His Foot Without Anesthesia Summary

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

I was just two weeks into my internal medicine rotation at Suez Canal University in Egypt, when I encountered a case that I still remember to this day. Ms. Rafat was an elderly diabetic patient that came into our clinic complaining of a persistent wound on the sole of her foot. Upon removing her boots, her complaint turned out to be a foot ulcer with an infection extending to the first and second metatarsal bones .Unfortunately for her, we had to break the news to her and her family that her foot would need amputation. Ms. Rafat was understandably upset but took the news in stride. Following up on her case, I learned that after the surgery, the blood flow to her leg became increasingly poor and she had to return to have a below the knee amputation. Ms. Rafat ended up dying of pulmonary embolism as a complication of her second surgery. This case stayed with me not only because it

The Practice Nurse at the GP’s surgery had administered a tetanus booster injection as Jean could not remember when she had one last and the trolley had appeared to be rusty. I undertook a full wound assessment which showed a wound 3cm by 3.5cm to the left calf area. The wound bed was 70% yellow sloughy fibrous tissue and 20% granulation tissue. There was

You work in a small family practice in rural Virginia, (much better than Texas!). A man in his early 50s comes in with a complaint of intermittent fever (102-103 F) and headache for the past two weeks. The physician examines him and takes a history. The only clinical finding is a wound about the size of a quarter on his right thumb. Axillary lymph nodes are swollen and tender. The man says he cut himself while skinning a rabbit three days ago. On the basis of these observations the physician prescribes streptomycin and asks the man to call if his symptoms don’t improve in three days.

HISTORY AND PHYSICAL EXAMINATION_______________________ Patient Name: Chapman Robert Kinsey Patient ID: 110589 Room No.: 322-B Date of Admission: 23 February ---Admitting Physician: Martha C. Eaton, MD, Geriatrics Chief Complaint: Admitted from Dr. Max Hirsch’s office due to deep ulcer on left toe. Admitting Diagnoses 1. Severe peripheral vascular disease, status post deep ulcer on left toe. Rule out thrombolysis. The patient was admitted to a regular floor. Condition is serious. 2. ALLERGY TO PENICILLIN, which puts patient into anaphylactic shock. 3. Continue with home medications. DETAILS OF PRESENT ILLNESS: Mr. Kinsey is an 87-year-old white gentleman with history of (1) Chronic atrial fibrillation, on Coumadin. (2) Chronic deafness,

Cabeza De Vaca gave the man two stitches, and two days later he took he took them out and the man was healed.

Why was skin-grafting necessary in this patient? (why not just let the skin heal on its own)

Not terrible. Hey, really - they can sew it back on - really.Right I’ll bet they can"(pg.63), Dave Jensen tells Lee Strunk that the nurses can sew back his leg together after a landmine blow it off, even though Dave Jensen knows that Lee’s leg is gone for good he still tells Lee Strunk that his leg can be fixed because that's what friends do for each other in desperate situations.

In the case of Darling verse the Charleston Community Memorial Hospital, Darling presented to the hospital’s emergency department with a broken leg. The hospital treated Darling’s leg with a cast and he was sent home to heel. The attending physician had put Darling’s cast on too tight and the circulation of his bottom leg was cut off. Because of this a portion of his leg had to be amputated.

And when she discovered what was actually causing that problem she was shocked. The doctor told her that the blister was due to bite from a poisonous recluse spider. She was described with antibiotics and she had to put bandage on her leg and to change it every day. After 2 weeks of the treatment she was in huge pain and when she went to the hospital she was prescribed with

The 12-year-old, who contracted the deadly infection as a 17-month-old, chose to have his lower leg amputated last year after the pain of operations to repair damage to the limb became too much.

The injuries he suffered were overwhelming, and so sudden that at first, he didn't know anything was wrong. Only when he tried to put weight on his leg did he realize the extent of the damage. He jokes about it today. "I found that I didn't have a leg to stand on," he chuckles. Most of the flesh on his leg was ripped away, leaving his foot attached only by the tendons in the back of his calf. Bones were exposed and the bleeding was profuse. He also suffered head and internal injuries.

During the home health observation day, there were several opportunities to observe a variety of patients with varying levels of functioning ability, different illnesses, and different needs and levels of interaction with the nurse. The first patient seen was a seventy-three year old Caucasian female with an ulcer on her right heel. Several weeks prior, she had scratched her left leg and she also had several small wounds on her left leg. The orders were to clean and redress the ulcer. She has a history of end stage renal disease, pneumonia, weakness, diabetes, dialysis, and right hip fracture. Upon entering the home, the patient was found to be sitting in a wheel chair in the living room watching television with her husband close by her side. She greeted the nurse with a smile and began to update her on her current condition. Her heel was “hurting” and she rated her pain an 8 on a scale of 1 to 10. She also had some “swelling” that she could not “get to go away; because, she could not get up and walk. They need to fix my foot so that I can get up and get around.” She told the nurse that she had been to see the doctor “yesterday” and the doctor had given her a written order that she wanted her to see. The order was written for an evaluation for a soft pressure shoe fitting. The nurse read the order to

25). Unfortunately, the article regarding Mr. Benson’s case did not give detail on whether or not proper documentation had occurred. However, one can assume documentation was not done properly as the wrong leg had been amputated. If proper documentation had been completed in Mr. Benson’s case, it is possible someone besides the surgeon may have caught the wrong leg was about to be amputated. An example of proper documentation would be the consenting of the patient for surgery. Mr. Benson had to have been consented for surgery, which means a doctor or a nurse practioner would discussed with the patient which leg was to be amputated, signs and symptoms of complications and what to expect after surgery. If there was any question once the patient was in the operating room, which leg to amputate, anyone could have looked in the patient’s chart to see what Mr. Benson had been consented for. Documentation of the time out could have also prevented Mr. Benson from having the wrong leg amputated. The reason being is, everyone involved in the case would have stopped and made sure the right patient was in the operating room and the right surgery was to be performed so it could be documented this act was completed. Not only proper documentation could have prevented this horrible act but also the help of the nurses could have prevented a mistake like this from happening.

(How Indie’s hoof looked) It became apparent that there was an infection and a veterinarian needed to be called. This was the first time that the vet had to be called out for Indie