The 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.
2. Identify the muscle groups likely to be affected by Ms. G's condition by referring
to "ARC: 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.
4. What factors are present in this situation that could delay wound healing, and
what precautions are required to prevent delayed wound healing? Explain.
ANSWER
Cellulitis is a common, potentially serious bacterial skin infection. It appears as a
swollen red area of the skin that feels hot and tender,( Mayo Cl inic ). It may start as
as a small area of pain and redness on the skin and can be caused by many factors and
conditions, or any injury to tissue can invoke an inflammatory response (Copstead,&
Banasik 2012). Injury can occur from sources outside the body (exogenous) or from
sources inside the body (endogenous). Some of the examples of exogenous injuries are
surgery, trauma, burns and skin injury from chemicals.
Endogenous injuries may result from tissue ischemia like myocardial infarction or
pulmonary embolism. Inflammation may be due to sprain injuries of joints and also may
be due to sterile surgical infections. Other disease processes such as diabetes may
predispose a person to infections and inflammations. Thrombophlebitis and blisters
formation can also result in inflammation.
In the case scenario provided, Ms. G is diabetic and is reported to have cellulitis on her
left lower leg which has become painful and she has developed chilling. There is
heaviness in her leg , drainage and the calf measurement is greater on the left leg. She
also has fever of 38.9 degrees C. White blood cells are elevated which means more
production to fight inflammation and also would culture reveals Staphylococcus aureu s .
Clearly all the signs and symptoms indicate inflammation and infection so due to the
fever, the bacteria, and the exudate formation and rise of the white blood cells I would
recommend continues treatment and also because Ms. G has diabetes, this would also
be a reason to put her on antibiotics because diabetes predisposes her to infection. The
muscles that to be affected are the G astrocnemius and Soleus group of muscles.
The significance of the subjective data provided with regard to follow –up
diagnostic/laboratory testing, education and future preventive care is that she lives alone
so care may be compromised as there is no caretaker and the fact that she has no help in
preparation of meals may impede healing as diet especially high protein is essential for
body cell repair and growth. Ms. G also has limited mobility and has been in bed for 3
days this would make her condition worse a s she may also develop deep venous
thrombosis because she is not ambulating.
The factors present in delaying wound healing are diabetes condition, also use of heating
pads is not the best form of treatment and not having a caretaker or helper may be a
problem to have any meals prepared and also delay in seeking treatment may delay the
, healing. The precautions that are required to prevent wound healing are seeking medical
attention and not using heating pads, early and appropriate treatment with antibiotics that
will be effective in treatment of Staphylococcus aureus and a well balance diet will be
important.
Reference
Copstead,L.C., and Banasik, J .L. (20 12) Pathophysiolog y (5 th ed.). St Louis, MO:
Saunders Elsevier. Retrieved from http;//evolve. elsevier .com/copstead
Mayo Clinic. Cellulitis. Retrieved from http://www.mayoclinic.org/diseases-
conditions/cellulitis/basics/definitions/con-20023471
RESPONSE 1
Thank you for your post. You make a great point about delaying treatments. We all have
seen so many times where people think they 'are ok', or do not realize they are having
signs & symptoms that need to be treated. Many times it is the family or friends who
recognize something as not being right and press them to see someone. I had that happen
with my 93 yo mother in-law. She was in a very nice assisted living complex and when I
went to visit she had a small sore on her ankle. She said it was nothing but a scratch. It
didn't look right to me and I took her in to get a culture. Sure enough, it was MRSA. I had
to take her every day for 14 days to the infusion center for medications. We just never
know sometimes. Has anyone had anything similar to this happen to you?
RESPONSE 2
Thank you for your post. I would like to raise a point about caregivers many times not
taking care of themselves. My own brother faced that with a sick wife, taking care of his
business, and trying to do everything. She was in and out of the hospital and did not want
anyone else to help. She had cirrhosis, esophageal varices (which ruptured a couple times
for him to clean up), and was generally going down hill. I could hear in his voice he was
losing strength, will to keep going, and getting depressed as she was not getting better.
When she passed, he was so worn down I was concerned he might not come back to his
prior state. I went down and helped with everything and got him on a good track with
reorganizing his business stuff and working through issues. Thankfully, today he is
good.:) Sometimes just helping people with a little redirection works as they have been in
such a routine and cannot see outside of that.
RESPONSE 3
You asked if anyone has had anything similar that has happened to them where they had
to take a relative or loved one to get medically checked because they thought it was
nothing and it turned out to be more serious. Yes, it has happened to me with my mother.
She was complaining about this cough that she had and I asked her has she had an
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