Wound case study

Wound case study

L. G. is a 68-year-old man who goes to the hospital emergency department with a complaint of left foot pain. He has a 7-year history of type 2 diabetes controlled with metformin (Glucophage) 500 mg orally twice daily.

 Subjective Data

• States he stepped on “something” in the yard a few days ago
• States he is unable to bear weight on the left foot
• Has been nauseated and “just haven’t felt good”.

Objective Data

Physical Examination

• Blood pressure 160/90, pulse 110, respirations 24, temperature 99.8° F
• The left foot is swollen, red, and warm to touch
• Open area on the ball of the left foot near the first metatarsal, with tissue loss and irregular wound margins Measures 2 cm in diameter, with a moderate amount of thick yellow drainage
• Bilateral paresthesia in lower legs

diagnostic studies

• Blood glucose 350 mg/dL
• White blood cell (WBC) count 19,200/µL; 80% neutrophils (12% bands)

Answer the discussion questions below. Please number your answers.

• What is the significance of the WBC count?
• Are L.G.’s manifestations of inflammation local or systemic? What information supports your response?
• How do you explain the slight elevation in L.G.’s temperature?
• What other diagnostic tests may be needed to help establish a diagnosis?
• By what method will L.G.’s wound heal?
• What factors may interfere with or delay the healing of L. G.’s wound?
• L. G. will be admitted to the medical unit. What nursing interventions should be included in his plan of care?
• What will be L.G.’s priority discharge teaching needs?