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

This article discusses the application of clinical reasoning tool in nursing to address Patient Bacci's medical assessment and wound care. It explores the key nursing priorities, management protocols, and drug management for positive outcomes. The patient's history of type II diabetes, peripheral vascular disease, and obesity are taken into consideration. The article also highlights the complications of type II diabetes and the impact on wound healing. The importance of proper wound care and medication management is emphasized.

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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

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worsening wound state. With the current medical diagnosis of diabetic foot ulcer and diabetes
mellitus, there is need to focus on management of impaired tissue integrity caused by wound
infection arising from diabetic foot ulcer (Pirozzi et al., 2016).
Key interventions to undertake for the patient entails close monitoring of temperature,
color edema and general appearances of the surrounding skin continuously. Key rational for
this intervention is aimed at assessing systematically on skin inspection and identification of
possible appearance of the skin, this is intended to enhance the surrounding skin to be intact
and no inflammation.
Monitoring of site impairment of the tissue is vital for the patient. Maintaining the
integrity of the skin is fundamental for identification of dialyze signs and symptoms.
Assessment of patients’ sensation experience on the wound will be key. Key rational for this
action is geared towards addressing pain to the secondary change through a reduction of trauma
and wound pain which might occur he intended outcome is to ensure that the patient does not
develop any added signs of infection (Meyer et al., 2018).
Risk for infection
This emanates from the patient assessment reflected by deficient of cognitive
information linked to wound care management. The state of the patient can be relatively
evidenced by development to wound complications which might have been improved through
proper wound care. This reflects delayed wound care and arising complications.
The key nursing interventions to address entail blood glucose stability for the patient.
Assessment status indicates high glucose levels above the normal ranges. This state affects the
healing process, unstable blood glucose levels often contributed to delay wound healing.
Elevated blood glucose for a long time often warrants treatment medication such as adjustment

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to insulin drugs management. Assessment of necrotic tissue surround the skin is crucial in
assessing the patient state. The necrotic tissues often surrounding the wound depict poor blood
flow, which hinders the wound healing process (Armstrong, Boulton & Bus, 2017).
Reducing and correcting patient risks factors is essential. There is a need to educate the
patient on clean wound care and management of dressing s as indicated. This is aimed at
preventing the development of infections which are often associated with wound care
management, further enhancing patient ability to follow the recommended medication
management essential. Blood sugar control is essential in the management of wound care as it
enhances blood flow. High blood glucose as observed from the patient Bacci is resulting in
poor blood flow around the wound areas, which leads to delayed treatment process (Amin &
Doupis, 2016).
Question 3- Evaluating outcomes and reflecting on the learning process
Diabetic foot ulcers often result from various consequences which lead to eventual loss
of the protective sensation caused by peripheral neuropathy due to foot numbness making the
injury to be unnoticed. The deficiency occasioned by arteries further complicates the
neuropathic ulcers leading to a poor wound healing process. Often occurrence of mechanical
stress at the wound site affects the wound healing process, coupled with uncontrolled
hyperglycemia and prior amputations compound the overall pathogenesis of the disease
progression. The infection further leads to deteriorated foot ulcers resulting in a chronic wound
healing process. The debridement for the necrotic tissue forms an integral part of the treatment
of chronic wounds as the healing process is affected by chronic wound not healing due to
presences of unviable tissue. Undertaking excision is essential in a wound healing process.
Removal of necrotic tissue on the wound can lead to the faster healing process of the wound
and lead to the attainment of full secondary closure (Pickwell et al., 2015).

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Management of foot is critical in order to prevent progression of diabetic foot issues.
Wound healing will entail a complex process which involves the regulation of responses,
harboring growth factors as they play a role in the wound healing process. Treatment of
diabetic foot infection often needs proper wound care and effective antibiotic therapy. The key
aspect of good management entails debridement, offloading practices, enhancing most wound
and infection treatment process. In achieving these outcomes it requires adequate training and
great clinical experiences as a nurse. Accurate assessment to fall factors including classification
of the wound, debridement has to be carefully considered (American Diabetes Association.,
2018).
Debridement process for the patient would entail removal for dead and damaged or the
affected tissues so as to improve wound healing ability and ensures the tissues remain healthy.
More often sharp debridement can be undertaken as it is a faster and effective method for
management. An occlusive dressing wound would require tissue fluid accumulation which ahs
macrophages, neutrophils and key enzymes which are able to remove bacteria and initiate
digestion of necrotic tissues. This can be done through a moist wound environment applied to
the patient (Fadini et al., 2016).
Establishing effective wound care for patient Bacci is essential. Wound care activity
allows for the management of diabetic foot and entails teaching the patient on the use of
normal saline to promote the moist wound healing process. Advice on the use of tropical
management for managing the patient state is crucial, and they include, hydrogels, alginates
dressing among others (Lindley, Stojadinovic, Pastar & Tomic-Canic, 2016).
Further, following appropriate drug regime is essential for managing the state of the
wound and also to reduce the hyperglycemia levels experienced by the patient. There is a need
to lower the blood sugar level so as to enhance blood flow the wound so as to facilitate a faster

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wound recovery process.
The key goal of diabetic management is the detection and identification of
complications which is managed through frequent assessments. Wound assessments need to be
identified and treated accordingly. Selection of appropriate dressing protocol for patients, there
is a need to bear in mind the ideal properties underlying the protocols chosen. They need to
offer a moist environment for the wound and be able to absorb any exudation, controlling
infection and offer an effective treatment process of diabetic foot wound (Ogrin, Houghton &
Thompson, 2015).
Conclusion
Proper wound care requires urgent attention through appropriate care management
protocol. There is a need to address patient Bacci resultant complication from diabetic foot
ulcer calls for engaging and implementing key goals such as restoring impaired tissue integrity
and wound management through eliminating the infection. Addressing these key issues is
essential to achieve better outcomes for the patient and facilitate a faster wound recovery
process. Thus proper management and patient adherence to medication management to reduce
risks factors linked to wound infection is essential.

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