Differentials for her Current Problems
1. The patient has an infected wound: The 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 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 both of which mirror some of the symptoms of type two diabetes in overweight patients (Zhou et al., 2018).
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Diagnosis of Most Concern
Now, I am most concerned with the wound on her feet, as it could be 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. I need to manage the two problems contemporaneously.
Diagnostic Images
I would order a whole-body Magnetic resonance imaging (MRI) since 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).
Laboratory Work
I would order a Bacterial culture to test the wound for infection (Milne, 2017). 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
I would process to admit the patient, both for the sake of further testing and for the management of diabetes. Both type two diabetes and an infected wound are treatable under an outpatient plan but a combination of the two needs close minoring and clinical attention (Nayak, Mahapatra & Das, 2016).
References
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).
