Wound infections are extremely common among patients; sometimes, they can have symptoms similar to sepsis or cellulitis. It should also be noted that Methicillin-resistant Staphylococcus aureus also becomes more widespread. This infection is extremely resistant to antibiotics and often cannot be cured by them, which leads to complications.
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To choose a primary diagnosis, the three proposed diagnoses need to be examined to understand whether they correspond with the provided information and laboratory results.
Sepsis is defined as a life-threatening condition that is caused by the body’s response to infection during which the body also injures its tissues and organs (Vincent, Opal, Marshall, & Tracey, 2013). Although the definition of sepsis varies, Vincent et al. (2013) stress that sepsis can often lead to organ dysfunction. Moreover, arterial hypotension is present during sepsis too. However, the patient history indicates that no organ dysfunction and arterial hypotension is present. Thus, it can be concluded that the patient’s condition is not sepsis.
Wound infection is a condition when a wound is colonized by bacteria and becomes infected. The signs of infection are the following: heat, pain, swelling, and erythema (Dealey, 2013). Erythema is usually localized, but, as Dealey (2013) notices, it can spread to a large area around the wound. Normally, swelling is also present around or near the infected wound. However, it should be noted that the color of the exudate can vary depending on the bacteria that has caused this infection.
Dealey (2013) stresses that the tissue near the wound will be hotter compared to the skin at a distance from it. Physical examination supports all the mentioned above signs of a wound infection. Increased pain and offensive odor are also considered to be the signs of an infection. Although the patient has not mentioned offensive odor, and it was not detected during the physical examination, increased pain was one of the primary complaints of the patient. Thus, it is possible to assume that right lower extremity wound infection is the primary diagnosis.
Cellulitis is a condition that is caused by various organisms. The main sign of cellulitis is “acute, tender, erythematous, and swollen area of skin” (Phoenix, Das, & Joshi, 2012, p. 1). Although accurate symptoms of cellulitis are yet to be designed, the signs mentioned above are often linked to cellulitis. Cellulitis is often linked to obesity as well. It would be possible to assume that the patient’s condition is cellulitis if there were not any wound. However, cellulitis can also arise if an acute infected wound is present. In this case, cellulitis is a symptom, not an independent condition.
It should also be noted that cellulitis at the late stages can also cause severe sepsis, hypotension, and tachycardia (Phoenix et al., 2012). None of these symptoms are present. Cellulitis is often confused with other conditions, especially those typical for lower extremities, e.g. venous stasis dermatitis (Phoenix et al., 2012).
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The following question needs to be answered: how can one prove that the patient’s condition is not cellulitis? First, the presence of a painful, swelling wound indicates that there is an infection. Second, cellulitis can arise with an acute wound if it is present (Flanagan, 2013). Thus, the primary diagnosis is right lower extremity wound infection.
Green (2012) notices that classic signs of an infection are the following: “pain, erythema, warmth, edema, purulence and fever” (p. 48). Among other symptoms, Green (2012) stresses the importance of increased temperature and erythema and edema. According to the author, if a tissue is surrounded with infection, increase in temperature is usually also present. It can be measured through a touch (it is obligatory to wear gloves) or with an infrared thermometer (Green, 2012). Edema can increase due to the inflammatory response of the body. The inflammation of an acute wound usually leads to vasodilation (erythema) (Green, 2012).
Although the patient tried to treat the wound, it was not effective and did not prevent it from becoming infected. According to Brölmann et al. (2012), use of alcohol, saline, and/or antibacterial soap is not an effective measure to prevent infection (p. 1174). That may be one of the reasons why the patient was not able to prevent contamination. Moreover, the patient’s infection can also be a MRSA infection that cannot be treated with antibiotics. There are different factors that can lead to contamination, e.g. an infected tool or improper hygiene. MRSA infections do not have specific symptoms; normally, they have the same symptoms as other infections. As the patient stated that she had used antibiotics to prevent her wound from contamination, it can be assumed that the patient was infected with MRSA. It should be considered that spread of MRSA into the bloodstream can lead to severe complications that are accompanied by the following symptoms: fever, shivers, low blood pressure, and inflammation near the wound.
The patient’s diagnosis is wound infection, possibly MRSA-infection. This type of infection is highly resistant to antibiotics and can lead to complications or even fatal outcome. MRSA-infections are transmittable, so the patient needs to be isolated.
Brölmann, F. E., Ubbink, D. T., Nelson, E. A., Munte, K., Van Der Horst, C. M. A. M., & Vermeulen, H. (2012). Evidence‐based decisions for local and systemic wound care. British Journal of Surgery, 99(9), 1172-1183.
Dealey, C. (2013). The care of wounds: A guide for nurses. New York, NY: John Wiley & Sons.
Flanagan, M. (2013). Wound healing and skin integrity: Principles and practice. New York, NY: John Wiley & Sons.
Green, B. (2012). Understanding infection in wound care: Wound care. Professional Nursing Today, 16(2), 48-55.
Phoenix, G., Das, S., & Joshi, M. (2012). Diagnosis and management of cellulitis. BMJ, 345(2), 4955-4955.
Vincent, J. L., Opal, S. M., Marshall, J. C., & Tracey, K. J. (2013). Sepsis definitions: Time for change. Lancet, 381(9868), 774-775.