1. 1. **Pathophysiology**
1.1. - Chronic hyperglycemia → microvascular damage → **poor wound healing**
1.1.1. 2. **Lab Values**
1.1.1.1. - **Blood Glucose**: 356 mg/dL (high)
1.1.1.1.1. 3. **Medications**
1.1.1.2. - **HbA1c**: 13.5% (severely elevated)
1.1.2. 2. **Peripheral Vascular Disease (PVD) / Coronary Artery Disease (CAD)**
1.1.2.1. 3. **Kidney Disease**
1.1.2.1.1. Electrolyte and fluid imbalances hamper immune function; poor clearance of toxins worsens systemic illness
1.1.2.2. 1. **Pathophysiology**
1.1.2.2.1. - Atherosclerosis → **narrowed vessels** → **poor peripheral perfusion**
1.1.2.2.2. - Reduced tissue oxygen → **delayed wound healing**, higher infection risk
1.1.3. Weakened immunity and wounds healing FROM PAD/CAD AND DIABETES.
1.1.3.1. - Impaired neutrophil function → **increased infection risk**
1.1.3.1.1. 2. **Lab Values**
2. 38-year-old man with Necrotizing Fasciitis as the primary probelm. This man was an uncontrlled diebetes, weigha 458lbs and a sedentary lifestyle. The patient suffers from a nutrient lacking, fat dense diet.
2.1. 4. **SEPTIC SHOCK**
2.1.1. - High glucose → weakened immunity → p
2.1.1.1. predisposition to sever infections
2.1.1.1.1. 1. **Obsiety Pathophysiology**
2.1.2. - **Key Concerns**: Sepsis, shock, multi-organ dysfunction
2.1.2.1. - **Lactate**: 4.2 mmol/L (lactic acidosis indicative of tissue hypoperfusion/sepsis)
2.1.2.2. Vital signs: Fever, tachycardia,
2.1.2.3. - **Potassium (K+)**: 5.6 mEq/L (hyperkalemia; related to kidney disease)
2.1.2.4. - **Respiratory Rate**: 24 breaths/min → **Tachypnea** (likely compensatory in sepsis)
2.1.2.5. - **Heart Rate**: 120 bpm → **Tachycardia** suggesting sepsis or systemic infection
2.1.2.6. - **Temperature**: 39.5 °C (103.1 °F) → **Fever** indicating infection
2.1.2.7. - **Oxygen Saturation**: 92% on room air → **Mild Hypoxia**
2.1.2.8. 3. **Medications** for SEPTIC SHOCK
2.1.2.8.1. - **Immunorate (corticosteroid)**: used for autoimmune conditions, but reduces immune capacity
2.1.2.8.2. ROUND of different antibiotics (vanco, zosyn etc)
2.1.2.8.3. Fluids
2.1.2.8.4. Sugar control (insulin)
3. Care Plan:
3.1. NANDA diagnosis: Impaired Tissue Integrity related to aggressive infection (necrotizing fasciitis) as evidenced by tissue necrosis, purulent drainage, and the need for surgical debridement.
3.1.1. OUTCOMES
3.1.1.1. The patient will keep normal vital signs like heart rate under 100 beats per minute, temperature under 38°C, and blood pressure stable, showing no major infection spread during their hospital stay. The patient will explain why consistent wound care and antibiotics matter before discharge, and demonstrate the correct dressing-change procedure if needed at home. The patient will show steady improvement in wound healing, with less dead tissue and more healthy “beefy-red” granulation visible, by the end of the first week.
3.1.2. Interventions
3.1.2.1. The nurse will carefully check and record the wound’s condition (like color, amount/type of drainage, size) every shift, keeping a close eye on any changes that might signal infection is getting worse. The nurse will give IV antibiotics at the exact times ordered and watch for any problems like allergic reactions or signs they’re not working (persistent fever, worsening wound). The nurse will work hand-in-hand with the wound care team, using the best possible techniques (such as negative pressure dressings) and clearly teaching the patient and family how to spot infection and perform any necessary wound care at home.