Cellulitis is a potentially severe bacterial infection that affects the cells and tissues.  Cellulitis appears as a swollen red region of the skin that feels tender and hot. Various factors and conditions cause cellulitis as well as injury to the tissues which brings about an inflammatory response. Injury can be exogenous such as through trauma, surgery, skin injury from chemicals and burns or endogenous such as ischemia of tissues from pulmonary embolism or myocardial infarction (Sullivan, 2018). Disease processes like diabetes may also predispose an individual to infections of the tissues particularly with potential skin breakdown like in thrombophlebitis and blisters.

Clinical manifestations and Recommendations

In the presented case, Ms. G is diabetic and has cellulitis of the left lower limb. The clinical manifestations that she has include heaviness in her leg due to the inflammation, drainage, and an increase in the measurement of the calf. Besides, she has a fever of 38.9 degrees Celsius accompanied by chills, the white blood cells are increased to fight the infection, and the wound culture reveals prescence of Staphylococcus aureus which is a gram-positive bacteria. The neutrophils are elevated with an increase in bands which are immature neutrophils, indicating a more severe infection.

The recommendation is to first obtain blood for culture and sensitivity before commencing any antibiotic therapy, which would allow for a more appropriate antibiotic to be given and has also been linked with a decreased infection-related mortality rate. The culture shows prescence of Staphylococcus aureus and can be treated using Nafcillin, and their counterparts, Cephalosporins, and sulfa drugs can be used to treat the microorganism (Sullivan, 2018). However, they have developed increased resistance, and therefore Vancomycin can be used in their place for treatment of more severe infection.

Muscle groups likely to be affected by Ms. G’s Condition

The muscle groups that are likely to be affected include the Tibialis with anterior-proximal two third of the lateral surface of the tibia, the interosseous membrane, lateral inter-muscular septum and the deep fascia which are involved in inversion and dorsiflexion of the foot. The flexor digitorium longus that is involved in eversion and dorsiflexion of the foot and extension of the toes is also likely to be affected since it lies posterior to the medial malleolus.

The significance of the objective and subjective data regarding follow up and diagnostics and Education

The objective and subjective data indicate that Ms. G is not controlling her diabetes and general health accurately. She is obese with a body mass index of 33. According to Lavelle et al., 2016, obesity is one of the risk factors that are outstanding for the development of diabetes type 2 with mid-segment having a higher risk than lower body fat. Ms. G should be given diabetic teaching urgently regarding exercise, diet, and medications. Her hemoglobin AIC should be taken to have a baseline showing how effective she has been managing her level of blood glucose for the last two to three months. The hemoglobin AIC level will be significant as it will indicate her control of blood glucose for further follow-up.

It is also important to monitor her complete blood count to assess the levels of WBCs which will show the effectiveness of the antibiotics given by decreasing. Ms. G should also be taught that she needs to take caution in care of her lower limbs since prolonged high blood glucose will lead to neuropathy, peripheral vascular disease, and ulcerations that can lead to cellulitis as she currently has. She should also be informed that she is at risk of developing wounds that can get out of control if she does not take proper care of her feet (Lavelle et al., 2016). Ensuring a tight glucose level control and teaching her on daily glucose monitoring will further help in preventing future ulcerations and vascular damage.

Factors that could delay wound Healing

One factor that could lead to delayed wound healing for Ms. G is the obesity that she has. The reason is that her cells have a lot of fat that delay wound healing as medications are not able to penetrate these cells adequately. Besides ischemia and hypoperfusion that occur in subcutaneous adipose tissue is a factor that could lead to delayed wound healing. The high blood glucose levels is another factor that could delay wound healing as microorganisms thrive well in an environment with high sugar levels (Tsourdi et al., 2013). The precautions to take is to ensure that the blood glucose is put under control at all times, ensure that she takes her antibiotics as prescribed and comply until the infection disappears. She should also vigilantly manage her weight to acquire an appropriate BMI to reduce her fat content in the tissues.

References

Lavelle D.,  Zeitoun J., Stern M.,  Butkiewicz E., Wegner E., & Reinisch C., (2016). Diabetes      Self-Management Education in the Home. Cureus. 2016 Jul; 8(7): e710.

Published online 2016 Jul 25. doi: 10.7759/cureus.710

Sullivan T., (2018). Diagnosis and management of cellulitis. Clin Med (Lond). 2018 Apr; 18(2): 160–163.doi: 10.7861/clinmedicine.18-2-160

Tsourdi E. et al., (2013). Current Aspects in the Pathophysiology and Treatment of Chronic      Wounds in Diabetes Mellitus. BioMed Research International Volume 2013, Article      ID 385641, 6 pages. http://dx.doi.org/10.1155/2013/385641