Question

So, I had a patient yesterday 39 yr old admitted for sepsis and cellulitis of right lower extremities. History of anxiety, asthma, medication side effects, throat pain. He was burning weeds last week with a torch when the device touch his leg causing a small burn. For several days, he has has increasing swelling pain and redness in the leg. He had signs of systemic illness with fever, tachy, and leukocytosis. Right foot is tender to movement, left foot is also tender to any flexing movement. He was also complaining of gout on both feet. He rated his pain to his right lower leg 5/10. Skin was warm, dry, and pink, rashes to his back, inner thigh, and axillary. He's on a regular diet. Vital signs were stable. Afebrile. He uses walker to transfer from bed to chair and to use the the bedside commode.

Labs were high:

WBC 18.1 H

Hgb 12.9 H,

Platelet count 675 H

Immature 0.54 H

Neutrophils 71 H

Lymphocytes 16 L

Absolute neutrophils 13.21 H

Absolute monocytes 1.09 H

Medications are:

Cleocin/D5W IV

Klor-con Sr

Pepcid

Zyvox

Colchicine

Allupurinol

Solu-Medrol Inj. IV ONCE

Rocephin

- What are the nursing diagnosis?

- What are the three top problems for this patient? Include "related to" and "as evidenced by".

- What are the goals presented for priority problems are listed with measurable outcomes?

- What are the interventions (at least one education intervention) Relationships apparent between interventions and each goal/outcome and problem. Be concise and clear, achievable, relates to the stated diagnosis and client outcome.

- Evaluation: States how client outcome was met, what might have helped or hinder attainment of the outcome, analyzes the care given. If needed, revisions in the care plan done; interventions, assessment, state if should have done something differently in retrospect.

- Labs: (discussed how the labs relates to the patient’s specific condition).

Answer 1

1. Nursing diagnosis are.:  

A. Impaired skin integrity related to cellulitis lesions over the right lower extremities and gout as evidenced by physical examination.

B. Acute pain related inflammation as evidenced by pain score 5/10.

C. Impaired physical mobility related to gout and swelling pain on legs as evidenced by patient walks with the help of walker.

D. Risk for complications: abscess, loss of sensory perception,shock related to disease condition.

2. 3 top problems with details.

A.impaired skin integrity related to cellulitis lesions over the right lower extremities as evidenced by physical examination.

B. Acute pain related inflammation as evidenced by pain score 5/10

C. Impaired physical mobility related to gout and swelling pain on legs as evidenced by patient walks with the help of walker.

3 . Goals and measurable outcomes.

Impaired skin integrity

Goal : The patient skin integrity will be improved as evidenced by decrease in swollen and lesions.

Acute pain:

The patient will be as comfortable and pain free as possible, the pain score attain to normative level.

Impaired physical mobility:

The patient will maintain adequate physical mobility as evidenced by ambulate ,move in room, and goes toilet without help of walkers.

4. Interventions

A. Impaired skin integrity

> Moniter skin condition regularly to determine treatment is working

>Apply topical agents as ordered to help suppress inflammation and itching.
> Provide skin care at bedtime to help promote comfortable sleep. Many antihistamines also have a sedative effect.
>Encourage patient to eat a high-protein dieto promote healing and replace lost protein. If lesions are generalized,

B. Acute pain

>Assess level of pain with pain scale and by observing facial expressions and positioning of body.

> Offer analgesics an prescribed.

>Deerease anxiety with relaxation technique.

> Maintain a comfortable environment, provide for privacy, position in good alignment and condort

ably and maintain a comfortable room temperature.

C. Impaired physical mobility

>Determine preillness and current level of mobility.

> Identify factors that affect ability to be mobile and active.

>Encourage patient to perform self-care to maximum ability.

>Provide active/passive range-of-motion (ROM exercises on a regular basis.

D.Risk for complications : abscess,loss of sensory perception, shock.

> Asses skin condition, sensory ability of affected part,and signs of shock

> Monitor vital signs

> Administration of medications as per order.

> Maintain strict aseptic technique during procedures.

5 . Evaluation

1. Acute pain

The patient is free from pain, he can walk.patient is comfortable with environment. By the interventions of relaxation techniques, analgesic.

2. Impaired skin integrity

Lesions are controlled,no swelling present.patient is able to socialise without difficulty. By medications, moist applications.

3. Impaired physical mobility

Physical mobility is attained to normal level , patient can walk without help of walker.

6. Lab values.

WBC 18.1 H

Hgb 12.9 H,

Immature 0.54 H

Neutrophils 71 H

Lymphocytes 16 L

Absolute neutrophils 13.21 H

Absolute monocytes 1.09 H

elevateddue to infection.

Platelet has decreased : thrombocytopenia present.

Before understand how this values are elevated ,must thorough about function of these cells.

White blood cells, also known as leucocytes, are immune cells that circulate in the blood and in the lymphatic system.

There are 5 main types of leucocytes:

• Neutrophils – main action against bacterial and fungal infections
• Monocytes – main action against bacterial infections
• Eosinophils – main action against parasitic infections
• Basophils – responsible for responses to allergens
• Lymphocytes – main action against viral infections

Neutrophils, eosinophils, and basophils are also known as granulocytes since they contain granules that can digest microorganisms.

Lymphocytes and monocytes are known as agranulocytes since they lack granules in their cytoplasm.

So when and bacteria or virus attack our body , immune system stinulates and produce more and more these types of cells to fight against the organism ,as a compensation mechanism of our body.

So it results elevation in blood..