Diabetic Foot Injury: Wound Management and Assessment Plan

This article discusses the diagnosis, evaluation, impacts, physiology of healing process, wound management plan, health education, and pain management related to diabetic foot injury. It also provides a wound care assessment plan for diabetic foot injury.

Running Head: Diabetic Foot Injury
Wound Management
-Diabetic Foot Injury
Name of the Student
Name of the University
Author Note

1Diabetic Foot Injury
1. Diagnosis of the chosen individual:
a. Presenting Problem:
The given scenario involves an elderly (70 year old) male patient, Mr X (name
withheld) suffering from Diabetic foot injury. The patient has a large wound on the left
great toe and under the heel, and is accompanied by bleeding (from the injured site)
and pain in the left foot. The wound is also accompanied by swelling and discharge
of exudates, and a bad smell. The wound is on the plantar and lateral aspects of the
foot and toe.
b. Other Medical Conditions:
The patient has a history of Diabetes type 2, as well as hypertension, obesity and
renal dysfunction. The patient also suffers from terminal neuropathy, which was
caused due to Diabetes, and has resulted in a reduced sensation in the lower
extremeties such as the foot.
c. The type of wound and how it occurred
The patient experienced an accidental injury to his left foot while walking.
However, due to his terminal neuropathy caused by Diabetes, he never felt the
injury, and subsequently led to the infection of the wound, bleeding and pain
(Feldman et al., 2017). The injury was aggravated by the improper foot protection
worn by the patient at the time of injury.
2. Evaluation of the wound
a. Wound bed status:

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The wound bed is dark red in color, and bleeds upon contact. The wound shows
signs of unhealthy granulation and infections. The wound bed is also covered with
necrotic tissue, which produces a pus like exudate, and produces a rotting smell.
b. Wound measurements:
The 2 inches in length and 1 inch wide, and 0.1inch deep
c. Condition surrounding skin
The skin surrounding the injury shows a discoloration, and swelling. The peri
wound skin also shows signs of maceration and excoriation. The skin is however
intact around the wound.
d. Wound exudates
The wound also produces brownish yellow exudates, and is accompanied by a
putrid smell. The exudates are also sticky in nature, with high viscosity, and contain
necrotic materials.
Wound Type Diabetic foot ulcer
Location
plantar and lateral aspects of the foot and toe (left
foot)
Dimensions (length, width, depth) 2inch, 1 inch and 0.1 inch
Stage 3
Exudate amount Heavy
Exudate type Serous
Odour Offensive
Colour of wound and surrounds Dark red
Surrounding skin discoloured, inflammaed, intact
Present on admission (yes/no) Yes
Pain in dressing change Constant
Pain Severety 7
Table 1: Wound assessment; Source: (Greatrex‐White et al., 2015; Logan,
2015).

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3. Actual or potential impacts of the wound:
Due to the nature of the diabetic foot injury and ulceration, the life of the patient is
affected by different factors caused by the injury/ulcer, such as:
A. Effect on the quality of life
The diabetic foot injury have resulted in a drastic reduction in the quality of life of
the patient, due to a loss of mobility (as the patient finds it increasingly difficult to
move about because of the foot injury) and thus perform simple activities like leisure
activities, and socializing with others. The patient is no longer able to meet his
friends or go on walks with his wife. This has also made the patient more irritable
and depressed (Pickwell et al., 2017).
B. Pain
The chronic pain associated with the injury/ulcer has also made the patient over
cautious to walk, and the constant pain has also made it difficult for the patient to
focus on anything or enjoy anything properly. The pain has also resulted in anxiety
and irritability exhibited by the patient. The patient also is unable to perform the
activities of daily living due to the pain.
4. Physiology of the healing process and how different factors impacts the
process
Healing of a wound is a complicated process that occurs in several stages,
that involves the process of blood clotting in which activated platelets and fibrin in the
blood produces a blood clot on the wound, followed by an inflammation phase where
white blood cells destroy the cellular debris and releases various growth factors.
These growth factors then cause proliferation of the cells, which promotes the growth

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of new tissues and is finally followed by maturation and remodeling of the cells,
which marks the completion of the healing process of the wound (Singh et al., 2017).
Factors that affects the normal healing process of the wound includes: a) Poor
blood circulation which prevents proper circulation of blood in the foot, making
wounds harder and longer to heal. b) Hyperglycemia or high blood sugar also slows
down the healing process c) diabetic neuropathy reduces the sensitivity of the foot
pain and thus of foot injuries (causing painless wounds, which develops to ulcers) d)
Age also causes reduction in the healing process and thus can prolong ulcers e)
Loss of balance and improper gait can also increase the risks of injuries to the foot
(Harper et al., 2014; Wong et al., 2015).
5. Evaluation of Wound management plan:
A. Dressings
Different dressing can be used for diabetic foot injuries such as:
1.Low Adherence: which is simple and inexpensive hypoallergic dressing, however
has minimal absorbency.
2. Hydrocolloid dressing which can be left for several days and used to aid autolysis,
however can cause maceration, unpleasant odours and can be ineffective on
infected wounds.
3. Iodine preparations which can be used as antiseptics however can cause iodine
allergy and discolored wounds.
(Jeffcoate et al., 2018)
B. Frequency of Dressings and change

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The dressing is to be changed daily, and the status of the wound should be
checked every time.
C. How the wound is cleaned
The wound can be cleaned by the process of debridement. For debridement
surgical removal of necrotic tissue as well as usage of fly larva can be utilized as well
as autolytic and hydro surgery procedures. Surgical debridement can allow the
removal of the necrotic tissues, reducing pressure, can allow the drainage of
exudates and pus and promote healing (Bilyayeva et al., 2017).
D. Progress made
The progress can be evaluated from improvement in the condition of the
wound and signs of healing of the wound.
E. Changes that occur to the plan during clinical placement
Changes to the care plan would depend on the status of the wound as well as
that of the chronic condition(s) the patient is suffering from.
Wound Location Left foot
Date
Frequency of dressing change Daily Twice a week Once a week
Cleansing Agent Saline
Antiseptics
Primary Dressing Polyurethane film Activated Charcoal Silver
Secondary Dressing PHMB Silicone Iodine
Table 2: Wound care
6. Health Education that can be provided to the individual in regards to the
wound:

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The patient can be educated to keep the blood glucose under check, keep the
wound clean and properly bandaged, cleaning the wound regularly and changing the
bandages, avoiding walking barefoot, and wearing appropriate footwear. The patient
can also be educated on healthy diet options, which can help to reduce the risks of
co morbidities (like obesity, diabetes, renal dysfunction and hypertension) and advise
on the types of activities the patient can involve in in order to meet the daily exercise
requirements. The patient can also be educated on strategies to self care the wound
and also reduce the incidence of further such wounds. Exercise routines focused on
improving the gait and balance of the patient, and reduce obesity, and meditative
practices to alleviate hypertension can also be suggested top the patient, as well as
other methods which can help to improve the diet (such as choosing food rich in fibre
and low in saturated and trans fat. It is also essential for the patient be educated on
healthy and unhealthy fats, and their sources, and how they affect the body,
especially in relation to the co morbidities and clinical diagnosis of the patient
(Margolis et al., 2015; Baba et al., 2015; Dorresteijn et al., 2014).
7. Pain management related to the wound:
Medication Time, Frequency and Dose Justification
Tricyclics and
antidepressants
For burning type searing pain
amitriptyline Before bed time, Once a day,
10-20mg, and increasing in
increments until the correct
dose is attained for the pain.
Sedative effect
nortriptyline or desipramine Before bed time, Once a day,
10-20mg, and increasing in
Lesser side effects and high
noradrenalin action

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increments until the correct
dose is attained for the pain.
Gabapentin (if trycyclics do
not work)
Three times a day, 100mg
tablets
Non-Steroidal Anti
Inflammatory Drugs
(NSAIDS)
Morning and evening, 100
mg
Anti inflammatory and
antipyeretic effect
Table 3: Pain management medications
8. Wound Care Assessment Plan
Assessment Diagnosis Planning Implementation Evaluation
Subjective
(patient
reported)
Impaired tissue
integrity
evidenced by
stage 3 diabetic
ulcer
Patient will
demonstrate
wound healing
Objective
(assessment of
skin, clinical
history, pain
assessment,
and wound
assessment)
mpaired tissue
integrity
evidenced by
stage 3 diabetic
ulcer
Patient will
demonstrate
wound healing
Table 4:Wound care assessment

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References:
Baba, M., Duff, J., Foley, L., Davis, W. A., & Davis, T. M. (2015). A comparison of
two methods of foot health education: The Fremantle Diabetes Study Phase
II. Primary care diabetes, 9(2), 155-162.
Bilyayeva, O. O., Neshta, V. V., Golub, A. A., & Sams-Dodd, F. (2017). Comparative
clinical study of the wound healing effects of a novel micropore particle
technology: effects on wounds, venous leg ulcers, and diabetic foot
ulcers. Wounds: a compendium of clinical research and practice, 29(8), 1-9.
Dorresteijn, J. A., Kriegsman, D. M., Assendelft, W. J., & Valk, G. D. (2014). Patient
education for preventing diabetic foot ulceration. The Cochrane Library.
Feldman, E. L., Nave, K. A., Jensen, T. S., & Bennett, D. L. (2017). New horizons in
diabetic neuropathy: mechanisms, bioenergetics, and pain. Neuron, 93(6),
1296-1313.
Greatrex‐White, S., & Moxey, H. (2015). Wound assessment tools and nurses'
needs: an evaluation study. International wound journal, 12(3), 293-301.
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healing. Surgery-Oxford International Edition, 32(9), 445-450.
Jeffcoate, W. J., Vileikyte, L., Boyko, E. J., Armstrong, D. G., & Boulton, A. J. (2018).
Current challenges and opportunities in the prevention and management of
diabetic foot ulcers. Diabetes care, 41(4), 645-652.

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Logan, G. (2015). Clinical judgment and decision-making in wound assessment and
management: is experience enough?. British journal of community
nursing, 20(Sup3), S21-S28.
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Pickwell, K., Siersma, V., Kars, M., Apelqvist, J., Bakker, K., Edmonds, M., ... &
Piaggesi, A. (2017). Minor amputation does not negatively affect health‐
related quality of life as compared with conservative treatment in patients with
a diabetic foot ulcer: An observational study. Diabetes/metabolism research
and reviews, 33(3).
Singh, S., Young, A., & McNaught, C. E. (2017). The physiology of wound
healing. Surgery-Oxford International Edition, 35(9), 473-477.
Wong, S. L., Demers, M., Martinod, K., Gallant, M., Wang, Y., Goldfine, A. B., ... &
Wagner, D. D. (2015). Diabetes primes neutrophils to undergo NETosis,
which impairs wound healing. Nature medicine, 21(7)

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