Patient Details

Telmisartan 40mg PO mane

Atorvastatin 40mg PO nocte

Digoxin 62.5microg PO nocte

Metformin XR 2g PO nocte

Lantus 20units S/C nocte

Novorapid 10/12/12units S/C TDS

Pantoprazole 40mg PO mane

Clexane 40mg S/C nocte

Paracetamol 1g PO Q4H PRN

Mrs Butterworth is on vascular ward at the John Hunter Hospital (JHH). She was commenced on Augmentin Duo Forte orally prior to transfer from Armidale Hospital due to concerns of the ulcer being infected. On arrival at JHH, she had an arterial doppler ultrasound and toe pressures on both legs which showed minimal arterial disease. She then had a sharp debridement in theatre, removing any non-viable tissue. She is now receiving daily saline-soaked gauze packs. The ulcer had been improving and the saline-soaked gauze is debriding any unwanted tissue on removal daily. There have been no postoperative complications. The blood sugars are now under control with an inpatient diabetic diet and an insulin chart sliding scale.

Mrs Butterworth is now requesting advice on managing her varicose veins. She doesn’t like the oedema it creates in her legs and the heaviness which comes with that.

Right 5^th toe amputation -> Pressure ulcer

Left inguinal hernia repair

Hypertension

Dyslipidaemia

AF -> Not anticoagulated

T2DM -> Insulin dependant

GORD

Varicose veins

Overweight -> BMI 29

NKDA 

Mrs Butterworth’s mother and father are both deceased. Her mother died of a large ischaemic stroke at the age of 75 and her father suffered with Alzheimer’s dementia and died at age 77. She has a younger sister in Armidale who had ischaemic heart disease and three children who are well. 

Mrs Butterworth is a retired baker and her husband passed away four years ago after a long fight with pancreatic cancer. She has lived alone since her husband passed and is independent with all ADLs. She has her younger sister and a son who live locally and are very supportive.

Mrs Butterworth does not drink any alcohol but smokes. She has a 25 pack year smoking history, roughly half a pack per day.