443 CASE SCENARIO. RIGHT HEEL INFECTED WOUND/DIABETES/ ISCHEMIC GANGRENE.

Age/ Sex : 69years. Female

Code Status: Full code.

Isolation Status: Contact Isolation.(MRSA wound)

Advanced directive NO.Copy of Advanced Directive on the chart.

02 at 4LNC.

weight : 180lbs,Height: 5ft 2inches.

High risk for fall yes.

Diet: Carb control Cadiac diet.

Allergy:NKDA.

Alert and oriented ×4.

Left lower extremity 2+ edema.

SCD to left lower Extremity.

Wound culture done + for staphylococcus aureus. Antibiotics sensitivity.

Bun: 22,Creatinine =1.3.

Purwick started today at 6pm.

No bowel movement today.

Right ac saline lock.

Vancomycin 1gm Q12hours at 1800.

Norco 10/325mg po Q6hours prn pain.

Laboratory Studies.

Vancomycin trough=18.5.

Bun=17,Cr =1.0

H/H9.8/34%.

WBC =13.00.

NA=136,K=3.9.

Consultations:

Wound consult.

PT consult.

(TPC02 less than 40%)

Surgery consult.

Neurosurgery consult.

Orthopedic consult.

Plans:

NPO after midnight.

D5w @ 75ml/hour.

Possible below the knee amputation of right lower Extremity.

Consent for blood and surgery signed.

Difficult patient must not disturb patient from midnight to 06am.

Published by edochie99

A Registered Nurse with over twenty years of hospital experience, an author with Masters Degree in Nursing,also Bachelor Degree in Nursing,graduated in 1996 from USC,University of Southern California.MSN in 2009 University of Phoenix.

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