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Pathophysiology and Nursing Management of ClientsThe case scenario provided will be used to answer the discussion questions that follow.Case ScenarioMs. 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 DataComplains 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 DataRound, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainageLeft leg red from knee to ankleCalf measurement on left 3 in > than rightTemperature: 38.9 degrees CHeight: 160 cm; Weight: 83.7 kgLaboratory ResultsWBC 18.3 x 10¹² / L; 80% neutrophils, 12% bandsWound culture: Staphylococcus aureusCritical Thinking Questions1.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.
Ms G. presents with a left lower extremity (LLE) wound that is round, measuring 2 cm in diameter and 1 cm deep that is draining a moderate amount of thick yellow drainage. Her LLE is also red and swollen with a three inch difference in diameter when measured at the location of the calf. Ms G. is also febrile and complains of a painful heavy leg. Ms G. has a wound that has become infected based on her clinical manifestations; fever of 102.02 accompanied by chills and elevated white blood cell count. Her laboratory results also show elevated neutrophils with an increase in immature neutrophils (bands) indicated a more severe infection (Copstead-Kirkhorn, 2010). I would first obtain blood cultures prior to any antibiotic therapy, this allows for a more specific antibiotic therapy to be initiated and has also been associated with a decrease in mortality rates related to infection (Institute of Healthcare Improvement, 2017). Following a sepsis protocol if other objective data warrants may be initiated by ordering a procalcitonin and lactic acid level. Sepsis is a concern with serious infections. The wound culture shows staph aureus which is a gram-positive bacteria and can be treated with common cephalosporin’s, naficillin and their counterparts as well as sulfa drugs, but increased resistance to these drugs have required the more frequent use of vancomycin to treat more serious infections (Staph infections Treatments and drugs, 2014). The cause of Ms G. ulcer should be looked into further since she has risk factors for both venous and arterial disease. Both of these types of ulcers require a different course of treatment (Grey, Harding & Enoch, 2017). An initial assessment of surrounding pulses, skin and capillary refill would assist in meriting further testing of arterial flow to the extremity. Obtaining a Venous Doppler study to rule out a deep vein thrombosis (DVT) isnecessary since this could be contributing to the ulcer and because the affected leg is three inches larger which is characteristic of a DVT. It is recommended to debride the