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comment from post 1

1.      The clinical manifestations presented in the case of Ms. G include: pain and heaviness of the left leg, discoloration of the left leg from knee to ankle, left calf is 3” bigger than the right calf. Presence of moderate thick and yellow drainage from the open area on the left leg, elevated temperature, elevated WBC and presence of Bands, and positive wound culture. All these manifestations are consistent with clinical manifestation of infection (pain, edema, pussy drainage, discoloration). The next course of action for treatment should be a course of antibiotic based on the sensitivity of the wound culture. 

2.      Muscles likely to be affected include: tibialis anterior, Gastrocnemius muscle, the soleus muscles, the extensor digitorun longus, Extensor halluces longus, peroneus longus and the peroneus brevis.

3.      The subjective and the objective data provided significantly pointed toward a possible infection. The diagnostics test ordered as the result of those data confirm the presence of infection. The blood test shows elevated WBC, neutrophils, and the presence of Band. “Neutrophils are early responders to an acute bacterial infection and arrive in large numbers very quickly” (Copstead-Kirkhorn & Banasik, 2014) . The wound culture was done to identify the organism responsible for the infection.  In regard to education, Ms. G need to avoid applying heat on her leg because as diabetic she is prone to neuropathy which causes impaired sensation to her extremities, Heat applications can cause further injuries to her leg such burn. In the future, Ms. G need to examine her extremities especially her feet on a regular basis. If any open area or cut to the lower extremity is noted, it must be reported to her physician so treatment can be initiated promptly. Ms. G also need to maintain a good glycemic control, it is important that she eat well balanced meal and check her blood sugar regularly. 

4.      Factors present in this case that could delayed wound healing is the presence of Chronic illness diabetes, and malnutrition. Diabetes alters the individual’s ability to resist infection. “Phagocytosis is impaired with hyperglycemia, and detection of the pain of infection may be delayed because of neuropathies. The invasiveness of the microorganisms is increased when exposed to hyperglycemic environments” ( Copstead-Kirkhorn & Banasik, 2014) . The second factor is poor food intake. Because Ms. G lives alone, she has not been able to cook her own meals when she is sick. This led to poor intake. At a time of sickness, the body needs more protein, cells building blocks, to regenerate new cell for healing; carbohydrates and fats are also needed for energy. Lack of nutrient leads to delay wound healing. Beside the macro nutrient, the body also need essential minerals and vitamins. “Vitamins are essential to synthesize new cell and to promote tissues growth” (Grand Canyon University, Lecture 1, 2013). 

To prevent delay in the wound healing, Ms. G must maintain a good glycemic control, because hyperglycemia delay the body response to infection. She must also eat a well-balanced diet rich in protein and vitamins. She must also follow the wound care treatment recommended and complete any medication (antibiotic) prescribed.



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