Topic : Mandatory Discussion Question

Ms. G has cellulitis of the left lower leg. Ms. G is presenting with an increased WBC count of 18.3 x 10¹² / L; 80% neutrophils, 12% bands. This indicates infection which is verified by the positive wound culture: Staphylococcus aureus. The wound is round, yellow-red, 2 cm diameter, 1 cm deep, located above the medial malleolus with moderate amount of thick yellow drainage.

The patient has erythema on left leg from knee to ankle. She has inflammation or edema on her left calf and has an increased body temperature of 38.9 degrees Celsius. Recommendations for continued treatment would include antibiotics to treat Staphylococcus aureus. I would recommend a wound consult along with an order to change wound dressing once or twice a day to ensure adequate healing.

I would recommend that an order be put in for pain medications due to the inflammation or edema on Ms. G's left leg, making it painful to stand and move around. I would recommend getting an order for a medication to help with the patients fever.

I would recommend QID glucose checks, considering the patient is diabetic, and making sure that her glucose levels are under control to ensure healing. High blood sugar levels can impair healing. I would recommend elevation of the affected limb as well as QID pedal pulse checks to make sure there is adequate blood flow to the limb.

Muscle groups likely to be affected by Ms. G's condition include the gastrocnemius, soleus, extensor hallucis longus, extensor digitorum longus, fibularis longus, vastus medialis, rectus femoris, and extensor hallucis brevis (ARC Resource Center, nd). With the subjective and objective data provided, follow-up laboratory/diagnostic laboratory testing should include Hgb A1C due to the patient being diabetic, and if a blood sugar is uncontrolled, then that can result in a decreased ability for wounds to heal and for conditions to get worse.

Other testing should include cultures of the wound to see if the antibiotics are treating the infection adequately. Education should include blood sugar control and what to do and not to do to maintain normalized blood sugars.

There should be education about why maintaining normal blood sugar levels is important regarding the healing process. Education about signs and symptoms of cellulitis if it were to happen again in the future, and when to seek medical attention would be important. Education on resources to help her with in home care if this was to happen again would also be beneficial. Future preventative care would include maintaining good blood sugar levels, a healthy diet, cleanliness, exercise, and regular check-ups with her primary care physician.

Factors that are present that could delay wound healing would include that fact that the patient is diabetic, overweight, and that her nutritional status may be impaired because she has been bedridden for 3 days and no one to help her with meals. Precautions that are required to prevent delayed wound healing would be regular glucose checks, a diabetic diet with foods that enhance wound healing, regular wound care, and taking the full regime of antibiotics prescribed.