Clinical Reasoning Tool Application in Nursing: Addressing Patient Bacci's Medical Assessment and Wound Care

Case study assessment
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Introduction
Clinical reasoning tool application in nursing is essential in facilitating care and
determining outcomes for patients. Its usage offers guidance on clinical nursing actions which
are aimed at addressing the needs of the patient and offering the necessary treatment protocols.
Clinical reasoning tool has been utilized in addressing Patient Bacci medical assessment and
path physiological issues related to wound care occurrence arising from Type II diabetes and
diabetic foot ulcer. The key nursing priorities identified for the patient entails addressing issues
relating to impaired tissue integrity and management of wound infection. The expedited
nursing outcomes are expected to address the patent issues and improve on care assessment for
the patients. Adequate management protocol and drug management protocol are essential for
positive outcomes. Thus these issues are discussed in depth in the subsequent information.
Question 1- Collecting cues, processing information and identifying patient issues
Patient Bacci is a 49-year-old Italian lady admitted from complications arising from
right foot ulcer occurring from the patient amputation of the forefoot on the great and first toes.
The patient has a history of type II diabetes, peripheral vascular disease, and obesity. She has a
history of diabetes and an administration of insulin management has been recommended for
her. Currently, the patient is under the administration of diabetes drugs and pain adjuvant
drugs. The patient’s vital statuses are normal having the right temperature, the normal pulse
rate, respiratory rate, and expiratory oxygen and right temperature. Toes assessment reveals
that she has a cold fever and capillary refill of 2-3 seconds. Wound assessment for the patient
reveals that there is an island film dressing on the incision wound which is wet and exuding
output. There is an occurrence of dehiscence on the suture line and sloughy tissue. The skin is
pink and dark pink with pain to touch.

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Patent Bacci is presenting with clinical path physiology of type II diabetes. It is
characterized by insulin resultant largely due to obesity and physical inactivity, which it both
offers a prediction on type 2 diabetes. The insulin resistance is largely due to metabolic
syndrome which has a cluster of risks factors which lead to insulin resistance. Type II diabetes
often presents a relative defect in insulin resistance (Huynh, Dawson, Roberts & Bentley-
Lewis, 2015). The resistance to insulin has been identified as the inability of the insulin to
perform its biological function. Further type II diabetes is often execebarated by other
underlying conditions. Linkage on cardiovascular diseases often increases the patient risks to
frequent admissions and declining state of the disease (Soleymanian et al., 2015).
The complications of type II diabetes is often linked to a variety of factors. The
presentation of the patient indicates a combination of varying degrees of insulin resistance and
relative insulin insufficiency and contributes to type II diabetes. The occurrence of type II
diabetes leads to developments of other conditions; this includes hypertension and
cardiovascular diseases (Janelidze et al., 2017). The patient has a past history of peripheral
vascular disease and obesity which is likely to be a factor in her state.
In diabetic mellitus, there is an elevated occurrence and development of diabetic foot
ulcers through the production of glucose and development of factors such as peripheral
neuropathy, peripheral vascular disease, and infection response. Further wound healing
disorder alters the diabetes state of the patient increasing the risks of r infection. Neuropathy
occurrence leads to skin damage which leads to the development of ulcers (Alsyani, 2015).
PVD results in arteriosclerosis, the atheroma causing of the core cholesterol join the
proteins with fibrous covering on the intravascular covering. It gradually progresses to
complete occlusions to medium size large arteries. Often vascular disease manifest through the
development of thrombi emboli compromising perfusion, they occur in lower extremities,

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various factors lead to thrombosis including sepsis, low cardiac output, and narrowing of the
lumen (Farahani, Vanda, Ghorbani, & Shakeri, 2017). The site of occlusion and the presence of
collateral circulation and nature of occlusion determine the severity of acute manifestation.
Emboli state tends to carry high morbid on the extremity and cannot develop collateral
circulation. Occlusion occurrence leads to proximal and distal thrombus as a result of
stagnation of flow (Qureshi et al., 2017).
The occurrence of the peripheral vascular disease leads to increased diabetic conditions
on patients; it causes intense severity and diffusion. The endothelial dysfunction, vascular
smooth cell dysfunction, hyper coaguability, and inflammation are the leading factors of
diabetic arteriopathy. Presence of PVD further increases claudication risks, gangrene, and
possible amputation and marked increased rates of ischemic attack (Coxe, Lennertz & Martine,
2018). In type II diabetes, there is an occurrence of tight control of glucose control which
reduces micro and macrovascular developments when therapy is initiated early.
Type II diabetes occurrence making it moiré difficult for wound healing to occur, the
presence of high glucose levels impairs the functioning of white blood cells which leads to the
inability to fight bacteria. Poor blood circulation occurring leads to difficulty in delivering
more nutrients to the wound, leading to a slow healing process. The peripheral vascular disease
leads t poor circulation of blood, thus limited supply of oxygen due to narrowing of the blood
vessel leading to low blood flow on the limbs, thus impairing healing progress (Dioszegi et al.,
2017).
Question 2-Establishing goals and taking action
Impaired tissue integrity restoration
Patient assessment reveals that there is a development of gangrene, open wound and