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: 5’5”     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 .

1. 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

2. 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:

3. 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

4. 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: 5’5” 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

5. 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?

6. 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;

7. display superior content, organization, style, and mechanics;
and