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.