Case Study 1:
1. Diagnosis: Based on the patient’s symptoms of severe pain, swelling, erythema, tenderness, and purulent drainage in the left 1st metatarsal, it is likely that she is suffering from acute paronychia. Paronychia is an infection that occurs around the nail bed and is usually caused by bacteria such as Staphylococcus aureus or Streptococcus species. The severity of the infection can be categorized into stages, with the patient’s symptoms indicating stage 3 paronychia. Stage 3 paronychia is characterized by fluctuance (a soft, compressible feeling due to the presence of pus) and abscess formation.
2. Treatment plan: The treatment for stage 3 paronychia typically involves an incision and drainage (I&D) procedure. In this procedure, the abscess is drained by making a small incision near the area of fluctuance to allow the pus to drain out. This should be accompanied by a course of antibiotics to address the underlying infection. A suitable antibiotic choice would be dicloxacillin or cephalexin, considering the likely pathogens involved. Additionally, warm water soaks for the affected toe can help reduce swelling and discomfort.
3. Post-procedure instructions: After the I&D procedure, the patient should be instructed to keep the area clean and dry. To prevent contamination and further infection, she should avoid soaking her foot in Epsom salts or using antibiotic cream. Regular dressing changes should be performed to promote healing. The patient should also be advised to take the prescribed antibiotics as directed, even if symptoms improve. If her pain or symptoms worsen or if she develops a fever, she should seek medical attention promptly.
Case Study 2:
1. Treatment steps: The first step in treating this patient with a 3-inch laceration on his right forearm would be to assess the wound and determine if sutures are necessary. The wound should be thoroughly cleaned with sterile saline or water to remove any debris or foreign materials. Next, the wound edges should be carefully inspected to assess the need for sutures. If the wound edges are clean, without significant tissue loss or contamination, sutures may be indicated to facilitate proper wound healing. However, if the wound is jagged, contaminated, or shows signs of tissue loss, primary closure with sutures may not be appropriate, and other wound closure techniques like adhesive strips or staples may be considered.
2. Post-procedure instructions: After suturing the wound, the patient should be given specific instructions to care for the wound at home. It is important to advise the patient to keep the wound clean and dry. A sterile dressing or adhesive bandage should be applied to protect the wound and promote healing. The patient should be instructed to change the dressing regularly or if it becomes wet or soiled. Additionally, it is important to educate the patient about signs and symptoms of infection, such as increased pain, redness, swelling, pus, or fever. If any of these signs occur, the patient should seek medical attention promptly.
3. Td immunization: Based on the information provided, the patient does not know when he had his last tetanus-diphtheria (Td) shot, but he thinks it was at least 12 years ago. It is recommended to administer a Td immunization if the patient’s last dose was more than 10 years ago and if the wound is dirty or contaminated. In this case, as the patient had a laceration with possible contamination from the broken window, he should receive a Td immunization, provided he is not contraindicated for vaccination.