Patient M is a White man, 67 years of age, with type 2 diabetes who is admitted to the hospital with a fever, two-day history of lethargy, and a rapid decrease in level of consciousness. His vital signs on admission are: temperature, 39.7 degrees Celsius; heart rate, 112 beats per minute, regular rate and rhythm; 26 respirations per minute and shallow; blood pressure, 88/40 mm Hg; blood glucose level, 329 mg/dL. The patient is complaining of a severe pain, reported at a 7 on a scale from 1 to 10. Physical assessment indicates:

Two lesions are present on the left lateral lower extremity, approximately 4 cm distal to the malleolus. The lesions are 5 cm in length, 3 cm in width, superficial depth, with yellowed edges, pale red base, and weepy.

Laboratory values reveal:

Patient M is admitted to the hospital with a diagnosis of septicemia secondary to a venous stasis ulcer, peripheral vascular disease, and uncontrolled hyperglycemia related to infection. He is started on antibiotic therapy, pain management, and dressing changes.

On day three of therapy, Patient M's temperature has been stabilized for the past 24 hours. Laboratory values are normalizing. His blood glucose levels remain elevated, with measurements between 276 mg/dL and 310 mg/dL. His pain is fluctuating between a 1 and a 5 and is being controlled with analgesics. Patient M's wound drainage is scant and yellow in color, with a slightly foul odor. His treatment plan consists of a moist, non-adherent dressing, and improvements have been noted. After three weeks of treatment, the wound assessment documentation indicates one lesion present on the left lateral lower extremity, approximately 4 cm distal to the malleolus. It is 4.6 cm in length, 2.8 cm in width, and superficial depth. The lesion is dry with irregular, yellowed edges and a reddened base. The surrounding tissue remains shiny and ruddy in color.

Patient M is discharged with orders for home health care for wound assessment and antibiotic therapy via a midline catheter.

Patient J is a White female patient, 54 years of age, with a history of uncontrolled insulin-dependent diabetes for the past 10 years. She is obese, with a body mass index of 41 kg/m². She reports a history of shortness of breath with minimal exertion and severe bilateral osteoarthritis of the knees. She was a two-pack-per-day smoker but has been cigarette-free for the past six months. She is scheduled for gastric bypass surgery in two days. Presurgical teaching includes:

The surgery is completed without incident, and Patient J appears to be recovering as expected. However, two weeks postoperative she begins to cough uncontrollably, neglecting to support her incision. This occurs a total of four times throughout the night. At approximately 4:00 a.m., Patient J feels her incision "let go" and begins to bleed profusely; her incision has dehisced. She is rushed into surgery to resecure the incision and stop the bleeding. Although the bleeding can be cauterized, the periwound is too friable and further suturing will not adhere.

Patient J's incision measures 15 cm from twelve o'clock to six o'clock, 10 cm from three o'clock to nine o'clock, and 6 cm in depth. It is beefy red in color and appears to be healthy, with granulation tissue present. The surgeon prescribes treatment of the dehisced incision with a vacuum-assisted closure. She is premedicated for pain prior to dressing initiation and for subsequent dressing changes every 48 to 72 hours. After three weeks of vacuum-assisted closure therapy, Patient J's incision measures 12 cm from twelve o'clock to six o'clock, 9 cm from three o'clock to nine o'clock, and 4 cm in depth. It continues to look healthy and show signs of granulation. No odor is present within the wound. Wound edges are healthy, without maceration or rolling. The vacuum-assisted closure therapy is continued. At Patient J's next appointment eight weeks after the surgical procedure, her incision is assessed to be 8 cm from twelve o'clock to six o'clock, 5 cm from three o'clock to nine o'clock, and 2 cm in depth, with healthy color and edges. Vacuum-assisted closure therapy is discontinued, and a saline dressing is applied. Patient J's surgery is a success for both weight loss and the healing of her dehisced wound.