A 45-year-old female client with a history of chronic renal insufficiency hyperl

Question

A 45-year-old female client with a history of chronic renal insufficiency hyperlipidemia, and atrial fibrillation presents to her primary care physician complaining of right leg lesion and low grade fever. The client reports that she fell 4 days and sustained an abrasion to her right leg. He was evaluated in the emergency department and was prescribed an cephalexin (Keflex) and discharged home. On examination, the client is vital signs are as follow: temperature is 101.6 F, pulse 112 beats/minute, blood pressure 134/84 mm Hg, respiratory rate 18 breaths/minutes, and oxygen saturation is 97% on room air. Right anterior lower leg noted with 10 cm ulcerated area, surrounded with erythema and warmth. No exudates or malodor. The remainder of the exam is normal.

1. What are the subjective data in the scenario?

2. What are the objective data in the scenario?

3. What is the most likely medical diagnosis would the nurse expect the ED physician to diagnose the client with?

4. What is the pathophysiology of the disease process.

5. What diagnostic and or laboratory tests would the nurse anticipate the ED physician to order for this patient?

6. What are the reason for ordering or not ordering diagnostic and/or laboratory tests?

7. Provide one or two medications that would anticipate the ED physician to ordered for this client?

Explanation / Answer

Subjective data is the feelings and complaints expressed by patient.In this scenario the subjective data is patient;s complaints she is having low grade fever and right leg lesion and there was history of fall before four days with an abrasion present in right leg. Objective data is the data collected by observing the patient.The objective data in the scenario is T- 101.6 F, P- 112 beats/minute, BP- 134/84 mm Hg, RR- 18 breaths/minutes, and SPO2 -97% on room air,10cm Ulcer with erythema and warmth present in right anterior leg. Venous leg ulcer Venous return to heart is decreased due to patients history of atrial fibrillation, chronic renal insufficiency; hyperlipidemia. Due to low blood flow because of narrowed arteries dilation and congestion of the capillaries the abrasion changed into ulcer without sufficient oxygen supply. Lipid profile, Blood chemistry, serum electrolytes,PT ,APTT,INR,ECG,Ankle-Brachial Index (ABI) to determine if there is also arterial insufficiency,Doppler ultrasonograph,Doppler bidirectional flow studies,Venography. To rule out extent of disease and to start anti coagulants Tab acetaminophen 650mg

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