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Please write a paragraph responding to the discussion bellow. Add citations and references in alphabetical order.
These manifestations are positive for SIRS and meets Sepsis criteria. This requires immediate intervention. Sepsis is “an overwhelming infection that may lead to shock, multiple organ failure, and death” (Copstead & Banasik, 2010). The patient must meet minimum of two of the Sepsis criteria which include:
1.Temp >38°C (100.4°F) or < 36°C (96.8°F)
2. Heart rate > 90
3. WBC > 12,000/mm³, < 4,000/mm³, or > 10% bands
4.Respiratory rate > 20 or PaCO₂ < 32 mm Hg
5. Suspected or present source of infection
6. Lactic acidosis, SBP <90 or SBP drop ≥ 40 mm Hg of normal (MDCalc, 2016)
Also, the presence of immature neutrophils (bands) in the circulating blood is often used as a clinical indicator of sepsis (Cavallazzi, Bennin, Hirani, Gilbert & Marik, 2010). A band count greater than 10% is one of the American College of Chest Physicians/Society of Critical Care Medicine’s systemic inflammatory response syndrome (SIRS) criteria used to diagnose sepsis and Mrs. G’s band count is 12%
ii.) To manage the Sepsis diagnosis, I would begin immediate treatment.
- Measure lactate level which will determine the presence and severity of sepsis
- Obtain blood cultures prior to administration of antibiotics
- Administer broad spectrum antibiotics like Vancomycin and piperacillin tazobactam
- Administer 30 ml/kg crystalloid for hypotension or lactate ≥4mmol/L (Critical Care Medicine, 2015)
- Reassess Lactate Level after fluid administration
b.) For the obvious open wound infection on the leg I would order a wound consult. I would anticipate a debridement and possibly a wound vac application depending on how deep they had to go.
c.) Next, I would have the hospitalist order a consult with infectious disease to manage the positive Staphylococcus aureus infection.
d.) Lastly, glucose testing and a consult to endocrinology to help manage the diabetes.
2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
- The muscle groups affected by the wound on Ms. G’s lower left leg are the gastrocnemius (large calf muscle forming the bulge visible beneath the skin) medial and lateral head, fibularis longus, extensor and flexor digitorium longus, tibialis anterior, soleus, and the extensor hullucis longus .(at the ankle) (ARC, Media). These are primarily superficial muscles from the knee to the ankle
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.
The subjective data allows us to understand how Ms. G is feeling and what she is experiencing (DuPont, 2017). Ms. G informed the health care provider that she is unable to care for herself and that her wound is too painful and swollen for her to manage.
She also admitted that she is not eating. Here she is demonstrating that she cannot make rational decisions regarding her diabetes and she states that she has no one to help her at home. I would recommend a consult to social work to provide options for her after discharge such as home health nursing for wound care and PT/OT for muscle strengthening. She might also need a home health aide to assist with ADL’s and meal preparation. Along with these recommendations, is providing education for Ms. G such as diabetic education including ADA diet (Collins & Sloan, 2013), wound care, medications and disease process.
I would recommend follow-up lab work along with routine assessments of the wound, noting color, temperature, edema, and presence of drainage. She will also need social work follow-up visits and counseling sessions to assess Ms. G’s home life, diabetes, access to medications as ordered, and any other issues, questions or concerns that that she may have about her situation (Medical social worker, n.d.).
