Diabetes Management Case Study

This essay analyzes the underlying pathophysiology and causes of a patient's post-operative wound status in a diabetes management case study. It also discusses nursing priorities and appropriate nursing management.

Running head: DIABETES CASE STUDY 1
DIABETES MANAGEMENT CASE STUDY
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DIABETES CASE STUDY 2
Introduction
The essay will respond to the provided questions with reference to the case study of
Mrs. Gina Bacci, 49 years from Italy. Mrs.Bacci was hospitalized for two weeks awaiting
surgery due to a complication from right foot ulcer. Her forefoot, first and great toes were
partially amputated. She has a history of Peripheral Vascular Disease, Type II diabetes, and
obesity. She has been started on insulin regimen due to the worsening of her diabetes. She has
presented to the outpatient department for examination and management of her wound. With
regard to this, the paper will discuss the underlying pathophysiological mechanisms and
causes of Mrs. Bacci’s wound status after operation. The paper will also highlight two
nursing priorities for the patient and outline the safest and most appropriate nursing
management.
Question 1: Based on the case study, critically analyse and discuss the underlying
pathophysiology and causes of the patient’s post-operative wound status
Type II diabetes is one of the chronic conditions that impacts the mechanism of
metabolization of sugar or glucose in the body. In type II diabetes, there are two major
mechanism which are involved, that is, insulin resistance and reduced production of insulin
hormone which plays a key role in the maintenance of normal levels of blood sugars. Some
of the common symptoms of type II diabetes are increased frequency of urination, increased
thirst, fatigue, blurred vision, sores or ulcers which are slowly healing, frequent infections,
increased hunger, and unintended loss of weight (Dangwal et al., 2015).
In the outpatient department, Mrs. Bacci’s surgical wound was examined and was
found to have some dehiscence and sloughy tissue along the suture line. Additionally, it was

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discovered that the surrounding area of the wound site was dark pink, painful to touch, and
warm. The presence of the infection and complication indicates poor progress of the process
of wound healing. Sometimes, the wound may end up not healing based on the medical
conditions of the patient, that is, type II diabetes, obesity, and Peripheral Vascular Disease
(Al-Goblan, Al-Alfi, & Khan, 2014).
Type II diabetes is a metabolic disorder that is long-term and is characterized by
elevated Blood Sugar Levels secondary to insulin resistance and relative lack of insulin.
Some of the manifestations of type ii diabetes are sores and ulcers which do not heal. With
regard to the case study, the patient developed a complication of right foot ulcer whose
surgical wounds seems to be hard to heal. Largely, insulin resistance is caused by physical
inactivity and obesity. In most instances, the diabetic wounds demonstrate slow healing
process due to various factors (Dangwal et al., 2015).
First, the high levels of blood sugar in type II diabetes contributes largely to poor or
delayed healing of the diabetic ulcers or wounds. Glucose in the body plays a crucial role in
one’s level of energy, the ability of the body to heal wounds or injuries, and the medical
needs of the patient. High levels of glucose in the body stiffens the blood vessels thus
interfering with the smooth flow of blood (DeFronzo, Eldor, & Abdul-Ghani, 2013). Reduced
blood circulation results in low supply of oxygen and nutrients which are required in the
repair of the surgical wound. Reduced oxygen supply in the area causes death of cells and
eventually tissue necrosis or amputation.
The second factor that contributes to the current status of the patient’ wound is
diabetic neuropathy which involves nerve damage due to high levels of blood sugar in the
body. Neuropathy results in numbness and tingling making it hard for the patient to feel the
injury. The third element which may have contributed to the poor healing of the diabetic

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surgical wound of the patient is reduced functioning of the immune system (Murphy &
Evans, 2012). When someone is cut, his or her immune system keeps the germs and foreign
invaders away. But incase the invaders get into the wound area; the immune system initiates
the mechanism of fighting them to stop infections.
In a patient with type II diabetes, the body produces hormones and enzymes which
reduce the effectiveness of the immune system. This increases the risk of the patient getting
more infections which cause the diabetic surgical wound take long time for the healing
process thus requiring medical attention. In relation to the case study, the patient’s wound has
a complication of wound dehiscence and infections which make the surrounding skin are be
painful on touch and dark pink (Steinsbekk, Rygg, Lisulo, Rise, & Fretheim, 2012). The
inflammation stage of the wound healing process usually takes longer compared to other
stages, thus it may result in pain and warm skin. Therefore, the current status of the patient’s
diabetic surgical wound may have been contributed by high levels of blood glucose,
neuropathy, and impaired functioning of the immune system of the body (Ozougwu, Obimba,
Belonwu, & Unakalamba, 2013).
Question 2: Identify 2 main nursing priorities of care for this patient and provide a
justification and rationale for each
1. Wound assessment and care- Wound assessment is one of the key steps to find out
whether the wound is ischemic, neuropathic, or neuropsychic for the implementation
of the most appropriate measures. Understanding the unique features of the wound
category is important since it enables the identification of wound progression, healing,
and infection. Failure to identity the characteristics of the wound may result in
ineffective treatment of the diabetic wound. This may result in long-term
complications and amputation of the entire limb. Based on the case study, Mrs.Bacci

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has arrived to the outpatient department and on examination, her surgical wound is
infected and has a complication of dehiscence and sloughy tissue. The post-operative
surgical wound dehiscence may lead to morbidity and mortality to the patient. The
necrotic tissue should be removed to reduce pressure in the wound area thus
stimulating wound healing and preventing infections which may delay the process of
wound healing. The complications have negative impacts on the role physical,
physical functioning, bodily pain, and social functioning dimensions of the quality of
life of the patient. The condition of the wound if not well management may turn out to
be septic which can lead to the total amputation of the patient’s lower right limb
(Dangwal et al., 2015).
2. Blood Glucose Level (BGL) control- According to the case study, the patient has a
BGL of 12.6 mmol/L which is high. This is a priority since high levels of sugar in the
blood poses high risk of development of multi-organ complications which may result
in death of the patient. Hyperglycemia has serious health issues including the damage
of the blood vessels which transport blood to the body’s vital organs. It also increases
the risk of development of other complication fatal complications such as
cerebrovascular accident, heart disease, vision problems, skin problems, kidney
disease, and nerve damage. Nerve damage reduces the supply of nutrients and oxygen
to the wound healing site thus resulting in poor or delayed regeneration of body
tissues. Therefore, control of the Blood Glucose Levels would be a priority to
minimize the risk of occurrence of other complications which are life-threatening to
the patient (Mirza, Fang, Weinheimer-Haus, Ennis, & Koh, 2014).
Question 3: From your identified priorities, outline and justify the appropriate and safe
nursing management of the patient during this time

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From the identified priorities, the nursing management for Mrs. Bacci should focus on
glucose control and maintenance and wound care. Based on the wound condition of the
patient, it should be opened and cleaned with sterile and aseptic materials to promote healing.
The patient should be enlightened on keeping the wound clean all the time to prevent entry of
dust particles and other pathogens from entering the wound site. Some of these factors may
worsen the condition of the wound causing further complications (Fisher et al., 2012).
The patient should be enlightened on some of the risk factors which may increased the
risks of the patient contracting type II diabetes. To aid and prevent early of type II diabetes
the nurse should be explain the importance of preventing type II diabetes at a personal level.
In accordance with the case study, Mrs. Bacci has an history of obesity which is one of the
greatest risk factors of type II diabetes. The nurse should enlighten the patient on the
importance of controlling weight and the function of diet in the prevention of the
exacerbation (Haas et al.,2012).
The nurse should promote self-care to the patient. To support self-care of the patient,
the nurse should help the patient develop her own self-care. Based on the condition of the
patient, nutritional and lifestyle modification would be essential. In type II diabetes, the
recommended diet comprises of complex carbohydrates like whole wheat, brown rice, fruits,
beans, quinoa, vegetables, lentils, and oatmeal. The foods that should be avoided in type II
diabetes include processed and simple carbohydrates like white bread, sugar, cookies,
pastries, flour, pasta, and white bread (Karlsen, Oftedal, & Bru, 2012).
In the nursing management, the nurse should implement interventions which are
aimed at the achievement of the glycemic control. Insulin regimen should be administered to
lower the patient’s BGL to the expected range. According to the case study, the patient has
been initiated on Lantus and Novorapid regimens of insulin which are used to control her

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BGL. From the case study, the patient states that she does see the need of taking all her
medications as prescribed. This is an indication of poor adherence to the medications given.
The nurse should therefore enlighten the patient on the importance of complying with the
prescribed medications in relation to her current health status (Schellenberg, Dryden,
Vandermeer, Ha, & Korownyk, 2013).
From the case study, the patient has Peripheral Vascular Disease which is one of the
illnesses which contribute to the exacerbation of the patient’s health condition. The patient
should be enlightened on smoking which poses great risk to the patient’s health condition.
The patient should be enlightened on the importance of physical activity and regular exercise
in relation to her current health condition. Increased physical activity increases the rate of
consumption of oxygen by the body muscles thus lowering the levels of glucose in the blood
(Korat, Willett, & Hu, 2014).
There should a multidisciplinary approach of managing the patient. The team should
first have a physician who should examine the patient and prescribe the most appropriate
regimens of care. The nurse should also be there to act as the advocate for the needs of the
patient and ensure provision of a holistic and patient-centered type of care. There should also
be a nutritionist or dietician to provide nutritional review and prescription of the safest and
most appropriate diet for the patient to ensure that the BGL remains within the expected or
optimum range. Additionally, there should a social worker to provide social support to the
patient since some of the health condition may result in depression or emotional trauma to the
patient (Schellenberg et al., 2013).
Conclusion
Type II diabetes, Obesity, and Peripheral Vascular Disease are associated with an
increased risk of development of complications such as foot ulcer and poorly healing sores. It

DIABETES CASE STUDY 8
is always a priority that the patient’s Blood Glucose Level be controlled and maintained at
the optimum range. With reference to the case study of Mrs. Gina Bacci, the paper has
critically analyzed and discussed the underlying pathophysiology of the wound status of the
patient after operation. The paper has identified to primary nursing priorities required in the
planning of the Mrs. Bacci’s care. The paper has also outlined and justified the safe and most
appropriate nursing management required for Mrs. Bacci. The wound healing process in a
patient with type II diabetes is influenced by multiple pathophysiological mechanisms such as
neuropathy, infections, inflammation, and high levels of blood sugars. These factors result in
delayed would healing process and other complications. Control and maintenance of blood
glucose through lifestyle and nutritional modification is essential in the management of Type
II diabetes.
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