Comment 1: Nutritional management should be key component of therapy and imperative to wound healing. As a diabetic patient, control of glycemic index is very important with proper nutrition and adequate calorie intake to promote wound healing. Also, since she lives alone,has been in bed for 3 days and complained of not having any help with meal preparation. Nutritional intake could be critically imbalanced in her case and strategies for weigth reduction.

With thick yellowish drainage and elevated WBC, wound is probably infected, would need antibiotic regimen to combat infection, NSAIDS to reduce fever and decrease swelling and pain.

Physician to assess extent of tissue damage and make recommendations for wound care. Wound care team/ PT to be involved in wound treatment and care. Would possibly need wound debridement and wound vacuum assisted closure.

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

Likely muscle groups affected include: the gastrocnemius(back calf muscle), extensor and flexor digitorum longus, anterior tibialis muscle, extensor hallucis longus of the ankle and fibularis longus. (ARC Media).

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.

Objective data gathered indicate a non-healing wound that is infected going by the lab results. also, yellowish wound drainage, elevated temperature and swelling to leg. As a diabetic patient this is an indication of lack of good glycemic control. Rationale is, elevated blood sugar levels prevent nutrients and oxygen from energizing the cells that fights infection and promote wound healing, prevents the immune system from functioning efficiently and increases inflammation in the body which slows down wound healing. (Dening, 2017). So going forward, blood glucose level monitoring and control is very crucial and weight reduction.

Subjective data which is what the patient tell us indicate inability for Ms.G. to care for self and deficient calorie intake, as evidenced by complaint of lying in bed for 3 days, living alone and no one to help with meal preparation. Adequate nutrition is very essential to wound healing. Going forward, provision of balanced nutrition will be needed especially, high protein intake for collagen formation to promote wound closure. (Russell, 2001). It is noted that exudate loss results in protein deficit and need to be replaced. (Russell, 2001). She will need the services of OT and social workers to help with nutritional management and provision. Also, home health assistance with meal preparation and ADLS or meals on wheels services. Need to be properly educated on diet, exercise and blood glucose monitoring / therapeutic treatment of elevated blood sugar and care of lower extremities to prevent injuries.

Comment 2: the patient has an acute systemic infection and a draining wound with a Staphylococcus aureus. According to the CDC, Staphylococcus aureus is among the bacteria that cause necrotizing fasciitis which is inflammation of the fascia [tissue under the skin that surrounds muscle, nerves, and fat] (CDC, 2018). As I mentioned in my post, patient education about managing blood glucose level and weight is vital to healing and preventing recurrent infections. Many patients I take care of are admitted with cellulitis and many also have diabetes. I noticed that the lack of access to primary care and sufficient funds is one of the reasons patients are not able to manage their diabetes.