I need a response/discussion based off info placed below. Please add some meaningful content to the discussion.
The patient’s chief complaint is a painful swelling on the left leg below the knee, which has gotten progressively worse and intolerable. The primary symptoms presented by the patient include swelling on the left leg under knee, pain, tenderness, warmth to touch, and weeping. Overall, patients with similar conditions manifest symptoms such as an irritated skin area that spreads, swelling, pain, warmth, chills, rashes, and tenderness (Han et al., 2020). The patient denies fever, spots, chills, skin dimpling, and blisters. Applicable medical history is poorly controlled diabetes which may interfere with the healing of the swelling. Additionally, the patient has alcohol and tobacco habits which may hinder effective healing, as such behaviors compromise a person’s immunity. Given Mr. B’s manifestation, the appropriate working diagnosis is cellulitis, as the condition manifests through tenderness, swelling, pain, and weeping.
Description of the Objective Data
The physical examination skills necessary to support the working diagnosis include inspection, palpation, measurement, and assessing peripheral pulses and skin integrity. Inspection is necessary to observe the swelling’s appearance, discharge, and redness. Palpation is necessary to determine tenderness, warmth, fluctuance, and indications of abscess. Measurement is essential to determine the size of the swelling. Assessing peripheral pulses can help ascertain whether blood flow is sufficient to the affected leg, as interfered blood supply can complicate cellulitis management. Assessing skin integrity can help identify skin breaks, cuts, ulcers, and maceration, which are common in cellulitis.
Additional findings that one would expect on physical examination if the patient had cellulitis include erythema, pain on palpation, and enlarged lymph nodes. Erythema is common in cellulitis patients, as the swelling site becomes red and begins to spread. Enlarged lymph nodes may indicate the body’s response to the infection. The underlying pathophysiological mechanism of cellulitis involves a bacterial invasion of the skin’s subcutaneous tissue, leading to an infection. Streptococcus species and Staphylococcus aureus are the primary causative agents of the condition. The bacteria triggers an inflammatory response that results in cellulitis symptoms, including swelling, pain, warmth, and erythema.
Differential and Primary Diagnoses
Differential Diagnoses
Deep Vein Thrombosis (DVT) (ICD-10 code: 182.40.
The probability of the condition being DVT is low because the patient is experiencing localized swelling, tenderness, and warmth, whereas DVT manifests through unilateral swelling that is not localized (Lee et al., 2022).
Osteomyelitis (ICD-10 code: M86.9).
Although osteomyelitis is usually localized, the pain and swelling affects deeper structures of the skin (Hostee et al., 2020). The weeping experienced by the patient indicates a superficial infection rather than a deep infection like osteomyelitis.
Peripheral Arterial Disease (PAD) (ICD-10 code: 173.9)
PAD manifests through unilateral swelling and pain, decreased peripheral pulses, claudication, and cyanosis. However, the warmth and weeping experienced by the patient are not typical symptoms of PAD.
Venous Insufficiency (ICD-10 code: 187.2).
Although the condition causes swelling and pain, it is highly chronic, manifesting through long-term edema. It is also naturally bilateral, meaning it would have affected the patient’s both legs. Therefore, the acute nature of Mr. B’s symptoms implies his condition is not venous insufficiency.
The Primary Diagnosis
Cellulitis (ICD-10 code: LO3.90).
Cellulitis is the diagnosis for the patient. The condition affects the superficial layers of the skin as witnessed in Mr. B’s case, and manifests through localized swelling and pain. Weeping, warmth, and tenderness are common indications of cellulitis.
Diagnostic Tests to Perform Basing on the Primary Diagnosis
