Nursing Priorities In The Management Of Diabetic Foot Ulcers – Patient Bacci Case Study

Pathophysiology of foot ulcers

Patient Bacci state, and the path physiology assessment has discussed relating to the patient situation, cues of action and information processing based on the indications presented. Priority nursing interventions has been assessed using the identification of patient problems and establishing goals of care (Hunter & Arthur, 2016). Identified priorities entail an examination of diabetic foot ulcer and wound care management. Finally, justification of nursing priorities reviews action taking and evaluation of outcome stage of clinical reasoning cycle.

Patient Mrs Gina Bacci depicts a state of diabetic foot ulcer with the previous history of type II diabetes, peripheral vascular disease and obesity. The evaluation of the patient foot ulcers is critical. The pathophysiology arises from various complications occurring from multiple causes. The damage of the weak foot muscles has to lead to an imbalance of flexion-extension of the foot causing the skin to break down and forming the ulceration (Formosa, Gatt & Chockalingam, 2016).

Infection is a serious medical condition, which threatens the state of Patient Bacci due to these consequences of deep infection. In the foot ulcers, the complications tend to increase. The difficulties arise from intercommunication and the spread of the infection; with low pain detection, leads to the continuation of the ambulation further expand the range. Thus, the combination of various factors such the obesity, glucose level intolerance, and peripheral disease worsens the state of the disease (Zhang et al., 2017). 

Patient Bacci body mass status indicates that the presence of obesity is imminent. This facilitates insulin resistance. The development of insulin resistance develops to type II diabetes leading to metabolic syndrome. This has led to patient development of type II diabetes, leading to elevated levels of sugar levels in the blood. During the diabetic state of the patient, there is an increased risk of worsening state of diabetic foot ulcers (Jaiswal et al., 2016). The wound healing disorder affects the treatment process which further exacerbates the patient state of infection. Skin damage on the foot ulcer is imminent which result from shift change of pressure points (Brennan et al., 2013). This will proceed to form skin damage developing into ulcers. The underlying neuropathy lowers the state of oil glands and sweater making the foot moisture to reduce and hence increasing susceptibility to injury, while sensory neuropathy decreases the sensation of wound pain. Status of the immunopathy reflects the underlying causes (Jupiter et al., 2016). 

With Patient Bacci diabetic mellitus state, there is decreased healing of the soft tissue leading to ulcers. During the advanced stage of diabetes, skin structure tissue, nerves, and blood vessels are damaged hence there is no control of blood, this slow progress of wound healing in the wound lower risk of wound complication (Barshes et al., 2016).

Complications associated with peripheral artery disease, diabetes, and obesity

The patient state of neuropathy remains to be primarily an underlying condition for type II diabetes. The occurrence of tingling, pain, and numbness are clear symptoms of peripheral neuropathy, leading to vulnerable infections thus exacerbating the contamination of the patient. The weakened immunopathy of the patient is further worsening the healing process of the patient also declining the state of foot ulcers causing more infection (Tokuda et al., 2018).

The diabetic foot ulcer increases the condition associated with peripheral arterial disease of Patient Bacci, coupled with neuropathy, ischemia, and infection. Compromised metabolic mechanism elevates the risks of infection and wound healing for the patient. This is exacerbated by peripheral vascular disease, ulceration, and gangrene formation. Further, the declined state of the immunopathy of the patient leads to more susceptibility of infections. The associated metabolism syndrome impairs the synthesis of portions, fibrinogen, and collagen. Research has shown that immune system impairment occurs among patients with lower blood glucose level tolerating infection worsening wound state (Clerici & Faglia, 2016).

The autonomic neuropathy complications lead to diminished sweating, with underlying skin becoming dry and susceptible to developing an infection. The occurrence of the external conditions of Patient Bacci worsens the state of the patients. Peripheral disease occurrences are the significant manifestation of type II diabetes presented the patient. Often peripheral vascular disease occurs at all levels of the arterial tree and bifurcation sand bends of the artery, located in the hemodynamic shear stress is low. In the diabetic state, the distal vessels such as the anterior, posterior tibias and perinea are inclined (Jupiter et al., 2016).  

Nursing priorities in the nursing process of Patient Bacci are critical for wound management. The following nursing priorities are essential for the patient are the periodic examination and patient screening and Wound management care. Rationales wound management care is the improvement of nursing care is a crucial aspect of managing the state of the patients. According to the WHO, nurses play a critical role in reviewing patient status as they are the most significant component of health care. The nurse’s role includes prevention of the disease and health promotion on Patient Bacci state (Clerici & Faglia, 2016). The nurses offer a combination of these care services and seek to eliminate and provide health services, which aim to reduce physical, emotional and mental needs of the patient.

These diabetic foot ulcers management can often result in various risks factors which need urgent attention. Thus causes detachment from the skin and impair the wound healing for the patient. The state of the peripheral neuropathy can lead to excessive pressure, and further ischemia can lead to increased susceptibility of ulceration impairment on the peripheral of the patient (Ali, Ozdemir & Hinchliffe, 2018).

Role of nurses in screening and examining patients

With the increasing prevalence of diabetes and the associated complications, there is need to have focussed nursing priorities which target on the patient symptoms such as obesity and management of wound and medication management of the type two diabetes (Noronen, Saarinen,  Albäck & Venermo, 2017).

Diabetic foot presents a common cause of hospitalisations of patients; thus nursing role is dedicated towards the prevention and diagnosis of complications linked to diabetic for. Nurses in the care team need to focus on enhancing the patient ability and to provide adequately for wound for the patients (Brownrigg et al., 2016). 

Nurse’s role in the management of diabetic foot ulcers of Patient Bacci is essential in the early stages of management of care. The role of nurse entails foot examination, dressing of the wound and encouraging the patients to enhance and follow treatment. The critical goal of screening is to identify foot problems with a focus on identifying those at risks and aiming at reducing risks of ulcers (Normahan et al., 2018).

The presence of peripheral neuropathy, vascular disease, and infection occurring on the wound of the patient is the top significant factors for the patient. These are threatening factors which cause gangrene and amputation to the patient. Peripheral neuropathy has been observed to produce 80% of the foot ulcers among diabetic patients. This shows that neurological assessment is the critical aspects of the management of care. Screening of the patient is an essential aspect; thus the emphasis on the nurse’s role in the evaluation of diabetic foot ulcers is of great importance (D’Souza et al., 2015).

Screening facilitates identification of Patient Bacci underlying asymptomatic state. The key to managing diabetic feet is key to prevention. The development of diabetic foot ulcer often leads to high risks development of below-knee amputation Reference??. Limb amputation is the most significant risks factors associated with foot ulcers, thus the needed for critical nursing care on screening and examination for early identification of patient complications as observed from the case study patient (Elgzri et al., 2015).

Diabetic foot examination plays a fundamental role in managing the patient. Nurses require patients to remove any socks covering to assess the status of the wound and determined high risks status and to offer the needed management of the case. Diabetic foot examination is a routine management practice for nurses in managing diabetic foot ulcers, (Elgzyri et al., 2015). Diabetic foot assessment is not limited to foot alone, vascular status evaluation with an estimate of some pressure, the temperature of the foot and evaluation of the associated foot problems, in this way diabetes foot ulcers will be assessed and identified easily (He et al., 2017). Thus, enhancing screening and examination is fundamental in nursing care.

Wound management care

Attending to wound care is vital and essential; enhancing wound management care is critical. Research has shown that between 15%-20% of patients will develop a foot ulcer, with a risk of limb amputation being high for patients with a diabetic foot ulcer. The associated risks of foot ulcer can improve through offering high-quality care which entails management of glycemic control, offering podiatry intervention which prevents trauma from pressure and monitoring in the early stages (Armstrong, Boulton & Bus, 2017).

Wound management is essential for nurses. However, it is challenging in that it carries high risks complication — the associated complexity linked to various issues that need to address. Nursing care on the microvascular can lead to diminished blood flow to the foot leading to ischemia and other neuropathic changes, which reduced the moisture of the skin (Game et al., 2016). 

Thus, key-nursing action will entail foot wound management to prevent further cross infection, reducing the debridement of dead tissue and proper dressing action of the wound. Nurse’s work on cross infection will entail the prevention of cross infection through the adoption of precautionary measures such as hand washing and usage of gloves. Further removal of the dead tissue around the wound is critical in alleviating trauma and injury (Yazdanpanah , Nasiri & Adarvishi, 2015 ) . Removal is essential for aiding visibility, promoting adequate assessment and facilitating appropriate treatment. The dead skin often attracts pathogens which affect the healing process of the wound (Noronen, Saarinen,  Albäck & Venermo, 2017).

Research has shown that the use of appropriate dressing promotes the healing process. This evidence further suggests that warmth on the wound and moisture facilitating actual wound healing process (Game et al., 2016). Thus nursing action on the choice of dressing material which maintains moist wound with no maceration on the tissue is essential. Appropriate nursing action on the wound can facilitate proper infection diagnosis by reducing the susceptibility of the patient through the use of proper microbial activity (American Diabetes Association, 2015).

Conclusion

The situation of the patient signifies diabetic foot infection coupled with various complications arising from the patient state. The patient is experiencing different conditions with significant diabetic condition with a history of amputation. Post-surgical management is of critical importance to the patient. There is the presence of significant effects on the neuropathy of Patient Bacci, worsening of diabetic foot ulcers and obesity management affecting care process. Focusing on patient care is imminent, thus focus goals on managing the wound, close examination and screening of the wound are essential. These key foci are essential in ensuring that Patient Bacci does not develop further complications thus gearing towards improving the patient status. 

Nursing priorities and interventions

References

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