Sherman Red Case Analysis Paper

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

African- American female, 71 years old, has been admitted to the hospital from her primary care provider ten days post-op following a right below the knee amputation. Her only complaint is that of abdmonial pain. Her vitals are as follows: BP 100/70, HR 122, RR 22, Temp 101.1, and oxygen level 96% on room air. Glucose level is 563mg/dl on glucometer and the patient states that she takes a round white pill for her diabetes. She has also been diagnosed with hypertension in the past and takes a white oval pill for it. Head to toe assessment that has been completed noted a foul smell omiting from the bandage where the leg has been amputated. Clearly this patient is exhibiting clinical signs of sepsis. The initial thought is that the source of infection is the surgical wound since the foul odor is present. The next few hours are critical in initating treatment for sepsis. Multi-organ failure can result if treatment is not received in

I was just two weeks into my internal medicine rotation at Suez Canal University in Egypt, when I encountered a case that I still remember to this day. Ms. Rafat was an elderly diabetic patient that came into our clinic complaining of a persistent wound on the sole of her foot. Upon removing her boots, her complaint turned out to be a foot ulcer with an infection extending to the first and second metatarsal bones .Unfortunately for her, we had to break the news to her and her family that her foot would need amputation. Ms. Rafat was understandably upset but took the news in stride. Following up on her case, I learned that after the surgery, the blood flow to her leg became increasingly poor and she had to return to have a below the knee amputation. Ms. Rafat ended up dying of pulmonary embolism as a complication of her second surgery. This case stayed with me not only because it

Septic shock is the leading cause of death for patients in intensive care units and is the final stage in a continuum of infectious and inflammatory processes. This continuum begins with bacteremia, which is the presence of bacteria in the blood. Normally the body’s immune system can fight off a localized infection caused by a small amount of bacteria in the blood and the person will remain asymptomatic. However, a hospitalized patient could be immunocompromised, have a

It is estimated that 387 million people, globally live with diabetes (Phillips & Mehl, 2015). According to Medical News Today [MNT], diabetes is a metabolic disorder; which causes patients to be extremely thirsty and produce a lot of urine. Diabetes arises due to high blood pressure, due to the body not being able to produce enough insulin or because the body does not respond well to high insulin levels (MNT, 2016). There are four types of diabetes; there is the pre-diabetic stage, type 1 diabetes, type 2 diabetes and gestational diabetes. In 2014, 29 million people died due to diabetes. This equates to 1 diabetic patient dying every seven seconds due to preventable complications (including complications affecting lower limbs) caused by diabetes. It is said that 20-40% of health care costs are spent on the treatment of lower limb complications due to diabetes. The risk of a diabetic patient developing a foot ulcer is 25% and foot ulcers account approximately 85% of lower limb amputations. Diabetic complications that affect lower limbs are caused by both type 1 and type 2 diabetes (Phillips & Mehl, 2015). It is said that the World Health Organization described diabetic foot syndrome as including all possible complications in relation to the feet of a diabetic patient. Diabetic foot syndrome is defined as the ulceration of the foot, from the ankle downwards. Causes of foot ulceration include peripheral sensory neuropathy, vascular disease (ischaemia) and infection

venous leg ulcers and diabetic foot ulcers. Canadian Association of Wound Care (CAWC) has published

From observation, currently, the risk of delayed wound healing is managed, by nursing interventions and verbal health promotion, which may be due to the deficiency of packages designed for patients. This is supported by Collier (2003), who highlights the importance of nursing assessment, interventions and evaluation in improving wound healing. However, the importance of patients’ education, about balanced nutrition and dietary control of diabetes, may not be under estimated, as this may reduce the risk of infection and improve wounds healing (Casey, 1998, Dealey, 2005, Kemp, 2001, Timmons 2003, Ward, 2002). According to patients’ experience, their knowledge about nutrition helped them to achieve wound healing (Wound Care Information Network, 2008). For example, balanced proteins intake may encourage tissue repairs, as well as vitamin C intake may reduce the risk of infection, which may improve wound healing (Kemp, 2001, Ward,

After the initial investigation, the BSN nurse would then research current treatments for pressure ulcers as they relate to diabetic patients. To properly care for a diabetic foot ulcer, the BSN nurse would suggest debridement and a dressing to prevent tissue dehydration, absorb excess fluid, and to prevent wound contamination (American Diabetes Association 2006). Patient education would also be necessary to ensure she does not bear weight on the affected limb to promote healing. According to the American Diabetes Association, the biggest challenge for healing a diabetic wound is keeping the patient from bearing weight on the affected limb. The BSN nurse may be equipped to handle the patient education better than the ADN nurse due to the amount of research done on the subject.

Sepsis is a phenomenon in which an infective agent results in a physiological response in excess of the pathogenic insult. Efforts to define and investigate sepsis have been somewhat fruitful in elucidating the nuances of this phenomenon. Yet, gaps exist in identifying and investigating sepsis. Recent efforts have streamlined the definition and identification criteria of sepsis and septic shock. The treatment of sepsis is based on the elements of identification, hemodynamic interventions (fluid and vasopressor resuscitation), and antimicrobial therapy/source control. A two-tiered approach employing the qSOFA (Quick Sepsis-Related Organ Failure Assessment) and SOFA (Sepsis-Related Organ Failure Assessment) tools now provide a succinct criteria for sepsis and septic shock. Various approaches may be taken to assess fluid responsiveness, provide fluid resuscitation, and determine the need for vasopressor support. Early, aggressive antimicrobial therapy is essential to the treatment of sepsis. Obtaining source control and considering early surgical

Today, despite precise surgical techniques to cut out dying tissue, artificial skin and other high-tech treatments, hard-to-heal wounds remain a huge problem. Diabetic foot ulcers alone strike about 600,000 people annually and lead to thousands of

Septic shock is treated with prompt administration of antibiotics depending on the source and type of underlying infection. These patients are often dehydrated and require large amounts of fluids to increase and maintain blood pressure.

Treating the underlying disease is the most important and should identify the underlying cause of the DFU during the patient assessment, if possible correct or eliminate it. Treating any severe ischaemia is crucial in wound healing, regardless of other interventions. It is recommended that all patients with ischaemia of the limb, rest pain, ulceration and tissue loss, should be referred for consideration of arterial reconstruction. Achieving optimal diabetic control involves tight glycaemic control, managing risk factors such as high blood pressure, hyperlipidaemia and smoking. Nutritional deficiencies should be rectified for better wound

Therefore, the aim of this literature review is to explore issues in relation to patient concordance in their leg ulcer care in the

Sepsis is defined as the invasion of infection into the bloodstream (septicaemia) and start to affect other organs in the body (Foster, Whetsone, Prevost, & S, 2012). Septic shock can cause multiple organ failure and also can cause blood clots to form thus compromising the vital organs with enough oxygen and nutrients .Sepsis can cause a decrease in tissue perfusion which results in systemic vascular dilation .In this essay progression of infection will be explained, stages of septic shock, major causes of septic shock and the effects on perfusion and microcirculation on major vital organs (Foster, Whetsone, Prevost, & S, 2012).

They have diminished inflammatory response even when extreme soft tissue and bone infection are present. Identification of foot infections in the patient with diabetes mellitus requires vigilance because the signs of infection may not be present ( Baranoski and Ayello, 2003,p.327). The most common bacteria found in non-limb threatening infection are Staphylococcus and Streptococcus. These infections should be treated with oral antibiotics. If the limb is threatened with the infection, parenteral antibiotics and surgical debridement of necrotic tissue needs to be executed. Most limb threatening infections are polymicrobial. Staphylococcus aureus, group B atreptococci, Enterococcus, and facultative Gram-negative bacilli are the major pathogens involved in these types of