Sarah Smith is the patient that sought medical help with the wound to the top of her left foot after she scraped it on the pavement several days ago. Sarah denies any other injury, fever, or chills but has been experiencing generalized pain in the wounded foot and foul-smelling drainage over the past twenty-four hours, which she has been sanitizing with hydrogen peroxide. The patient did not seek medical attention since obtaining the injury and is unclear about her last tetanus vaccination. This paper aims to analyze Sarah’s symptoms and medical diagnoses, list existing differentials for her current problem, order certain diagnostic images and laboratory work, as well as propose a comprehensive plan of care.
The primary examination of the skin area with the wound shows the evident signs of the diabetic foot ulcer caused by an injury. It is complicated with foul-smelling discharge and painful skin due to delayed help-seeking (“Frequently asked questions,” 2020). A simple abrasion is also not considered as the patient’s PMH marks positive for DM II. This proves the wound’s failure to heal for several days and the complications that follow. The undertreatment of diabetes, as in Sarah’s case, causes the blood glucose to remain high, preventing the white blood cells from functioning correctly, thus, lessening the body’s ability to fight bacteria and close the wound. The fact that Sarah is African American and used to be a smoker adds to the condition deterioration. The ulcerated malignant melanoma is less likely for Sarah because of the protective effects of melanin in her skin due to her being African American.
Considering the foul-smelling drainage from the wound, a blood infection might occur. Such diagnostic scanning as an x-ray should be ordered to strictly determine the tissue damage severity and search the areas of pus discharge. Moreover, to avoid further complications, blood tests must be taken for bacterial culture, including a Gram stain for infective organisms and staining for fungal cultures (“Wound and skin infections,” 2020). Additionally, the antimicrobial susceptibility test should be taken to predict the bacteria’s sensibility to particular medications, which helps prescribe appropriate antibiotics. The latter will appear necessary to stop the spread of bacteria and prevent the infection (Altoé et al., 2019). Based on the blood tests and x-ray results, the antibiotics can be only topical for topical treatment or intravenous medications therapy in a more severe case. If a foot ulcer is positive, to reduce the possibility of foot amputation, the wound must be cleaned thoroughly, dead skin and tissue removed, and the off-loading of the pressure area must be performed. All the above must be complemented by managing blood glucose for the wound to heal.
To conclude, three possible differentials were considered in the patient’s case, the most probable of which is the diabetic foot ulcer caused by physical trauma and insufficient blood glucose maintenance. The probability of such a condition is reinforced by Sarah being African American and a smoker in the past. The wound fails to heal, and the tests must be conducted to exclude the blood infection, such as x-ray scanning and tests for bacterial culture, a Gram stain, staining for fungal cultures, and antimicrobial susceptibility. Antibiotics should be implemented based on the results of the test, and meanwhile, the wound should be cleaned, dead skin removed, and off-loading of the area should be conducted. Thus, the wound will be well-maintained while waiting for the results to state a precise diagnosis.
Altoé, L. S., Alves, R. S., Sarandy, M. M., Morais-Santos, M., Novaes, R. D., & Gonçalves, R. V. (2019). Does antibiotic use accelerate or retard cutaneous repair? A systematic review in animal models. PloS One, 14(10), e0223511. Web.
Frequently asked questions: Diabetic foot ulcers. (2020). Regents of the University of Michigan. Web.
Wound and skin infections. (2020). American Association for Clinical Chemistry. Web.