Diabetic Case Scenario: Pathophysiology, Causes, and Nursing Management

This case scenario discusses the pathophysiology, causes, and nursing management of a diabetic patient with peripheral vascular diseases and obesity. It focuses on foot ulcers, wound assessment, and medication management. The patient's wound is wet with serous exudate output and sloughy tissues. The priority areas of care are the infected wound and the patient's poorly managed medication. Nurses play a key role in providing high-quality care by conducting routine assessments, educating the patient about medication importance, and addressing hygiene and wound healing.

Running Head: CASE SCENARIO
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Diabetic case scenario
Essay
student
4/8/2019

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Type-two diabetes is the condition in the body cells cannot use the blood sugar
effectively for energy. This condition takes place when the body cells are unable to use insulin or
become insensitive to it and the blood sugar levels increase gradually. Globally, nearly 422
million adults had diabetes in 2014, and majority of them affected by type 2 diabetes. In
Australia, nearly 1.2 million adults were suffering from this disorder in 2014-2015 (Holman,
Young, & Gadsby, 2015). In this particular case study the pathophysiology, causes of post-
operative wound status, two priority nursing care, and the safe nursing management of the
patient will be discussed.
As discussed in the case study Mrs Gina Bacci was diagnosed with diabetes type 2 and
peripheral vascular diseases, and obesity. After the treatment process, she has been admitted in
the OPD for the wound assessment. The assessment identifies wound is wet with serous execute
output and sloughy tissues. Worsening of diabetes might be associated with the wound in case of
Mrs Gina Bacci. Diabetes type two results from the advanced development of the insulin
resistance cells and the following dis-functioning of the pancreatic β cells (Kautzky-Willer,
Harreiter, & Pacini, 2016). Fat stored in abdomen unlike the subcutaneous fat, is actually
resistance to the advanced antipolytic impacts of insulin. Increased levels of free fatty acids
result in insulin resistance. This will ultimately lead to enhanced gluconeogenesis in the patient's
liver and inhibition of the uptake of insulin-mediated glucose by the body muscle cells, resulting
in the enhanced levels of blood glucose. Resistance of glucose and the related increase in the
amounts of the insulin triggers the pancreas to secrete enhanced amounts of insulin. These
increased levels of insulin impair the functioning of the pancreatic beta cells which further leads
to insulin output reduction (Cornell, 2015).

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Foot ulcer is the most common symptoms of worsening or poorly managed diabetes. The
patient had wound drainage with serous exudate output. This particular type of wound drainage
occurs due to the infections at the wound site. Serious exudate is actually thin, clear and watery
plasma which secretes during the inflammatory wound healing stages. One of the main causes of
serous exudate production is due to inflammations and the injuries of tissues. (Driver et al.,
2015) A serous exudate is generally comprised of watery fluid of electrolytes and sugars. It
might also contain proteins, WBC or white blood cells, and some microorganisms. At the initial
stage the serous exudate releases from the swollen skin as the outcome of a disease. Increased
secretion of this exudate is the indication of having high burden bioburden in which the
microorganisms like bacteria are present on the wound surface. Mrs Gina Bacci stated that
sometime she forgets to take medicines and think that there is no need to take all the medicines.
This might be associated with inhibition of wound healing process and causing infection of the
wound site. She also reveals that she used to wear bed socks. There might be a possibility that
the socks are not that clean, thus led to case microbial infection at the wound area. Unhealthy
diet or lack of nutrients in the body might also be associated with the occurrence of this type of
foot ulcers in the case of Mrs Gina Bacci. She also mobilizes with the offloading boot and
walking stick. However, there is some pressure on the wound which hinders the healing process.
Diabetic foot issues arise from combinations of macro and microvascular complications. These
issues are associated with increased morbidity risk. Diabetic foot ulcers are generally caused by
two different mechanisms. Neuropathic ulcers caused as the result of peripheral neuropathy that
leads to a loss of pain sensation. This will further results in unnoticed foot trauma until the
substantial impairment has caused. These types of ulcers can be profound but are also painless
sometimes. Another cause is ischaemic ulcers caused by the decreased blood supply to the

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patient’s foot (Chammas, Hill, & Edmonds, 2016). This is commons occurs as the patients also
have peripheral vascular disease. Consequently, the delivery of nutrients and O2 which is needed
for ulcers to treat or heal is compromised. These types of ulcers are commonly painful and
usually occur at the distal end part of the toes. As discussed in the case study Mrs Gina Bacci
also had dark pink and painful to touch wound. Foot ulcers are likely to the infections that occur
due to the causative organisms' Staphylococcus species and Streptococcus species. Some of the
aerobic microorganisms may also cause ischaemic ulcers (Markakis, Bowling, & Boulton, 2016).
The two priority area in case of Mrs Gina Bacci is her infected wound and her
unmanaged medication. As discussed in the case study the patient had serous wound with dark
pink appearance and painful in touch. The poorly managed serous exudate wounds also called
ischaemic wounds might cause serious problem to her. As she mentioned she is not taking
medication there is a chance that the wound infections may become worse. Mrs Gina Bacci is a
59 years old lady and it is hard to manage the wound hygiene and doing daily life word on her
own. Due to the painful wound, there is a possibility of fall while walking, however, she uses a
stick and offloads shoes to walk. She also has imbalanced BMI with 110 kg of weight which
might put extra pressure on the wound and prevent it from healing quickly. It may also be the
additional factor in increasing the chances of patient fall. It is also known that the serous wound
may become purulent and more infectious of not treated earlier (Bonner, Foster, & Spears-
Lanoix, 2016).
Another main priority area in case of Mrs Gina Bacci is that she lost her belief in the
medication. As she discussed that she is not taking her medicines regularly and forgets to take
them on time. Different studies conducted on diabetes identified that the patient with diabetes
type 2 commonly felt frustrated due to the long treatment process and thus enhanced the chances

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that they develop a feeling that the current medications cannot help them to recover from the
disorder (Yazdanpanah, Nasiri, & Adarvishi, 2015). These obstacles are directly associated with
the development of psychological issues like depression, stress, anxiety and other problem
(Semenkovich, Brown, Svrakic, & Lustman, 2015). Not taking the medicine on time may lead to
the imbalanced blood glucose level and may impact other vital signs like temperature, and Blood
pressure. Due to the lack of awareness and knowledge about the benefits of the medicines
prescribed to her, the patient developed such issues.
Nurses can play a key role in providing high-quality care for Mrs Gina Bacci. As a nurse
spends more time with the patients, therefore they can be a core member of the health care team
assigned for the care of Mrs Gina Bacci. There are two different priority of nurses in this case;
routine assessment and patient education. Patients initial assessment after operations shows that
she had BP: 120/70 mmHg. Pulse: 88 bpm, RR: 18 bpm and SpO2: 97 per cent at RA and
temperature: 37.8 degree C. Regular assessment of blood sugar level is necessary as it is the
main cause of diabetes. The patient should also be assessed for daily nutrition uptake and
patient’s wound must be examined in regular intervals to identify the wound healing process.
Wound upkeep patients need augmented protein in their diet (Yazdanpanah, Nasiri, & Adarvishi,
2015). As many individuals are hesitant what right protein selections are, be unquestionable to
review satisfactory food selections with the patient. A nurse should try to ask the patients what
type of food they ate daily rather than just inquiring if they ate protein or not. The vital signs of
the patient including BP, SpO2, temperature, respiration rate should also be assessed by the
nurses. After the administration of medicine, prescribed to Mrs Gina Bacci, including novo
rapid, Lantus pregablin, and paracetamol, the nurses should also assess the patients for any type
of side effects caused by these drugs. The comprehensive assessment should also include the

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patient's hydration, cognition, hygiene, and incontinence (Dunning, 2013). Unluckily, numerous
individuals lack the simple requirements to care for their cleanliness correctly; when nurses are
observing the patient, they must be conscious that they might live deprived of running water.
Even though maximum patients have contemporary facilities, washing, bathing, and showering
slowly become more problematic with age. When the diseased person lacks simple hygiene, it
may worsen the situation must any skin upkeep problems occur. Individual hygiene and skin
protection are essential parts of nursing intervention. Fatness is likewise an aspect of hygiene
problems. Both the age and fatness make it problematic for patients to touch certain parts,
particularly feet and perineal parts (Powers et al., 2015).
Patient education needs a concerted approach amongst all disciplines, counting social
work, case managing, respiratory rehabilitation and clergy if wanted. Nurses must address
manifold areas as they regulate how the person and caregiver are best capable to learn; this
comprises not solitary the capability and willingness to learn but likewise any obstacles to
education (Coppola, Sasso, Bagnasco, Giustina, & Gazzaruso, 2016). Culture, belief and
language alterations request that teaching is attuned to the patient and family members.
Expressive, physical, cognitive, and financial limitations are additional issues. Teaching can be
both formal and informal, and methods must be diverse to make sure multiple chances to
preserve and understand the information and to permit time for queries. Education approaches
used can include lecture, diagram, demo, teach-back, conversation, prose and hand-outs. Patient
education is another nursing interventions which also essential in this case. As the patient
revealed that she sometimes forgets to take her medicines, therefore she must be educated about
the importance of taking all the drugs prescribes by the physician (Chrvala, Sherr, & Lipman,
2016). A nurse should encourage the patient to take everyday bathing or hygiene upkeep as a

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significant step for reducing infection probability, prevention, and treatment. The patient also
stated that she does not think that she needs to top take all her drugs prescribed drugs. This might
be indications that she has lost his belief in the medications. Therefore a nurse can educate the
patient about how important these drugs are to maintain her BGL and prevent wound infections.
The patient should also be educated about how to maintain her weight and manage the hygiene
of the wound to be safe from infection. The patients with diabetes commonly develop some
psychological problems like stress and depression due to the length treatment processes.
Therefore the nurse must provide emotional support to them. This may increase the patients’
belief in the medication (Coppola, Sasso, Bagnasco, Giustina, & Gazzaruso, 2016).
Type 2 diabetes is the health problem that occurs when the body cells become insensitive
to insulin. The pathophysiological causes of these health issues include dis-functioning of beta
cells. Foot ulcers are the main problems that occur with diabetes that are painful and discharge
serous exudate. These types of wounds called ischaemic wounds. Two main priority of care in
case of Mrs Gina Bacci is her foot ulcer, and she poorly managed medication. Some effective
nursing management approach can be used in this case are a complete assessment of the patient
and educate her about the importance of medication for the treatment process.

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References
Bonner, T., Foster, M., & Spears-Lanoix, E. (2016). Type 2 diabetes–related foot care
knowledge and foot self-care practice interventions in the United States: a systematic
review of the literature. Diabetic foot & ankle, 7(1), 29758.
Chammas, N. K., Hill, R. L. R., & Edmonds, M. E. (2016). Increased mortality in diabetic foot
ulcer patients: the significance of ulcer type. Journal of diabetes research, 2016.
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for
adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic
control. Patient education and counseling, 99(6), 926-943.
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A., & Gazzaruso, C. (2016). The role of patient
education in the prevention and management of type 2 diabetes: an
overview. Endocrine, 53(1), 18-27.
Cornell, S. (2015). Continual evolution of type 2 diabetes: an update on pathophysiology and
emerging treatment options. Therapeutics and clinical risk management, 11, 621.
Driver, V. R., Lavery, L. A., Reyzelman, A. M., Dutra, T. G., Dove, C. R., Kotsis, S. V., &
Chung, K. C. (2015). A clinical trial of Integra Template for diabetic foot ulcer
treatment. Wound Repair and Regeneration, 23(6), 891-900.
Dunning, T. (2013). Care of people with diabetes: a manual of nursing practice. John Wiley &
Sons.

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Holman, N., Young, B., & Gadsby, R. (2015). Current prevalence of Type 1 and Type 2 diabetes
in adults and children in the UK. Diabetic Medicine, 32(9), 1119-1120.
Kautzky-Willer, A., Harreiter, J., & Pacini, G. (2016). Sex and gender differences in risk,
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Markakis, K., Bowling, F. L., & Boulton, A. J. M. (2016). The diabetic foot in 2015: an
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Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., & Vivian, E.
(2017). Diabetes self-management education and support in type 2 diabetes: a joint
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Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes
Educator, 43(1), 40-53.
Semenkovich, K., Brown, M. E., Svrakic, D. M., & Lustman, P. J. (2015). Depression in type 2
diabetes mellitus: prevalence, impact, and treatment. Drugs, 75(6), 577-587.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of
diabetic foot ulcer. World journal of diabetes, 6(1), 37.