Clinical Reasoning and Physical Assessment (Research Paper Sample)

Nursing Care Plan and Rationale for Leg and Foot Cellulitis
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Plan for Clinical nurse Interventions
Rationale for Antibiotic Therapy
The patient’s primary diagnosis is cellulitis of the left leg and foot. According to Wingfield (2012 p. 18), cellulitis is caused by an acute spread of bacterial infection, leading to the inflammation of the connective tissue, and the subcutaneous layer of the skin. Since the bacteria predispose to inflammation, the person is likely to present with redness (erythema), warmth and swelling, as well as fever and pain. The patient’s chief complaint of feeling feverish, having chills, the feet feeling extra warm, as well as lower extremity pain and aches fit into the primary diagnosis of cellulitis.
The bacteria commonly implicated in cellulitis are Staphylococcus aureus and Staphylococcus pyogenes, commonly entering through broken skin to cause infection of the cutaneous tissue (Wingfield, 2009 p. 26). The involvement of the bacteria in the pathogenesis of the condition warrants the use of antibiotics for its treatment. Furthermore, the patient’s obese status and +2 pitting edema further predisposes her to opportunistic bacterial infection that can exacerbate the condition. As a result, antibiotics use is essential for the prophylaxis against exacerbation (Stevens et al. 2005 p. 1374). Therefore, antibiotics are administered as prescribed, while the patient’s condition is monitored for improvement or deterioration.
Rationale for Blood Cultures and Complete Blood Count with Differentials
The staphylococci have been implicated in the pathogenesis of cellulitis. A blood culture will help in identifying the causative bacteria for cellulitis (Joseph et al. 2014 p. 316). The culture will rule out other causes of the condition, narrowing on the bacterial involvement. Furthermore, the blood culture will be helpful in identifying the anatomic spread of the infection, such as the face and ocular region. A complete blood count on the other hand, is useful in monitoring the course of the infection and the effectiveness of the therapy given therapeutic agent (Joseph et al. 2014, p. 317). The differential count will aid in distinguishing early onset of the cellulitis from other causes. As a result, blood cultures and complete blood count with differentials is important in understanding the pathogenesis and aetiology of the disease.
Rationale for X-Ray of Left Foot
Since the patient is complaining of pain emanating from the left, visualization of the bony structures of the left foot is important in ruling out pain from a leg or foot fracture. As a result, the x-ray is useful in this regard.
Rationale for MRI Use
Sometimes, visualizing necrotizing soft tissues is essential in the assessing and treating cellulitis. An MRI machine is a powerful visualizing device that can detect necrotizing fasciitis (Joseph et al. 2014 p.3170. The machine’s imaging potential allows the clinical officer to determine its prognosis, and the extent of soft tissue damage. Therefore, through the MRI, the clinician is able to visualize necrotizing fasciitis, determine the stage of the disease, as well as the effectiveness of the given interventions.
Rationale for Pain Management
Cellulitis is characterized by acute pain and aching of the affected extremity (Wingfield, 2012 p. 18). The pain emanates from the inflammatory nature of the condition, in which the bacteria exacerbate the release of inflammatory mediators, through destruction of the connective tissues and the underlying cutaneous tissue of the skin. Furthermore, the patient suffers from other comorbidities that trigger noxious stimuli that leads to pain. For instance, the patient suffers from +2 pitting edema, which is very painful. Therefore, the patient’s condition, coupled with underlying comorbidities trigger a lot of painful stimuli that necessitate management through pain medications and other non-pharmacological techniques.
Rationale for Aspiration of the joint
Joseph et al. (2014 p. 317) contend that aspiration is performed only in selected patients, or in usual cases of cellulitis with bullae, those with diabetes, immunosuppression, or [patients with a history of immersion injury. The female patient in this case is obese, has a history of +2 pitting edema, and has bullae. These unusual conditions make the patient a candle for needle aspiration, to determine the aetiology of her condition.
Rationale for lithium and Depakote level
The patient also has a medical history of bipolar disorder. Her condition predisposes her to other disorders such as stress and depression that exacerbate her respo...