Cellulitis Diagnosis
For this assignment you will be given a case study about a young lady named Sarah Smith. Review the information provided and answer the questions following. Be sure to cite your references. Look at Sarah as if she is a patient in your office seeking care. What are your immediate concerns? What needs to be done for her? Be thorough and succinct in your responses. Case Study: Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had smelly drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar. PMHx: Asthma: no hospitalizations for exacerbation. DM II PSHx: Denies SHx: Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 years ETOH: socially Illicit drugs: denies FHx: Significant for paternal DM, otherwise unremarkable Medications: Metformin: 500mg BID po – did not take the last few days Albuterol MDI: 2 puffs every 6 hours prn – last use just PTA Singulair: 10mg po daily Trinessa: 1 tab po daily – last taken this am Allergies: PCN: hives LNMP: 2 weeks ago. G0p0 ROS: General: denies any weight changes, fatigue or fever; + body aches Skin: denies any rashes; + wound to left foot HEENT: denies headache, head injury, dizziness, lightheadedness; Denies any vision changes Denies any hearing changes, tinnitus, vertigo, earache Denies any nasal congestion, discharge, nose bleeds or sinus tenderness Denies any sore throat, difficulty swallowing Neck: denies any swollen glands, pain Breasts: denies any pain, discharge Respiratory: denies any dyspnea; positive cough and wheezing CV: denies any chest pain, edema GI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stools PV: denies claudication, swelling to LE GU: denies frequency, urgency, burning; Denies vaginal discharge, itching, sores Denies penile discharge, itching or sores MS: positive pain to left foot Psych: denies nervousness, depression Neuro: denies Headache, dizziness, vertigo, syncope, weakness; + numbness to right LE Heme: denies any easy bruising Physical Exam: Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA Height: 55 Weight: 250 lbs. Blood glucose: 230 (Fasting; states has not eaten yet today) patient awake, alert, oriented x 4 in NAD Skin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; + surrounding erythema extending up 7 cm proximally HEENT: head nontraumatic, normocephalic Pupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking noted Ears: bilateral TM with good cone of light and intact Nose: mucosa pink, septum midline; no sinus tenderness appreciated Mouth: mucosa pink, moist; tongue midline; tonsils 1+ without exudate Neck: supple; trachea midline; no LAD Resp: regular and unlabored; lungs with end expiratory wheezing throughout CV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciated Abdomen: soft, non-distended; Bs + x 4; no tenderness with palpation; no CVA tenderness with percussion Genitalia: deferred Rectal: deferred Extremities: warm and without edema; calves supple, non-tender PV: no LE edema MS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse; CMS intact; Cap refill < 2 sec. Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intact Questions: 1. List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential. 2. At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how? 3. What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out? 4. What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each. 5. What is your comprehensive plan of care? Include your rationales.
