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    Assignment Details
    For this assignment you will be given a case study about a young lady named Sarah Smith. Review the information provided and answer the questions following. Be sure to cite your references. Look at Sarah as if she is a patient in your office seeking care. What are your immediate concerns? What needs to be done for her? Be thorough and succinct in your responses.
    Case Study:
    Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had smelly drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar.
    PMHx:
    Asthma: no hospitalizations for exacerbation.
    DM II
    PSHx:
    Denies
    SHx:
    Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 years
    ETOH: socially
    Illicit drugs: denies
    FHx:
    Significant for paternal DM, otherwise unremarkable
    Medications:
    Metformin: 500mg BID po – did not take the last few days
    Albuterol MDI: 2 puffs every 6 hours prn – last use just PTA
    Singulair: 10mg po daily
    Trinessa: 1 tab po daily – last taken this am
    Allergies:
    PCN: hives
    LNMP: 2 weeks ago.
    G0p0
    ROS:
    General: denies any weight changes, fatigue or fever; + body aches
    Skin: denies any rashes; + wound to left foot
    HEENT: denies headache, head injury, dizziness, lightheadedness;
                Denies any vision changes
                Denies any hearing changes, tinnitus, vertigo, earache
                Denies any nasal congestion, discharge, nose bleeds or sinus tenderness
                Denies any sore throat, difficulty swallowing
    Neck: denies any swollen glands, pain
    Breasts: denies any pain, discharge
    Respiratory: denies any dyspnea; positive cough and wheezing
    CV: denies any chest pain, edema
    GI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stools
    PV: denies claudication, swelling to LE
    GU: denies frequency, urgency, burning;
                Denies vaginal discharge, itching, sores
                Denies penile discharge, itching or sores
    MS: positive pain to left foot
    Psych: denies nervousness, depression
    Neuro: denies Headache, dizziness, vertigo, syncope, weakness; + numbness to right LE
    Heme: denies any easy bruising
    Physical Exam:
    Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA
                            Height: 55    Weight: 250 lbs.
                Blood glucose: 230 (Fasting; states has not eaten yet today)
    patient awake, alert, oriented x 4 in NAD
    Skin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; + surrounding erythema extending up 7 cm proximally
    HEENT: head nontraumatic, normocephalic
    Pupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking noted
    Ears: bilateral TM with good cone of light and intact
    Nose: mucosa pink, septum midline; no sinus tenderness appreciated
    Mouth: mucosa pink, moist; tongue midline; tonsils 1+ without exudate
    Neck: supple; trachea midline; no LAD
    Resp: regular and unlabored; lungs with end expiratory wheezing throughout
    CV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciated
    Abdomen: soft, non-distended; Bs + x 4; no tenderness with palpation; no CVA tenderness with percussion
    Genitalia: deferred
    Rectal: deferred
    Extremities: warm and without edema; calves supple, non-tender
    PV: no LE edema
    MS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse; CMS intact; Cap refill < 2 sec.
    Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intact
    Questions:
    1. List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential.
    2. At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how?
    3. What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?
    4. What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.
    5. What is your comprehensive plan of care? Include your rationales.
    To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.
    Assignment Requirements
    Before finalizing your work, you should:
    be sure to read the Assignment description carefully (as displayed above)
    consult the Grading Rubric to make sure you have included everything necessary; and
    utilize spelling and grammar check to minimize errors.
    Your writing Assignment should:
    follow the conventions of Standard English (correct grammar, punctuation, etc.);
    be well ordered, logical, and unified, as well as original and insightful;
    display superior content, organization, style, and mechanics; and
    How to Submit
    Submit your Assignment to the unit Dropbox before midnight on the last day of the unit.
    When you are ready to submit your Assignment, select the unit Dropbox then attach your file. Save with your name in the title. Make sure to save a copy of the Assignment you submit.

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