Please respond to these discussion APA format with a reference

Discussion 1

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

Clinical manifestations for Ms. G. include red, swollen, and painfulleft leg which is three inches larger than the right leg. Shehas a yellow-red open wound with thick yellow drainage, a fever of102ºF, chills, and is non-weight bearing. I would recommendelevating the leg to reduce swelling, she will need to drink plenty offluids so that she does not become dehydrated, she will needantibiotics to deal with the S. aureus infection, and oralacetaminophen for her fever. She will also need treatment forher open wound possibly including a wet to dry dressing.

2. Identify the muscle groups likely to be affected by Ms. G'scondition by referring to "ARC: Anatomy Resource Center."

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

3. What is the significance of the subjective and objective dataprovided 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 healthcare team details such as how long they have had an illness or aninjury and what steps they have taken in order to treat it.Based on the subjective data provided by Ms. G. we know that she livesalone and has not been eating well lately since she is unable to getaround on her own for the past 3 days. Objective data is alsoextremely important as it guides the health care team towards the bestmethods of healing the patient. The open wound with yellowdischarge indicates that there is an infection. The fact thatshe is a diabetic and has been eating poorly also factors into her nothealing very well. The patient will need to be monitoredclosely as her wound and leg heal. She will need wound care anda course of antibiotics to clear up the infection. She shouldalso be examined and tested to ensure she has no blood clots, whichcould also be an issue due to the large amount of swelling. Ifthere is a clot, she will need a blood thinning product such aswarfarin or Coumadin, which require regular blood testing to ensuresafe levels. This patient would also benefit from educationabout leg, foot, and skin care for diabetics, the importance ofnutrition in healing, and healthy diabetic diets. I would alsoset up a consultation with a case manager or social worker since shelives alone, and may be a candidate for a meals on wheels program orpossibly home health nurse visits. She will also need to followup with her primary care physician, and be educated on the importanceof seeing a doctor in a timely fashion for wounds, illnesses, etc.(CREST, 2005).

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

Diabetics who are non-compliant or do not maintain healthy bloodglucose levels and follow a healthy diet are at risk for delayed woundhealing. Diabetics often suffer from poor circulation, which canalso delay healing. It is imperative that she follow a healthydiet, monitor her blood glucose levels closely, and ensure her glucoselevels are within the proper range using her prescribedmedications. She also needs to drink plenty of water to remainhydrated which is also important to healing (American DiabetesAssociation, 2014).

Reference

American Diabetes Association. (2014). Skin complications. Retrievedfrom 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’sclinical manifestations include pain, heaviness, and inability tobear weight on the left lower leg, with redness and swelling. Ms. Ghas fever (38.9* C) with lab result of high in WBC and neutrophilcounts and positive staphylococcus aureus on the open wound. Theseindicate Ms. G has progressive infection. the recommendation wouldbe that first intravenous antibiotic therapy treat staph aureusinfection because the IV therapy provide quicker and better into thebloodstream then oral, second regular cleaning the open wound andchange dressing to provide better chance of healing.

Ms. G'scondition likely affects her left leg muscle group on soleus muscleleft and gastrocnemius muscle left. Due to the infection at leftlower leg, it likely also affects extensor digitorum longus muscleleft, 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 significanceof the subjective data. Temperature of 38.9*C, Red from left knee toankle, 3 inches greater on left calf than right, and 2cm diameteryellow-red round open wound with thick yellow drainage above medicalmalleolus are the significance of the objective data providedimportant information of Ms. G may has a cellulitis. Lab and cultureare need to diagnose cellulitis. High WBC and neutrophils counts,and positive wound culture of staphylococcus aureus indicatecellulitis. Ms. G has been applying heating pads to the infected legfor the last two day, and she has diabetic. Education is necessaryand important to Ms. G. According to American Academy of DermatologyAssociation (2018), cellulitis is a common and potentially seriousinfection caused by bacteria below the surface of the skincharacterized by redness, warmth, swollen, and pain. Withouttreatment, the infection can spread quickly travel to lymph node andinto bloodstream. Early diagnosis and early treatment can avoidblood poisoning and severe pain. Antibiotics can effectively clearcellulitis. Appropriate wound clean and care can help the woundheal. Elevate leg to decrease swelling. heating pad should not beused to infected leg. this case need to forward to social worker tohelp her out because she lives alone and has nobody to help withmeal. To prevent getting cellulitis again, 1, when do any activity,avoid injuring skin.2. treat wound immediately when injure skin bywashing the wound, applying antibiotic ointment, and covering with aclean dressing. 3. Keep skin clean and moisturized to prevent cracksin the skin. Which can let bacteria into the body. 4. Treat medicalcondition like diabetes to reduce cellulitis risk.

Ms. G's diabetesand associated neuropathy in this situation that could delay woundhealing. Have diabetic under control. Check lower legs every day forinjury and infection because some diabetic patients fail to noticewhen they injure a foot, clean and change dressing every day for theopen wound to help wound healing.

Reference:

American Academyof 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 whatrecommendations would you make for continued treatment? Providerationale for your recommendations.

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

“Staphylococcus aureus:

Non–penicillinase producingPenicillin G or V Acephalosporin, vancomycin,

clindamycin, imipenem

Penicillinaseproducing Apenicillinase resistancepenicillinVancomycin, cephalosporin,

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

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

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

Identify the muscle groups likely to be affected by Ms. G'scondition by referring to "ARC: Anatomy Resource Center."

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

What is the significance of the subjective and objective dataprovided 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 beperformed to check for deep vein thrombosis, especially if Ms. G hasbeen less mobile in the past couple of days due to pain. According tothe Society for Vascular surgery a D-dimer and a duplex ultrasoundwould be recommended.

“tests may be recommended

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

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

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

Ms. G should be educated when to call a doctor should she notice aninfected wound again. She should be taught not to place heat over thewound, but to use ice to reduce inflammation. Ms. G should get followup dietary consult due to her diabetes to make sure she maintainsglucose levels to promote optimal healing.

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

Factors that are present in Ms. G’s situation that could delaywound healing is her diabetic condition. “Diabetes alters thehost's ability to resist infection. Phagocytosis is impaired withhyperglycemia, and detection of the pain of infection may be delayedbecause of neuropathies. The invasiveness of the microorganisms isincreased when exposed to hyperglycemic environments. With increasedglucose levels, Candida has been shown to flourish because ofincreased resistance to phagocytosis.” (Copstead-Kirkhorn (2010)Page 164)

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

Ms. G is 160cm which is 5 feet 2 inches and 83.7kg which is184.5lbs. Ms. G is considered obese (Printable BMI Chart. (n.d.)).Being obese could drastically affect wound healing. Being obeseaffects all the bodies organ systems, in the cascading effect, it canaffect wound healing as well. “Freqtiently, in obese patientsthe workload of the heart is increased by the strain of having tosupply oxygenated blood to all tissue. Wound healing is dependent onthe circulatory system to provide oxygen and nutrients to tissue.Ischemia, the deficiency of blood to tissue, may lead to tissuenecrosis” (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 fromhttps://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 ChronicWound 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 toWound Healing. CRITICAL CARE NURSING QUARTERLY, (2). 119.

Discussion 4

1. The clinical manifestations that are present in Ms. G'sscenario are both the objective and subjective data that wasprovided. Ms. G's complain of pain and the feeling of heaviness inher 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 lowerleg, she is febrile at a temperature of 38.9 degrees C, theyellowish-red open wound that has drainage, and her laboratoryresults an increase WBC count and a positive wound culture are allclinical manifestations that are present. The recommendations that Iwould make for treatment for Ms. G would be to have the wound on herleg evaluated. Her wound is infected which we know because of itsappearance and her WBC level and she will require antibiotics toclear up the infection and prevent it from gettingworse.
2. According to the ARC: Anatomy ResourceCenter (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 leftleg.
3. Ms. G’s lab results are significant because herWBC results show that she has an infection. Ms. G would have to havea follow up appointment to have another CBC drawn to see if her WBClevels have decreased after treatment. Also, at her follow upappointment, the physician and health care team would determine howwell her wound has healed and if she needs additional antibiotics ora different type of dressing. The objective and subjective dataprovided shows that Ms. G clearly is in need of education on herdiabetes. Providing her education on proper blood sugarmanagement, insulin or other medication administration, inspectingfor sores and informing her to seek medical attention sooner ratherthan later if she is having problems would be beneficial to Ms.G. Preventative care needs to focus on good control ofher diabetes, how to prevent getting large sores that could becomeinfected (proper shoes, assisted devices, clearly away clutter), ifshe needs help at home or perhaps needs to move in with a familymember if living alone is getting to be too much for her.
4. A factor that is present in Ms. G's situation that could delaywould healing is the fact that she is a diabetic. Becauseof this, her wound is going to take longer toheal. Diabetes.co.uk (n.d) stated that higher levels ofblood glucose in the blood due to diabetes over time affects aperson’s circulation which is needed for skinrepairs. This causes a diabetic to have slower woundhealing. If a wound goes unhealed and remains open, theperson is more susceptible to gangrene and bacterial and fungalinfections. A precaution that could prevent delayed woundhealing would be to make sure that Ms. G has good control over herblood sugar levels. Increased stress levels from an injury orinfection such as the one Ms. G has, causes the glucose levels inthe body to increase as well as decrease the number of insulinreceptors 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. Retrievedfrom https://www.diabetes.co.uk/symptoms/slow-healing-o…

Discussion 5

What clinical manifestations are present in Ms. G and whatrecommendations would you make for continued treatment? Providerationale for your recommendations.

Ms. G shows various clinical manifestations such as edema indicatedby enlarged left calf diameter, redness and swelling of the left leg(Erythema), suppuration of thick yellow drainage, also, thepatient’s temperature is also above the normal body temperature,38.9^oC. At this point of medical scenario, it’spresumed that the patient has not sought out medical attention in therecent past. Thus, in such a scenario, serious antibiotic treatment isnecessary to fight the infection of Staph aureus. Also, it seems thatthe infection is still contained in the affected leg, and probablyworsened by the patient's diabetes & associated neuropathy. Thus,there is a need for the recommendation for constant treatment plusself and family administration care to the victim (Canadian DiabetesAssociation, 2008). Finally, it's crucial to carry out the consistentcleaning of the wound to avoid infection and accelerate the healingprocessing of the wound.

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

Identify the muscle groups likely to be affected by Ms. G'scondition by referring to "ARC: Anatomy Resource Center."

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

What is the significance of the subjective and objective dataprovided about follow-up diagnostic/laboratory testing, education,and future preventative care? Provide rationale for your answer.

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

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

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

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

References

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

(2): pp.20-32.

Canadian Diabetes Association (2008). Clinical Practice Guidelinesfor the Prevention and Management of Diabetes inCanada. Canadian Journal of Diabetes, 8 (32), 28-46

Moorman, S. (2012). Patient Education is Critical to Minimizing theRisk of Recurrence and Long-term DiverticularComplications. 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 abovemedial malleolus with moderate amount of thick yellow drainage.
• Left leg red from knee to ankle
• Calf measurementon the left 3in more than right.
• Temperature: 38.9degrees C
• WBC 18.3 x 10¹² / L; 80%neutrophils, 12% bands
• Wound culture: Staphylococcusaureus

The Recommendations that I would make would be as follows:

• MRI of the left lower extremity to rule outosteomyelitis, due to possible wound infection advancing into thebone.
  • If positive for osteomyelitis, PeripheralInsterted Central Catheter will be needed for long termantibiotics.
• TCpo2 of the left lower extremityto assess the small blood vessels in the leg and feet.
• Wound care services, either at a skilled nursing facility ofhome health. Wound Care necessary to assess, clean wound and measureevery week and prevent it from deteriorating.

2. Identify the muscle groupslikely to be affected by Ms. G's condition by referring to "ARC:Anatomy Resource Center."

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

3. What is the significance ofthe subjective and objective data provided with regard to follow-updiagnostic/laboratory testing, education, and future preventativecare? 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 weobserved, and results from diagnostic studies. In regards to follow upcare it is very important relying on subjective data as well. Thepatient might be discharged from the hospital facility and during thedischarge instruction, the patient is encouraged to call the doctor ifthey present signs and symptoms of an infection, such as chills,feeling of lethargy, altered mental status, etc. This representsubjective data, this is what the patient tell us their symptoms areto include their feelings, perceptions, and concerns. Objective andsubjective data work hand in hand to reach a diagnosis and treat the disease.

4. What factors are present inthis situation that could delay wound healing, and what precautionsare 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 candeteriorate the wound or even develop new pressure ulcers due tolack of mobility.
• States she cannot bearweight on her leg and has been in bed for 3 days.
  • Patient in bed for 3 days, serious complications can arise dueto lack of circulation.
• Lives alone and hasnot had anyone to help her with meals.
  • Patient noteating well, patient needs nutritious meals specially with proteinfor wound healing.

Precautions required to prevent wound healing include:

• Prescription for pain medication in order for the patient tobe comfortable
• Home health with physical therapy toevaluate and treat patient.
• A care giver who can providethe patient with basic physiological needs, patient can also beregistered to programs such as “meals onwheels”.

References:

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