Diabetic Case Scenario: Pathophysiology, Causes, and Nursing Management

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

CASE SCENARIO
1
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).

CASE SCENARIO
2
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