During a clinical placement, a 51-year-old female patient presented to the clinic with a doctor’s referral for painful left hallux and indicated 5 from the 10 points VAS scale. She was a little limping and wears thong due to the pain. She works as a receptionist and walks for half an hour twice a week. Her BMI was 32 and she smokes about twenty cigarettes a day. She has no previous and current medical history except currently having Keflex due to the inflammation on the hallux. She has been troubled with the ingrown nail for the last fifteen years, but never been considering a surgery before due to the fear of surgery. Otherwise she is healthy and I was thrilled to have her to be a possible PNA surgery candidate.
The detailed assessment I
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performed revealed the patient has no neurological and vascular abnormalities, but paronychia and onychocryptosis(OC) were observed on the lateral aspects of the left hallux. The pain was not very severe and no structural abnormalities were found, but she has a signs of secondary infection as erythematous oedema and granulation soft tissue on the lesion with little fluid discharge (Karaca & Dereli, 2012; Khunger, 2012). I have discussed with the patient for the possible treatment as OC will regrow soon again if not treated properly. Also discussed a surgery is the optimal available option, and its recovery time and costs. As the patient requested, I performed a general treatment to trim nails and debride plantar callouses, granulation tissues and clear sulci.
Then obtained permission from the patient for the next procedure with a number 15 blade to penetrate the left lateral hallux nail. But patient could not tolerate the pain and it interfered me to proceed further and deeper. With a supervisor and the patient permission, I decided to inject a local anaesthetic of Xylocaine 2% on the dorsum of both proximal IPJs of the left hallux to numb the lesion (Watkins, 2010). The patient was become so anxious, and I was also getting nervous by doing an injection itself, then I accidently punctured into my thumb before applying it onto the patient’s. I immediately took off the glove and apply betadine with an appropriate wound dressing. It was a really embarrassing moment, which I became lose of …show more content…
confidence. However the patient was apologies that her nervous unsteady movement might have caused and promised to calm down as possible. I was expected something totally opposite that she would ask the supervisor to finish the job instead. Somehow this accident has been a turning point for both of us to be more relaxed with the procedure. When the lesion was numbed completely, I then penetrated the needle in diagonal angle until I felt a give away underneath the cuticle, then took out the lateral nail ends and residuals include clearing debris (Lee, Burm & Yang, 2013). Applied betadine and saline dressings with cutiplast and hyperfix to protect the wound lesion (Karaca & Dereli, 2012; Lyman & Vlahovic, 2012). A tuband tofoam was used to relieve and protect the pain and friction (Lyman & Vlahovic, 2012). Advised the patient to keep the dressing within next 24 hours then wash with saline or warm salt water with antiseptic dressing such as betadine as she is not allergic to iodine (Watkins, 2010). I have learned that in any case I must try not to lose a confidence and concentration, and appears professionalism in any future occasions. Always mind myself for safety refresher and practice more as possible as onychocriptosis is something that podiatrists to deal with almost any occasion. This patient has given me an opportunity to improve my learning experience and good lesson to improve psychological and practical aspects. While on a uniclinic, a 62-year-old female patient presented with a painful corn and indicated between 9 and 10 from the 10 points pain scale.
The patient has T2DM and her BGLs are averaging 9 mmol/L, however she does not check them regularly. She was complaining of the previous workmanship from the corn removal about 3 weeks ago, which has caused her to revisit the uniclinic.
On examination, she has hyperkeratosis(HK) and a haloma durum(HD) build up on the left 4th plantar MTPJ. Her sensations were within normal limits and she was very anxious with the pain. Corns are result from ‘hypertrophy of the stratum corneum with excess keratinisation’ and are frequent problems in diabetic foot, which a sharp debridement is the best intervention (Foster, Edmonds, Das & Watkins, 1989).
With a supervisor’s permission, I commenced the general treatment then debride the HK. Due to her disappointment from the previous treatment, I intended to enucleate her HD more invasively with a number 15 blade without anaesthesia (Hogan and Basile, 2012). I obtained the patient’s consent regarding what I would try to do. As Hogan and Basile (2012) stated the main treatment goals are to ‘remove the central keratin core for short-term pain relief’ and to prevent the excess friction. I slowly penetrated the HD lesion, but also it caused little bleeding during the procedure. On palpation of the lesion did significantly reduced her pain, and the patient was very happy with the result. Betadine, cutiplast
and hyperfix were applied then advise the patient how to check and wound dresses by herself. Due to the supervisor who gave me permission was not available, another supervisor took over and checked what I have done. The supervisor became angry and questioned me why I enucleated deep, which was approximately 3 to 4mm in depth, if I am aware she is a diabetic patient and what advises given to the patient. I explained the supervisor that the patient was unsatisfied with the previous result, I am aware she has the T2DM and debridement was done with caution and educated her how to change wound dressings and care. The patient has planned for overseas trip in about 2 weeks time, and removal of the painful corn was the main concerns. However I did not explain well for the wound dressing must be changed until it is completely healed. The supervisor requested me to record precisely what has been done, what advises were given in relations to the caution and the management from possible infection. Then provided a felt plantar deflection on the lesion. Additionally I advised the patient with the footwear during her overseas trip in regards to choice of shoes, possible usage of the current orthotic insoles and self-care protocol. It was an embarrassing moment in front of the patient. I did not think the removing corn by sharp debridement in the depth would make any complications as the patient has good vascular and sensations intact. As Hogan and Basile (2012) stated that corns debridement can reduce the incidence of ulceration especially in diabetic patients. I was expecting a compliment from the supervisor as I have not done it successfully before. Also I have observed during external placements that podiatrists used blades to take the corns out in depth of lesions for diabetic patients. I have learned that I would need to be more careful in communicating for my actions of plans to everyone such as quality of information exchange (Oliver-Baxter, 2013), and not to be afraid of asking help from other practitioners which I might have missed some important considerable facts and went too brief summary to the supervisor. This misunderstandings and poor standard communication could have decreased trust, confidence and lead to underlie complains, misinterpretation and predicts negligence claims with other practitioners and patients (NHMRC, 2004). I should also be very careful and precise for full detailed medical note takings all the time. Accurate and comprehensible records can also allow another practitioner to recognise and provide the fair continuity of care (NHMRC, 2004).
- If all of the options were explored, and patient is given antibiotics and is treated without any pain or suffering than the treatment identifies with the ethnical principles of autonomy, non-maleficence, and veracity. In turn, Mrs. Dawson will be happy with the outcome of the procedure.
G brings his 12-year-old daughter, Aliya, to Dr. Jordan’s office with the request that he perform the procedure on her. Although traditionally the procedure is performed without anesthesia or antiseptics, Mr. G says that he wants his daughter to have access to these, because he does not want her to suffer and wants her to be safe. Dr. Jordan does not find these concessions satisfactory, however. He believes that the practice, even with anesthesia, reflects an unacceptable disfigurement, repression, and control of women. Mr. G and his daughter insist that they want the procedure carried out; if not, they will seek the traditional method when they return to their home country for a planned visit.”
Your breath can have a sweet smell caused by the high levels of ketones in the body. Being a diabetic you are also prone to losing sensation in the lower extremities causing it to be difficult to notice any pain or injury in your feet. It can also cause your skin to dry and crack on your feet. It is extremely important to keep an eye on your feet to make sure no damage is done.
Med-Pharmex Incorporated is known nationally and abroad as a pharmaceutical manufacturer of animal-related products. Before gaining fame worldwide, the business began its journey to success as a small lab in 1983, which slowly grew over time. Since then, the company maintains its main goal, and that is to produce drugs that promote the health of companion animals, such as dogs, cats, and horses, as well as food-producing animals, such as pork and chickens. To ensure legal responsibility, the company’s manufacturing process is examined by the United States Food and Drug Administration (FDA). Med-Pharmex works closely with veterinary clinics who purchase their life-saving drugs and represent them in the market. Despite manufacturing drugs, the
Kalus A.A., Chien A.J., Olerud J.E. (2012). Chapter 151. Diabetes Mellitus and Other Endocrine Diseases. In Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K (Eds), Fitzpatrick's Dermatology in General Medicine, 8e. Retrieved March 29, 2014 from http://accessmedicine.mhmedical.com/content.aspx?bookid=392&Sectionid=411388744
A man came into the emergency ward at one o'clock. His thumb came in an
White or yellow spots on the toe that are caused by the fungus dislodging the skin on the toe
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et al., 2014).
Education on the use of risk assessment scales in practice is identified as a recommendation along with the continued use of nurses clinical judgment being used combined with a risk assessment tool. This, along with surveillance for complications, is very relevant when considering the diabetic foot. Living with foot ulceration has been linked to diminished wellbeing, quality of life and physical health in patients. Identification of the patient’s pain status is vital when treating patients with diabetic foot ulceration and addressing the challenges of either pain or no pain.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia
The first accident occurred on a 61-year old woman who was at a follow-up appointment after a breast tumor was removed. She felt a burning sensation and told the operator “you burned me”. She developed swelling and reddening, but the AECL declared this a normal treatment reaction and not a machine malfunction. Her condition wor...
He said that Mr. Rasak is a high-risk surgery candidate. He fears that with his heart, edema to the extremity that he is at high risk for a surgery not healing and risking an amputation. He would not recommend any surgery. He said that he has another injection that also included Toradol that may help to give him more relief for a longer period of time. He can have the injections every 3 to 4 months. He also told Mr. Rasak that he is leaving the practice moving to another State so another physician in the practice who specializes in ankles will take over his care. We also discussed the possibility that he may be helped with the pain with some other medications such as Mobic. He was told to speak with his primary care provider since he knows his history and all of the medications he takes. In the meantime, he can take Tylenol Arthritis. The injection was performed at the office and a new
Mayo Clinic is a hospital that is as well-known by many to be a haven of caring and concerned doctors whos’ sole focus is to give their patients the type of care they would want their families to receive if they were patients. According to Colquitt, LePine, and Wesson (Mayo Case Study, 2014), Mayo Clinic has established a customer service, patient first culture that puts the needs of those whom they serve ahead of other focuses, such as profit or patient quotas. This corporate culture has lead the hospital to become one of the most successful and iconic medical centers in the United States. Colquitt, LePine, and Wesson (Mayo Case Study, 2014) propose several very interesting questions at the end of the reading that they ask readers to ponder.