Clinical Case Study

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.

Using the case study and the information below, answer the following questions:
1) What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
2) Using the interactive anatomy and physiology resource, found in “Self-Assessment: 5 Foundational Knowledge”, identify the muscle groups likely to be affected by Ms. G’s condition.
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.

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

• 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 10^12 / L; 80% neutrophils, 12% bands
• Wound culture: Staphylococcus aureus
• Critical Thinking Questions
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  Solution Preview

1) Clinical manifestations include pain, heaviness, inability to bear weight on the affected leg, with redness, swelling. Patient is also above normal body temperature and early signs of fever, positive for Staph aureus at the site of the wound with clear signs of progressive infection (high neutrophils and WBC count). At this point, it’s assumed that the patient has not sought out medical treatment in the past, in which case aggressive antibiotic therapy would be advised to combat the infection of Staph aureus. It appears that the infection is still compartmentalized and localized to the leg in question, and likely exacerbated by the patient’s diabetes and associated neuropathy. Given this, systemic antibiotics although important, may have to be adjusted to ensure therapeutic doses reach the leg. Regular cleaning of the wound is necessary in order to ensure the wound itself has the best chance of healing. It is …