A patient with a non-healing wound on the right leg is diagnosed with MRSA and has poorly controlled diabetes. Based on the diagnostic findings, which nursing intervention should be prioritized to promote wound healing?

A) Administer prescribed vancomycin to target the MRSA infection.

B) Educate the patient on foot care to prevent further injury.

C) Initiate a diabetic meal plan to stabilize blood glucose levels.

D) Elevate the affected leg to improve circulation and reduce swelling.

A patient diagnosed with a non-healing wound infected with MRSA and poorly controlled diabetes presents with diminished peripheral pulses on Doppler ultrasound. Which nursing intervention is the priority to promote wound healing in this patient?

C) Administer prescribed intravenous vancomycin to address the MRSA infection.

A) Educate the patient on daily foot care and the importance of glycemic control.

B) Initiate a referral to a vascular specialist for further evaluation of blood flow.

C) Administer prescribed intravenous vancomycin to address the MRSA infection.

D) Consult with a dietitian for a nutritional plan to support immune function and wound healing.

A patient with a MRSA infection in the right leg is receiving intravenous vancomycin but reports increased pain and erythema in the affected area. What is the most appropriate nursing action to address this change in the patient's condition?

B) Assess the patient's vascular status and notify the healthcare provider

A) Increase the frequency of vancomycin doses

B) Assess the patient's vascular status and notify the healthcare provider

C) Apply warm compresses to the affected area to alleviate pain

D) Encourage increased oral fluid intake to promote circulation

A patient with a MRSA infection in the right leg is experiencing increased pain and erythema despite antibiotic therapy. The healthcare team is considering the possibility of underlying osteomyelitis. Which nursing intervention is most appropriate to prioritize while awaiting further diagnostic results?

C) Reinforce patient education on the importance of blood glucose control

A) Increase the frequency of vital signs monitoring

B) Initiate a consult with a physical therapist for mobility exercises

C) Reinforce patient education on the importance of blood glucose control

D) Prepare the patient for immediate surgical intervention

A patient with osteomyelitis presents with sudden right leg swelling, bullae, fever, and hypotension. Given the clinical findings and current management, which nursing intervention is most critical to prioritize?

B) Initiating fluid resuscitation to address hypotension

A) Administering analgesics to manage pain

B) Initiating fluid resuscitation to address hypotension

C) Applying sterile dressings to the bullae

D) Educating the patient about antibiotic therapy

A patient with suspected necrotizing fasciitis and osteomyelitis is being managed with broad-spectrum antibiotics and supportive care. Which nursing intervention is most crucial in preventing further deterioration of the patient's condition?

B) Monitoring vital signs and urine output hourly

A) Encouraging high protein intake to promote wound healing

B) Monitoring vital signs and urine output hourly

C) Applying cold compresses to the affected limb to reduce swelling

D) Restricting fluid intake to prevent fluid overload

A nurse is caring for a patient in the intensive care unit with a diagnosis of sepsis progressing toward septic shock. Despite the initiation of broad-spectrum antibiotics and aggressive fluid resuscitation, the patient's condition continues to deteriorate with signs of hypotension and decreased urine output. Which of the following interventions should the nurse prioritize to stabilize the patient's hemodynamic status?

B) Administer vasopressors as ordered

A) Increase the rate of intravenous fluids

B) Administer vasopressors as ordered

C) Initiate high-flow oxygen therapy

D) Prepare for immediate surgical intervention

A patient with sepsis is showing signs of progression towards septic shock, including fever, hypotension, tachycardia, tachypnea, decreased urine output, and a rising white blood cell count. Which nursing intervention is the priority in managing this patient's condition?

B) Initiating aggressive fluid resuscitation to maintain perfusion

A) Administering antipyretics to reduce the patient's fever

B) Initiating aggressive fluid resuscitation to maintain perfusion

C) Adjusting the antibiotic regimen to target identified pathogens

D) Monitoring urine output every four hours for changes

A patient in the intensive care unit is experiencing acute respiratory distress syndrome (ARDS) and acute kidney injury secondary to sepsis. The nurse is reviewing the patient's plan of care. Which intervention should the nurse prioritize to address these complications?

B) Initiating mechanical ventilation to improve oxygenation

A) Administering diuretics to manage fluid overload

B) Initiating mechanical ventilation to improve oxygenation

C) Starting a high-protein diet to promote renal function

D) Increasing fluid resuscitation to maintain blood pressure

A patient in the intensive care unit has developed acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) secondary to sepsis. Despite receiving supplemental oxygen, the patient's oxygen saturation remains low. Which of the following interventions should the nurse prioritize to address the patient's respiratory status?

B) Prepare the patient for potential intubation and mechanical ventilation.

A) Increase the rate of intravenous fluid administration to improve circulation.

B) Prepare the patient for potential intubation and mechanical ventilation.

C) Administer diuretics to reduce pulmonary congestion.

D) Adjust the patient's position to semi-Fowler's to facilitate breathing.

cellulitis right leg, non healing wound right foot - Nursing Case Study

Pathophysiology

• Primary mechanism: Cellulitis develops when bacteria, commonly Streptococcus or Staphylococcus, enter the skin through breaches such as a non-healing foot wound. This triggers an acute inflammatory response, characterized by redness, warmth, swelling, and pain in the affected area.

• Secondary mechanism: The non-healing wound on the right foot may result from poor blood circulation or diabetes, impairing the normal wound healing process. This creates a persistent portal of entry for bacteria, exacerbating infection and delaying recovery.

• Key complication: If untreated, cellulitis can progress to systemic infection or sepsis, particularly if underlying conditions like diabetes are present, emphasizing the need for timely intervention and wound management.

Patient Profile

Demographics:

52-year-old male, construction worker

History:

• Key past medical history: Type 2 diabetes mellitus, hypertension, previous cellulitis episodes

• Current medications: Metformin, Lisinopril, Atorvastatin

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Swelling and redness in the right leg with a non-healing wound on the right foot

• Key symptoms: Pain and warmth in the right leg, fever, fatigue, increasing drainage from the wound, difficulty walking

• Vital signs: Temperature 101.5°F, Heart rate 102 bpm, Blood pressure 145/90 mmHg, Respiratory rate 22 breaths per minute

Section 1

New Diagnostic Results:

As the healthcare team conducts further assessments, a series of diagnostic tests are ordered to evaluate the extent and progression of the infection. Laboratory results reveal elevated white blood cell count at 15,000/mm³, indicating an active infection. C-reactive protein (CRP) levels are significantly elevated at 22 mg/L, corroborating the presence of acute inflammation. Blood glucose levels are noted to be poorly controlled, with a fasting blood sugar of 180 mg/dL, highlighting the potential challenges in wound healing due to diabetes.

A Doppler ultrasound of the right leg is performed to assess vascular integrity, revealing diminished peripheral pulses and decreased blood flow, particularly in the area surrounding the non-healing wound. This finding suggests compromised circulation contributing to the delayed wound healing and persistent infection. Cultures taken from the wound drainage grow methicillin-resistant Staphylococcus aureus (MRSA), necessitating a change in antibiotic therapy to one that effectively targets this resistant pathogen.

These diagnostic results underline the need for an integrated approach to management, combining aggressive infection control, optimization of glycemic levels, and improved perfusion to the affected limb. The healthcare team must consider initiating intravenous vancomycin for MRSA coverage, along with a comprehensive diabetic management plan, including insulin therapy adjustments. This multifaceted strategy will aim to address both the microbial and systemic factors contributing to the patient's current condition and prevent further complications.

Section 2

As the healthcare team initiates the integrated management plan, initial responses to the interventions are closely monitored. The patient is started on intravenous vancomycin to target the MRSA infection, and adjustments are made to the insulin regimen to improve blood sugar control. Within the first 48 hours, there is a moderate reduction in the patient's white blood cell count, decreasing to 13,000/mm³, which suggests a partial response to the antibiotic therapy. However, the patient reports increased pain and tenderness in the right leg, with visible erythema extending further up the limb, indicating the potential spread of the infection despite initial treatment efforts.

Clinical reasoning prompts further investigation into the patient's vascular status and wound care practices. The healthcare team considers the possibility of an underlying osteomyelitis, given the persistent nature of the infection and the compromised circulation. An MRI of the right foot is scheduled to assess for bone involvement, which could explain the lack of healing and increased discomfort. Meanwhile, wound care is intensified, involving debridement and advanced dressings to promote a more conducive environment for healing, while ensuring stringent infection control measures are in place to prevent further complications.

The patient's blood glucose levels remain a challenge, with fasting levels fluctuating around 170 mg/dL, indicating a need for tighter glycemic control. This prompts a reassessment of the patient's insulin regimen and dietary intake, with the involvement of a diabetes educator to enhance patient education and adherence to the management plan. The multidisciplinary approach aims to stabilize the patient's condition, prevent further progression of the infection, and set a foundation for improved healing outcomes. As the situation evolves, the healthcare team remains vigilant, anticipating potential complications and ready to adapt the treatment strategy as necessary.

Section 3

New complications arise as the patient experiences a sudden increase in right leg swelling and the development of bullae over the affected area, accompanied by a fever of 101.8°F. Vital signs reveal a blood pressure of 98/60 mmHg, heart rate of 112 beats per minute, and respiratory rate of 22 breaths per minute. These findings raise concerns for systemic involvement, potentially indicating the onset of septicemia or a more aggressive soft tissue infection, such as necrotizing fasciitis. The healthcare team immediately initiates a sepsis protocol, including broadening antibiotic coverage to include piperacillin-tazobactam, and closely monitors hemodynamic status while preparing for potential surgical intervention.

Laboratory results reveal an elevated C-reactive protein (CRP) of 150 mg/L and procalcitonin levels suggestive of severe infection, both indicative of escalating inflammatory response and possible systemic spread. Despite these alarming results, the MRI of the right foot confirms the presence of osteomyelitis, necessitating a prolonged course of intravenous antibiotics and potential surgical debridement to address the infected bone. The worsening clinical picture prompts an urgent consultation with infectious disease specialists and surgical teams to refine the treatment strategy, emphasizing the importance of a coordinated and timely approach.

These developments necessitate a reevaluation of the patient's overall management plan. The healthcare team intensifies supportive care measures, including fluid resuscitation and vasopressor support as needed, while reinforcing wound care protocols to contain local infection. Attention is also directed towards optimizing the patient's nutritional status and glycemic control, crucial elements in supporting immune function and wound healing. As the patient's condition becomes more complex, the team remains committed to a holistic approach, ready to adapt interventions to the evolving clinical scenario while keeping the patient's safety and recovery as the primary focus.

Section 4

The healthcare team is closely monitoring the patient's response to the initiated sepsis protocol and broad-spectrum antibiotic therapy. Within 24 hours, a notable change in the patient's status is observed. The patient's fever persists despite antipyretic treatment, now reaching 102.5°F, while his blood pressure has dropped further to 90/58 mmHg, raising concerns for hypotensive episodes. The heart rate remains elevated at 118 beats per minute, and the respiratory rate has increased to 24 breaths per minute. These vital sign changes, coupled with a decreased urine output of less than 30 mL/hour, suggest worsening systemic involvement and potential progression towards septic shock.

In parallel, new diagnostic results indicate a rise in white blood cell count to 22,000/mm³, with a significant left shift, further corroborating the presence of a severe infection. Blood cultures drawn earlier return positive for Gram-positive cocci, prompting a reassessment of the antibiotic regimen to include vancomycin, targeting potential methicillin-resistant Staphylococcus aureus (MRSA) involvement. The infectious disease team collaborates with the surgical team to expedite plans for surgical debridement, aiming to control the source of infection and mitigate further systemic spread.

Given the deteriorating clinical picture, the healthcare team intensifies supportive measures. The patient is transferred to the intensive care unit for closer hemodynamic monitoring and aggressive fluid resuscitation. Continuous assessment of the patient's response to vasopressor support is initiated to stabilize blood pressure. The multidisciplinary approach remains crucial, focusing on rapid interventions and adaptive management to address the evolving complications while preparing for the potential need for further interventions, including advanced wound care techniques and additional surgical procedures. The team's vigilance and proactive strategies are essential in navigating this critical phase of the patient's journey, highlighting the importance of timely and coordinated care.

Section 5

New Complications:

As the patient settles into the intensive care unit, the healthcare team notes a further decline in his condition despite ongoing interventions. Within hours of transfer, the patient's oxygen saturation levels begin to drop, fluctuating between 88-90%, even with supplemental oxygen. Auscultation reveals diminished breath sounds and crackles at the lung bases, suggesting the development of pulmonary complications. A chest X-ray is expedited, which reveals bilateral infiltrates, raising concerns for acute respiratory distress syndrome (ARDS), a potential complication of sepsis.

Concurrently, the patient's renal function appears to be worsening. Laboratory tests show a rise in serum creatinine to 2.5 mg/dL from a baseline of 1.0 mg/dL, indicating acute kidney injury secondary to sepsis and hypotension. The urine output remains low, further confirming decreased renal perfusion. The nephrology team is consulted to evaluate the need for renal replacement therapy as part of the supportive care.

The emergence of these complications prompts the healthcare team to reassess the management plan. The patient's fluid resuscitation strategy is adjusted to balance the need for adequate perfusion with the risk of fluid overload, considering the evolving pulmonary and renal issues. The critical care team intensifies monitoring, utilizing advanced hemodynamic monitoring tools to guide fluid and vasopressor therapy. This stage necessitates heightened vigilance and adaptability, as the team works to stabilize the patient while preparing for potential escalation of care, including the use of mechanical ventilation and continuous renal replacement therapy if the patient's condition does not improve promptly.