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Clinical Case Study: Keflex

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1290 words
1290 words
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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 …show more content…

In this essay, the author

  • Narrates how a 51-year-old female patient presented to the clinic for painful left hallux and indicated 5 from the 10 points vas scale.
  • Explains that the patient had no neurological and vascular abnormalities, but paronychia and onychocryptosis were observed on the lateral aspects of the left hallux.
  • Describes how they performed a general treatment to trim nails, debride plantar callouses, granulation tissues, and clear sulci, then obtained permission from the patient for the next procedure.
  • Analyzes how the patient apologized for her nervous unsteady movement and promised to calm down as possible. the accident has been a turning point for both of them to be more relaxed.
  • Describes how they applied betadine and saline dressings with cutiplast and hyperfix to protect the wound lesion.
  • Explains that onychocriptosis is something that podiatrists to deal with almost any occasion. this patient has given them an opportunity to improve their learning experience and good lesson.
  • Narrates how a 62-year-old female patient complained of the previous workmanship from the corn removal about 3 weeks ago, which has caused her to revisit the uniclinic.
  • Explains that the patient had hyperkeratosis and a haloma durum build up on the left 4th plantar mtpj. corns are result from 'hypertrophy of the stratum corneum with excess keratinisation'
  • Describes how they commenced the general treatment then debrided the hk. they obtained the patient's consent regarding what they would try to do.
  • Explains that the supervisor who gave them permission was not available, so another supervisor took over and checked what they had done. the supervisor became angry and questioned why i enucleated deep, which was approximately 3 to 4mm in depth
  • Explains that the supervisor requested them to record exactly what has been done, what advises were given in relation to the caution and the management from possible infection.
  • Opines that removing corns by sharp debridement in the depth would not make any complications as the patient has good vascular and sensations intact.
  • Explains that misunderstandings and poor communication could have decreased trust, confidence and lead to underlie complaints, misinterpretation and predicts negligence claims with other practitioners and patients. accurate and comprehensible records can also allow another practitioner to recognise and provide the fair continuity of care.

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…

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

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