Question

Patient Profile

G. is a 68-year-old man who goes to the hospital emergency department with a complaint of left foot pain. He has a 7-year history of type 2 diabetes that is controlled with metformin (Glucophage) 500 mg orally twice daily.

Subjective Data

States he stepped on “something” in the yard a few days ago

States he is unable to bear weight on the left foot

Has been nauseated and “just haven’t felt good”

Objective Data

Physical Examination

Blood pressure 160/90, pulse 110, respirations 24, temperature 99.8° F

Left foot swollen, red, and warm to touch

Open area on ball of left foot near first metatarsal, with tissue loss and irregular wound margins Measures 2 cm in diameter, with moderate amount of thick yellow drainage

Bilateral paresthesia in lower legs

Diagnostic Studies

Blood glucose 350 mg/dL

White blood cell (WBC) count 19,200/µL; 80% neutrophils (12% bands)

Discussion Questions

What is the significance of the WBC count?

Are L.G.’s manifestations of inflammation local or systemic? What information supports your response?

What other diagnostic tests may be needed to help establish a diagnosis?

By what method will L.G.’s wound heal?.

What factors may interfere with or delay the healing of L. G.’s wound

L. G. will be admitted to the medical unit. What nursing interventions should be included in his plan of care?

What willbe L.G.’s priority discharge teaching needs?

Answer 1

1. WBC or white blood cell count indicate the presence of inflammation, allergies, leukemia or immune disorder. The normal WBC count is 4000 to 11000/mcl .Here in case of L.G. WBC count is 19,200/ mcl. So, it is higher than the normal WBC count. It indicates that he has a local or generalized inflamation.

2. L.G.'s manifestations f inflamation are systemic inflamation. As, the physical examination shows that he has an increase in body temperature 99.8 degree F, pulse is increased 110 beats/min, the left foot is swollen, red and worm. These are signs of systemic inflamation.

3. The other diagnostic tests has to perform are =

a) ESR test or Erythrocytes Sedimentation Rate haa to perform. An elevation in ESR count indicates systemic inflamation.

b) cRP ( C reactive protein test ) = it produces due to natural response of liver against inflammation. The cRP is elevated due to inflammation. CRP count make differentiate between acute and chronic inflamation.

c) Serum protein electrophoresis (SPE) = it is a best test to identify a chronic inflamation.

d) Plasma Viscosity test = in inflammation Plasma Viscosity increased.

e) Blood culture = culture of blood sample in various medium helps to identify the specific bacterial infection.

f) Other diagnostic tests = the other diagnostic tests can be performed like as x-ray, MRI etc. to see the radio image of internal structures.

4. By proper wound care and dressing and proper control of blood glucose level L.G.'s wound will heal.

The Foam and alginate dressing is highly effective for moderate to heavy exuding wound. The use of antibiotic Neomycin, Gentamicin or Mupirocin has to be used in dressing for quick healing process.

5. The factors that interfere with the healing process of L.G.'s wound are described below =

a) High blood glucose level = .G. has a high blood glucose level of 350 mg/dl. This high amount of blood glucose makes stiffen the blood vessels, and reduce the flow of blood al the wound site. So, the wound site doesn't get much oxygen and nutrients to heal.

b) Periferal Neuropathy = high blood glucose causes damage of the nerve endings and causes tingling sensation and numbness which makes harder to feel the injury.

c) Reduce Immunity = Diabetes causes reduce the immunity of our body. So, body loss the power to fight against the microorganisms and delay wound healing.

d) Knowledge deficit of the patient = if the diabetic patients doesn't follow the preventive measures properly then the foot ulcer will not heal quickly. He has to maintain proper personal hygiene, wear a soft shoes, not move the foot in which wound is formed etc.