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Ms. G is a 23 year-old female with a history of diabetes that presented to the hospital with cellulitis of the left lower leg.  Lab results revealed elevated white blood cell count, elevated neutrophils, and bands.  These results along with the wound culture that is positive for Staphylococcus aureus indicate the presence of infection.  Antibiotics would be the recommended treatment for a Staphylococcus aureus infections with cephalosporins, sulfa drugs or vancomycin being the most common antibiotics used (Mayo Clinic, 2017).

Ms. G’s wound in located above the medial malleolus.  The flexor digitorum longus muscle is located posteriorly to the medial malleolus and could be affected by the wound (Grand Canyon University, n.d.).  The soleus muscle left also has the potential to be impacted if wound reaches the muscle.

Subjective and objective data can help clinicians make determinations about the cause of the patient’s condition and the best way to proceed.  In Ms. G’s case the subjective data is the complaint of left leg pain and heaviness, reports of being unable to bear weight on the leg, and inability to get her own meals for three days while she was not able to get out of bed because she lives alone.  Objective data in her case includes the laboratory results, assessment of left lower extremity color, difference in size between bilateral lower extremities, elevated temperature, and wound properties.  With this information providers can make treatment recommendations and determine what additional tests are needed.  Given Ms. G’s history of diabetes the provider may determine that a HgbA1c test is needed to assess how well she is doing at controlling her diabetes.  Ms. G needs reeducation on her diabetes and a consult should be placed to a diabetes educator to see her while she is admitted to reinforce teaching on such topics as importance of diet, compliance with medication regimen, and monitoring of blood glucose levels.  Ms. G should also be evaluated by case management to determine if she will be able to perform her wound care, be able to afford her medications, and determine if she needs either home health or rehab placement on discharge.  Before being discharged from the hospital Me. G needs to have an appointment set to follow up with her doctor or clinic.

Elevated blood glucose levels can delay wound healing (American Diabetes Association, 2018).  It is important that Ms. G understand how her glucose levels can impact the ability of her wound to heal.  Another issue that can impact wound healing is proper wound care.  Prior to discharge the nurse needs to make sure that Ms. G understands how to clean her wound and complete her dressing changes.

References:

American Diabetes Association (2018). Foot complications. Retrieved January 30, 2019 from http://www.diabetes.org

Grand Canyon University (n.d.). Anatomy resource center. Retrieved January 30, 2019 from https://lc.gcumedia.com

Mayo Clinic (2017). Staph infections. Retrieved January 30, 2019 from https://www.mayoclinic.org