

• Round, yellow-red, 2 cm 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 left 3 in > than right
• Temperature: 38.9 degrees C
• Height: 160 cm; Weight: 83.7 kg

Laboratory Results

• WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
• Wound culture: Staphylococcus aureus

Critical Thinking Questions

1. 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 are: 

Patient reported pain and heaviness in leg; Patient reported unable to bear weight on leg for the past three days;

open wound above the medial malleolus on the left lower leg with, moderate amount of thick yellow drainage; redness from the knee to ankle on the left leg, swelling of the left calf; elevated WBC, neutrophils and bands; elevated temperature(102.02 deg. F); wound culture positive for Staphylococcus aureus (bacteria);

My recommendations would be for Ms. G to elevate the left leg on two pillows while in bed to decrease the swelling, continue taking antibiotics as prescribed to decrease  inflammation. Ibuprofen (NSAID) as this will help to reduce the fever, pain swelling and inflammation. NSAIDs work in the body by inhibiting prostaglandins, a chemical that can cause inflammation in the body (Wiley, 2015). While in the hospital I would continue to monitor the blood sugar and cover with sliding scale as ordered and maintain a diabetic diet.

1. Identify the muscle groups likely to be affected by Ms. G's condition by referring to "ARC: Anatomy Resource Center." The muscle groups that are most likely to be affected are;  Flexor digitorum  longus, Soleus, Gastrocnemius, Tibialis posterior.
2. 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 information that is gathered from what the patient or the person who responsible tells you, it is added information that the use might not be able to detect using the senses; the pain, swelling, heaviness, and inability to bear weight on the affected extremity is due to the inflammatory process that is taking place in the wound. Objective data refers to information that was collected using the five senses. This includes physical exam, observation, palpation, percussion, auscultation, laboratory and diagnostic tests (Mosby’s Medical dictionary, 20090 . The subjective, objective, diagnostic and laboratory tests all correlate and confirmed the diagnosis of cellulitis of the left lower extremity. 
3. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain. The factors that would affect the healing process of Ms. G are: Diabetes, obesity, no one to assist with meal preparation. I would educate MS.G on the importance of adherence to a proper balanced, diabetic diet so that her weight would be under control. As indicated Ms.G is 160cm and weighs 83.7 Kg,  according to the BMI index she is considered obese. Obesity affects how the body regulates glucose, resulting in elevated levels of glucose in the blood, the client already has a diagnosis of diabetes which makes the situation worse. Elevated levels of glucose in the blood can result in narrowing and stiffness of the blood vessels. As a result, the flow of red blood cells decrease and surrounding tissues become deprived of the necessary oxygen and nutrients that is required for normal cell function, this delays the healing process.  I would obtain a consult with the social worker for MS. G so she could get some assistance with meal preparation or a placement to a rehab until she has improvement/ more function of her left leg. Her body needs a well balanced diet of fat, carbohydrate, protein, vitamins, and mineral for normal cell function. I also  think that Ms. G. would also benefit from a dietary consult for diabetic teaching. 
4. Reference:

The National Institute of Diabetes and Digestive and Kidney Diseases. (2015). Health Risks of Being Overweight. Retrieved from, niddk.nih.gov

NRSNG. (2017). Objective Vs. Subjective Data: How to tell the difference in nursing. Retrieved from, nrsng.com

Wiley, F. (2015). What is Ibuprofen (Advil)?. Retrieved from everyday health.com

ARC: Anatomy Resource Center. (n.d.). Explore the human body. Retrieved from http://conhs.gcumedia.com/bio155/anatomy/arcBio155v2.swf

Lee_Ellen, C.,  Banasik, J.L. (2013). Pathophysiology. 5th ed. Retrieved from https://pageburstls.elsevier.com