Differentials for her Current Problems
1. The patient has an infected wound: She has a perforation on her foot with visible crusting and purulent drainage. A further basis for the diagnosis is the bad odor and puss emanating from the wound (Milne, 2017). A potential differential diagnosis is that the patient has used the wrong chemicals to wash the wound leading to corrosion. The patient has been using Hydrogen peroxide to clean the wound. Of the chemical had been exposed to light, its chemical composition may have altered, which may affect the wound. The wound may also be undergoing tissue-breakdown with the anaerobic bacteria causing the smell.
2. The patient also has uncontrolled type two diabetes due to a lack of proper medication. The basis for the diagnosis of the previous diagnosis and poor adherence to the medical regimen. Differential diagnosis includes metabolic syndrome and Hyperthyroidism which mirror some of the symptoms of type two diabetes in overweight patients. The patient may be mimicking symptoms of diabetes due to an ineffective digestive system (Zhou et al., 2018). Finally, the patient may be having complications relating to asthma. Currently, the patient is under Albuterol and Singulair but has been inconsistent in taking the drugs. Asthma and inconsistent use of prescription drugs could be causing complications for the patient.
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Diagnosis of Most Concern
Now, I am most concerned with the wound on her feet, as it is infected and has the potential of exacerbation including potential for amputation (Nayak, Mahapatra & Das, 2016). The type two diabetes problem is also a bearing factor as it can inhibit the healing process. The management of diabetes will directly contribute to the healing of the foot. Hence, I need to manage the two problems contemporaneously.
Diagnostic Images
I would order a whole-body Magnetic resonance imaging (MRI). The patient has been complaining about general achiness, which means that the fall could have resulted in another injury. Further, this is the first instance of treatment after the patient fell hard enough to injure her leg. The MRI would confirm or rule out any other injuries (Kim, Hong, & Cho, 2019). I would also order a chest x-ray to establish the condition of her respiratory system. The patient has a history of chain-smoking combined with intermittent use of asthma medication, hence the need to assess the status of her lungs and chest cavity.
Laboratory Work
I would order a Bacterial culture to test the wound for infection. The culture test would not only confirm infection but also reveal the nature of infection and the most suitable treatment regimen (Milne, 2017). I expect to find evidence of infection and an absence of the same would be abnormal as all signs point to an infected wound.s Further, I would consider a C-reactive protein (CRP) to establish if the chest-related symptoms are a result of an infection (Cag et al., 2019). However, evidence of an infection in the chest would be abnormal as her symptoms mainly point to asthma. Further, the infection has the potential to exacerbate asthma. I would also order second fasting blood sugar (FBS) test based on observation to ensure the patient has fasted, as the first one relied on the patient’s word. Finally, I would order a urine test for ketones to establish the suitability of exercise is an effective way of controlling blood sugar (Colberg et al., 2016).
Comprehensive Plan of Care
Initial Goals : Admit the patient for diagnostic processes and for observation. Diagnostics include Bacterial culture, C-reactive protein (CRP), fasting blood sugar (FBS) test, and a urine test for ketones. Further, diagnostics tests include full-body MRI and a chest X-ray.
Physician Orders : Patient is highly allergic to Penicillin
Nursing Orders : the cleaning and dressing of the wound on the patient's left leg.
Social Services : Connect the patient with social support for patient education regarding self-care and consistent use of prescription medication.
Dietary Orders : Place the patient in the requisite diet for type II diabetes. Patient education on the management of diabetes is also necessary.
References
Cag, Y., Pacal, Y., Gunduz, M., Isik, S., Kertmen, B. A., Toprak, N., ... & Kut, A. (2019). The effect of peripheral blood eosinophilia on inflammatory markers in asthmatic patients with lower respiratory tract infections. Journal of International Medical Research, 47(6), 2452-2460.
Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., ... & Tate, D. F. (2016). Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes care , 39 (11), 2065-2079.
Kim, M., Hong, T. H., & Cho, H. J. (2019). Validity of bone scans to detect missed injury in patients with major trauma. Ulusal Travma ve Acil Cerrahi Dergisi , 25 (2), 183-187.
Milne, J. (2017). Accurate chronic wound assessment in the community setting. Journal of Community Health Nursing , 31 (2), 25-28.
Nayak, B., Mahapatra, K. C., & Das, R. R. (2016). Management of complex diabetic foot wound by external fixation: An effective way for limb salvage. Journal of Health Specialties , 4 (2), 128.
Zhou, Y. C., Fang, W. H., Kao, T. W., Wang, C. C., Chang, Y. W., Peng, T. C., ... & Chen, W. L. (2018). Exploring the association between thyroid-stimulating hormone and metabolic syndrome: A large population-based study. PloS one , 13 (6).
