Mr. Godbless,Jose Lindsey.
Age 59years.
Sex : Male.
Medical record :Q0000566778.
Location: 2North, room221102
Admitted: 09/03/2009
Attending doctor: Dr Bigboy, J.
Admitting Diagnosis: Osteomyelitis Drainage from fourth toe,uncontrolled blood sugar (blood sugar in Emergency room was 600)
Secondary Diagnosis: Acute kidney injury, CKD,HTN,HLD,Diabetes.
Language: Spanish speaking only.
Height: 6ft 2 inches.
Weight : 240lbs.
Right Great toe and pinky toe amputation.
Right fourth toe Diabetic ulcer.Chronic wounds are usually the wound that do not heal in a normal time that it is supposed to heal.They became stagnant in one of the healing phases. Re- evaluation of treatment modality is needed. Wound consult ordered.
(Sometimes a new treatment modality might be needed to heal the wound. )
Alert and oriented × 4
Room Air. Lungs clear.
Allergy: NKDA
Diet: Carb Control Diabetic diet.
Wound Consult done.
Recommendations:
Daily Dressing change ,and prn.
Clean wound with normal saline
Apply 4×4 Non adhesive dressing
Wrap with kerlix roll.
Elevate on pillows.
Skin intact except wounds.
Ambulate with FWW.
MEDICATIONS:
Dilaudid 4mg IV × 1now.
Morphine 2mg iv Q3hrs prn pain.
Percocet tablets 5mg 1tablet po Q4hours prn pain less than 4
Percocet 5mg 2tablet po Q4 hours for pain level greater than 4.
0.9NS at 75ml/hr left forearm.
Lab results:
WBC :8.8
H/H 11.5/34.4.
Blood sugar check Qac and Qhs.
PLAN:
Discharge patient to SNF with the same orders. Doctor Bigboy, J. is the same doctor following patient in SNF.( He said that if the nurses have any question,they should page him.
Questions :
There is order for dilaudid 4mg iv ×1.The nurse administers the dilaudid medication, two hours later the patient again complains of pain again. And the nurse administers a second dose of dilaudid 4mg iv push slowly. Which of the following describes the nurse liability.
The answer is:
The nurse violated the narcotic law because there was no order to administer the dilaudid 4mg iv a second time. She should have called the doctor or offer percocet or morphine 2mg iv to patient.
What is chronic wound?
Why is the wound not healing?.
Is his blood sugar affecting his wound healing?.
Why do you elevate the affected leg on pillows ?.
What is the difference between chronic wound and acute wound?.
Is it right for the patient to be transferred to SNF with same orders?.
Why should the nurses have questions?.
Is this doctor following the correct procedure for transfer of patient to SNF?.
To prevent Osteomyelitis in a child who has fracture and is in Skeletal traction, the nurse should plan to :
Answer: Encourage good nutrition.
Rationale :The best strategy for preventing Osteomyelitis is to maintain skin integrity and provide good nutrition protective Isolation is not necessary. Osteomyelitis is caused by bacteria invading bone tissue.
Nurses You Move Me 