History of present illness: patient sustained a gunshot wound to left

 

CHIEF COMPLAINT: draining left thigh wound

HISTORY OF PRESENT ILLNESS: patient sustained a gunshot wound to left

thigh in 1992. plate became loose likely secondary to infection in 1999. he

was treated with antibiotics and the wound allowed to heal by secondary

intention. wound intermittently underwent breakdown and drainage in 2014

following stress put on leg when patient stood for long hours. Plastic surgeon

didi a culture and found it was infected and erecommended a debridement which

was done July 15. He was discharged on pain killers and antibiotics. ID saw

patient in August 2016 per his Plastic surgery’s recs and determined that

stronger IV antibiotics would be required.

Baird, M. S., Keen, J. H., & Swearingen, P. L. (2005). Manual of critical care nursing: Nursing interventions and collaborative management. St. Louis, Mo: Elsevier Mosby.

Gulanick, M., & Myers, J. L. (2007). Nursing care plans: Nursing diagnosis and intervention (6th ed.). St. Louis, MO: Mosby.

Herdman, T. H., & North American Nursing Diagnosis Association. (2008). NANDA-I nursing diagnoses: Definitions & classification, 2009-2011. Oxford: Wiley-Blackwell.

Hi. this the marked care plan.

please see that attachment

thanks

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