Diabetic Foot Ulcer: Causes, Pathophysiology, and Nursing Management

This essay discusses the causes and pathophysiology of diabetic foot ulcers, focusing on a case study of a patient with diabetes and peripheral vascular disease. It explores the importance of proper wound care, glucose level management, and physical activity in promoting healing. The essay also highlights the need for a multidisciplinary team approach to provide effective nursing management.

Running head: DIABETIC FOOT ULCER
DIABETIC FOOT ULCER
Name of the student:
Name of the university:
Author note:

1DIABETIC FOOT ULCER
Introduction:
Mrs Bacci is a woman from Italy who is 49 years of age. From the past 6 years of
duration she has been in misery due to diabetes. She has underwent a surgery which has resulted
in foot ulcer. In this essay, the main cause for her foot ulcer is discussed. In addition the
pathophysiology of the ulcer is also discussed in the essay and along with that the hurdles which
are preventing the healing procedure. By seeing the patient current situation, specific
intervention has been articulated and an effective nursing management is also provided in order
to get an operative treatment (Pérez Rivas et al., 2016).
Consideration of the patient situation:
Mrs Gina Bacci who is an adult Italian women. She was admitted to hospital for a
surgery related to her foot ulcer complication. She experienced surgery for fractional exclusion
of the forefoot and first and the great toes. She had a past medical condition of type 2 diabetes
for last 6 years. She has also been suffering because of peripheral vascular disease. Her body
mass index is about 40.4m2 and is obese, with a body weight of 110 kg. For diabetes she had to
take insulin to manage her insulin level (Budiman, 2016). After her surgery she was discharge
from the hospital and had to visit doctor for her regular checkup. Mrs Bacci was administered
with different medication such as, pregabalin 75mg, novorapid TDS 12 units, paracetamol 1g
QID, lantus 30 units note. She sometimes forget to take her medication which is making the
situation worse. According to her, she was fine and does not any of the medication. Her blood
pressure is around normal, 120/70. Pulse rate of Mrs bacci is 88 bpm, which is also normal and
respiratory rate of the patient is also normal. Her body temperature is 37.8 degree Celsius. Mrs

2DIABETIC FOOT ULCER
bacci was only facing problem due to her wound in the foot which was continuously wet along
with some exudate discharge, which is painful and warm to touch.
Pathophysiology of the wound:
There is some island film bandage done on her wound. Mr Bacci’s wound has some
dehiscence related to the suture line and from there some kind of slough tissue is coming out.
After several tests, it is concluded that, her wound is because of the diabetic neuropathy
(peripheral diabetic neuropathy). In case of diabetic patient the nerve responsible for pain
transmission does not work properly, which inhibits the brain to understand the severity of the
wound (Alavi et al., 2014). Hence is such cases wearing tight shoes, blisters can cause diabetic
foot ulcer (Ahmad, 2016). In the case of peripheral vascular disease, the capillaries narrows
down and the flow rate of blood reduces. These decreased flow of blood assist in further damage
of the foot ulcer and in addition it also prevents the wound healing process. This ineffectiveness
of the wound to get healed properly is due to the increased blood glucose into the body of the
patient. Hence in such patient, any small injury can lead to foot ulcer (Hinchliffe et al., 2016).
Reason for the post-operative wound:
In the case of diabetic patient, foot ulcer is commonly observed. The foot ulcers
witnessed on the bottom of the feet. Around 15 % of the overall diabetic population are suffering
from such kind of ulcer. Mrs Bacci went through a surgical procedure for the amputation of the
fore foot and first toes, where a wound was located and due to diabetic neuropathy, chances of
wound healing is decreased (Volmer-Thole & Lobmann, 2016). The chance of healing wound in
case of diabetic patient decreases with age. The actual reason behind the wound of Ms. Baaci is
the nerve injury (avoids pain transmission) and reduced flow rate of blood because of the

3DIABETIC FOOT ULCER
narrowing of peripheral artery. She was already diagnosed previously with the peripheral
vascular disease, which consequences in the narrowing of the capillary, and lowering down the
circulation of the blood and also prevents the wound from getting healed (Kullo & Rooke, 2016).
Nursing priorities:
As main worry of Mrs Bacci is the foot ulcer, hence an action is conducted to treat her
wound. In addition to it she will also be educated that administrating medication at adequate
amount and time is significant and prevent her health from further deterioration.
Intervention
Intervention Justification rationale
Provided with chair cushion
and the mattress system and
also encouraged to engage in
daily physical activity
(Balducci et al., 2014).
It helps in preventing the
further deterioration of the
wound.
Mrs bacci had underwent
a surgery in the past for
the partial amputation of
her feet and right and
great toes so she avoids
standing for a long time
as it will provide
pressure on the ulcer and
it can further deteriorate
(Bus et al., 2015).
In case of the diabetic
patient, engagement n
physical activity helps in
maintaining the blood

4DIABETIC FOOT ULCER
glucose level and
prevents the BGL from
getting increased
(Balducci et al., 2014).
Her body glucose level is
monitored regularly, of
possible every morning and
Hydrogel should be used
(Saco et al., 2016).
It assists in wound healing BGL level of Mrs bacci
is 12.6mmol/l, which is
much higher than that of
the normal blood glucose
level (5.56-6.69mmol/l).
this increased blood
glucose level delays the
wound recovery process.
Hence to get the wound
healed her body glucose
level is regular assessed
and managed to the
normal level (Alavi et
al., 2014).
For the dressing of her
wound, hydrogel should
be used, as it hydrates
the ulcer. It allows
granulation soft tissue of

5DIABETIC FOOT ULCER
body to custom ended
tendon (Saco et al.,
2016).
Safe nursing management:
Nursing administration is used in providing operative management of the patient and also
helps to avoid any future difficulty. The main aim of nursing management is to supply primary
treatment. In case of Mrs. Bacci, she has been suffering due to diabetic, hence her body sugar
level is regularly managed to avoid any further deterioration (Balducci et al., 2014). She has
acknowledged that she every so often to forget her medication and also does not feel like
consuming it even if Ms. Gina remembers it. Hence in such circumstances, registered nurse
should educate the patient and aware those regarding the importance of the prescribed
medication and also that it should be taken frequently as recommended by the general physician.
She should monitor the procedures of NMBA standard of nursing in order to deliver operative
treatment to patient, such as appealing in therapeutic relation with the patient and developing a
nursing care plan by considering patient illness (Al Sayah et al, 2014). Her regular diet should be
also framed accordingly such as, diet containing low glucose diet. In framing the nursing care
plan, MLT (multiple disciplinary team) should be involved which include, physician for various
medication, diet with the help of dietician, physical workout with the help of physiotherapist and
also consultant for creating awareness about the program. As from the wound, discharge is
continuous hence dressing should be done properly by hydrogel which hydrates the wound and
help in wound healing. To sustain the level of glucose in the body, physical exercise such as
running and aerobic workout are encouraged as these helps in managing the body glucose level
as well as help in lowering the body weight. As the patient is careless regarding her medication,

6DIABETIC FOOT ULCER
hence nurse should also include family of the patient in order to get the effective result
(Yazdanpanah, Nasiri & Adarvishi, 2015).
Conclusion:
From the essay it can be concluded that, in case of Mrs bacci an immediate nursing care
is required. She is suffering from diabetes and in such patient foot ulcer is commonly observed.
She had underwent a surgery which results in foot ulcer and due to the diabetic neuropathy and
peripheral vascular disease her wounds are not getting healed. Hence to get the wound healing,
engagement in physical exercise is encouraged, hydrogel is used during dressing and body
glucose level is managed accordingly. To get effective result from the treatment, an operative
nursing management approach is expressed with the help of multiple disciplinary team.

7DIABETIC FOOT ULCER
References:
Ahmad, J. (2016). The diabetic foot. Diabetes & Metabolic Syndrome: Clinical Research &
Reviews, 10(1), 48-60.
Al Sayah, F., Williams, B., Pederson, J. L., Majumdar, S. R., & Johnson, J. A. (2014). Health
literacy and nurses’ communication with type 2 diabetes patients in primary care
settings. Nursing research, 63(6), 408-417.
Alavi, A., Sibbald, R. G., Mayer, D., Goodman, L., Botros, M., Armstrong, D. G., ... & Kirsner,
R. S. (2014). Diabetic foot ulcers: Part I. Pathophysiology and
prevention. Journal of the American Academy of Dermatology, 70(1), 1-e1.
Alavi, A., Sibbald, R. G., Mayer, D., Goodman, L., Botros, M., Armstrong, D. G., ... & Kirsner,
R. S. (2014). Diabetic foot ulcers: part II. Management. Journal of the American
Academy of Dermatology, 70(1), 21-e1.
Balducci, S., Sacchetti, M., Haxhi, J., Orlando, G., D'errico, V., Fallucca, S., ... & Pugliese, G.
(2014). Physical exercise as therapy for type 2 diabetes
mellitus. Diabetes/metabolism research and reviews, 30(S1), 13-23.
Budiman, E. S. (2016). U.S. Patent No. 9,326,709. Washington, DC: U.S. Patent and Trademark
Office.
Bus, S. A., Van Deursen, R. W., Armstrong, D. G., Lewis, J. E., Caravaggi, C. F., Cavanagh, P.
R., & International Working Group on the Diabetic Foot (IWGDF). (2016).
Footwear and offloading interventions to prevent and heal foot ulcers and reduce
plantar pressure in patients with diabetes: a systematic
review. Diabetes/metabolism research and reviews, 32, 99-118.

8DIABETIC FOOT ULCER
Hinchliffe, R. J., Brownrigg, J. R. W., Apelqvist, J., Boyko, E. J., Fitridge, R., Mills, J. L., ... &
International Working Group on the Diabetic Foot (IWGDF). (2016). IWGDF
guidance on the diagnosis, prognosis and management of peripheral artery disease
in patients with foot ulcers in diabetes. Diabetes/metabolism research and
reviews, 32, 37-44.
Kullo, I. J., & Rooke, T. W. (2016). Peripheral artery disease. New England Journal of
Medicine, 374(9), 861-871.
Pérez Rivas, F. J., Martín‐Iglesias, S., Pacheco del Cerro, J. L., Minguet Arenas, C., García
López, M., & Beamud Lagos, M. (2016). Effectiveness of nursing process use in
primary care. International journal of nursing knowledge, 27(1), 43-48.
Saco, M., Howe, N., Nathoo, R., & Cherpelis, B. (2016). Comparing the efficacies of alginate,
foam, hydrocolloid, hydrofiber, and hydrogel dressings in the management of
diabetic foot ulcers and venous leg ulcers: a systematic review and meta-analysis
examining how to dress for success. Dermatology online journal, 22(8).
Volmer-Thole, M., & Lobmann, R. (2016). Neuropathy and diabetic foot
syndrome. International journal of molecular sciences, 17(6), 917.
Yazdanpanah, L., Nasiri, M., & Adarvishi, S. (2015). Literature review on the management of
diabetic foot ulcer. World journal of diabetes, 6(1), 37.