Posted: April 13th, 2023

Clinical Manifestations and Recommendations:

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

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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

What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
Identify the muscle groups likely to be affected by Ms. G's condition by referring to "ARC: Anatomy Resource Center."
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.
What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.

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Clinical Manifestations and Recommendations:

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Clinical manifestations present in Ms. G include pain, heaviness in her leg, inability to bear weight, redness of the left leg, an open wound with yellow drainage, elevated body temperature (fever), and an elevated white blood cell count with a predominance of neutrophils and bands. Based on these findings, the following recommendations can be made for continued treatment:

Antibiotic Therapy: Given the wound culture results indicating Staphylococcus aureus, appropriate antibiotic therapy should be initiated to target the infection. Empiric antibiotic coverage can be started with a broad-spectrum agent such as cephalexin or clindamycin, which are effective against Staphylococcus aureus. However, the choice of antibiotic should be guided by local antibiotic susceptibility patterns and the severity of the infection.

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Wound Care: The open wound above the medial malleolus should be carefully cleaned and dressed with sterile dressings. The wound should be assessed regularly for signs of improvement or worsening. If there are signs of increasing infection or poor wound healing, further interventions such as wound debridement or surgical consultation may be necessary.

Pain Management: Adequate pain relief should be provided to Ms. G to improve her comfort and promote mobility. Nonsteroidal anti-inflammatory drugs (NSAIDs) or other appropriate pain medications can be prescribed to alleviate pain and reduce inflammation.

Diabetic Management: As Ms. G is a diabetic, her blood glucose levels should be closely monitored and managed. High blood glucose levels can impair wound healing and increase the risk of infection. Appropriate diabetes management, including medication adjustments, dietary modifications, and blood glucose monitoring, should be implemented.

Muscle Groups Likely Affected:

Based on the provided information, the muscle groups likely to be affected by Ms. G's condition include the muscles in the lower leg, such as the gastrocnemius, soleus, tibialis anterior, tibialis posterior, and the muscles of the foot. These muscles may be affected due to the inflammatory process and potential complications associated with cellulitis and wound infection.

Significance of Subjective and Objective Data:

The subjective and objective data provided have several implications for follow-up diagnostic/laboratory testing, education, and future preventative care:

Follow-up Diagnostic/Laboratory Testing: The elevated white blood cell count, presence of Staphylococcus aureus in the wound culture, and the clinical signs of infection indicate the need for further diagnostic testing. This may include repeated blood tests to monitor the response to treatment, such as the white blood cell count and differential. Additional wound cultures may also be warranted to assess the effectiveness of the chosen antibiotic therapy.

Education: Ms. G should receive education on proper wound care techniques, including cleaning, dressing changes, and signs of infection or worsening. She should be educated about the importance of adherence to her diabetic management plan and regular monitoring of blood glucose levels. Furthermore, she should be informed about the potential complications associated with cellulitis and the importance of seeking prompt medical attention for any worsening symptoms.

Future Preventative Care: Once Ms. G's current condition is resolved, preventive measures should be emphasized to reduce the risk of recurrent infections and delayed wound healing. This may include proper foot care practices, such as regular inspection for cuts or wounds, keeping the feet clean and dry, wearing appropriate footwear, and maintaining good glycemic control to minimize the risk of diabetic complications.

Factors Delaying Wound Healing and Precautions:

Several factors present in this situation could delay wound healing:

Infection: The presence of Staphylococcus aureus in the wound culture indicates an active infection. Infections can delay wound healing by prolonging the inflammatory phase and impairing tissue