Question

Please help

71 y/o male with PMHx significant for DM with PN and PAD s/p RLE peroneal artery angioplasty 11/2018, admitted for right 2nd digit gangrene and cellulitis. Empiric broad - spectrum antibiotics were started immediately, and podiatry. Vascular surgery, and interventional Radiology were consulted. his problem are

Right 2nd toe gangrene with cellulitis I the setting of severe PAD and he had amputation. Right BKA. Peripheral arterial disease. Hypertension. Type 2 diabetes. Coronary artery disease

Base on his problem please help to answer these question below

Age/Gender:

Nursing and Safety Considerations:

Code Status:

Nursing Consideration

Family/ /Cultural Data/Language Barriers:

Nursing Considerations

Allergies/Reactions:

Nursing and Safety Considerations

Previous Surgeries

Nursing considerations.

Contributing Medical History

Nursing considerations

Primary Medical Diagnosis:

Patient specific pathophysiology and nursing considerations:

Contributing Secondary Diagnosis/diagnoses:

Patient specific pathophysiology and nursing considerations:

Answer 1

The Principal/Primary Diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

Secondary diagnosis or “other diagnosis” as = conditions that coexist at the time of admission, or develop subsequently, and that affect the patient care during the current episode. It developed after admission, so it would be a secondary diagnosis.

In this case the primary diagnosis include :-

Type 2 diabetes mellitus

Hypertension

Coronary artery disease

Peripheral arterial disease

Peripheral neuropathy

Gangrene and cellulitis of right 2nd toe

# Pathophysiology :-

Dry gangrene is the type of gangrene that can occur as a complication of a pre-existing health condition, including type 1 and type 2 diabetes.

As a result of damage to the blood vessels throughout the body due to prolonged hyperglycemia, it is possible for blood circulation to be cut off. Blood carries oxygen and nutrients to the tissue around the body and so without it, the tissue will eventually die.

This usually happens in the extremities first, in the toes, feet and fingers.

# Nursing Interventions :-

Seek care immediately if:

Your symptoms return or you have new symptoms.

Contact your healthcare provider if:

You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

Antibiotics help treat a bacterial infection.

Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day.

NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.

Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Self-care:

Elevate your arm or leg above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your arm or leg on pillows or blankets to keep it elevated comfortably.

Rest as directed. Do not return to your usual activities until healthcare provider says it is okay. It may take several weeks for you to recover.

Eat a variety of healthy foods. Healthy foods will help you heal. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask if you need to be on a special diet.

Care for your wound as directed:

Carefully wash around the wound with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. If your wound is left open, change the packing as directed. Always wash your hands before and after you touch your wound. Check your wound every day for redness, swelling, and pus.

Prevent gangrene:

Care for all wounds and incisions as directed. Always wash your hands before and after you touch your wound or incision. Use soap and water or an alcohol-based hand rub. Carefully wash around the wound or incision with soap and water. Dry the area and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. Call your healthcare provider if your wound or incision becomes red, swollen, or drains pus. Early treatment can help prevent gangrene.

Manage other health conditions. This includes diabetes, peripheral artery disease, and problems with blood clotting. These conditions can increase your risk for wound infections.

Seek care immediately for symptoms of a blood clot or poor blood flow. Symptoms of a blood clot include an arm or leg that feels warm, tender, and painful. It may look swollen and red. Symptoms of poor blood flow include an arm or leg that is cold, pale, or numb.

Follow up with your healthcare provider as directed:

You may need to return for hyperbaric oxygen therapy. Write down your questions so you remember to ask them during your visits.

# Secondary diagnosis in this case is amputation.

# Pathophysiology of amputation is due to entire cut or block of the blood supply to the lower digits due to diabetic neuropathy. It lead to amputation of the right leg below knee.