Mr Rajesh Kumar (61)

Case notes

Notes: You are the practice nurse at Hillview Medical Practice. Mr Kumar attends the nurse clinic.

Patient details
  Name:          Rajesh Kumar
  DOB:           22/08/1963 (61 yrs)
  Address:       8/41 Station Road, Hillview
  Occupation:    Taxi driver (long shifts, sitting 10–12 hrs/day)
  Next of kin:   Wife, Priya

Social background
  - Married, 2 adult children (not living at home)
  - Wife cooks traditional meals, high in carbohydrate
  - Smokes 10 cigarettes/day (40 pack-year history); "not ready to quit"
  - Rarely exercises; BMI 31

Medical history
  - Type 2 diabetes (2009) — metformin 1 g BD, gliclazide 80 mg BD
  - Peripheral neuropathy both feet (2019)
  - Hypertension — perindopril 5 mg daily
  - Hyperlipidaemia — atorvastatin 40 mg nocte
  - Allergy: penicillin (rash)

Nursing clinic notes
  05/05/2025  Presented with ulcer L great toe (plantar surface) — first noticed 3 wks ago,
              "didn't hurt so ignored it". Size 1.5 × 1.2 cm, depth 0.3 cm, sloughy base.
              No odour. Pedal pulses weak bilaterally. Monofilament: reduced sensation both feet.
              HbA1c 9.4% (target < 7%). Dressing applied. Advised offloading — pt continues driving.
  12/05/2025  Size unchanged. Wearing tight work shoes. Mild erythema around wound edge.
              Swab taken.
  15/05/2025  Swab: Staph aureus — GP prescribed doxycycline 100 mg daily × 7 days
  19/05/2025  Erythema resolved. Ulcer 1.4 × 1.2 cm — minimal improvement over 2 weeks.
              Callus build-up around margin. Pt admits not checking feet daily (poor eyesight).
              Wife willing to help with foot checks.

Plan
  - Refer to podiatry for debridement, offloading footwear assessment
  - Continue twice-weekly dressings at practice
  - GP to review diabetes medication; dietitian referral sent
  - Smoking cessation discussed — pt declined

Writing task