Diabetic Foot Ulcer: Pathophysiology, Nursing Care, and Management

This essay provides a detailed analysis of diabetic foot ulcers, including the pathophysiology, nursing care priorities, and safe nursing management. It discusses the case of a patient with a diabetic foot ulcer and highlights the importance of proper nursing care for effective treatment and recovery.

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

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Introduction:
Mrs. Bacci is an Old Italian woman of 49 years age who has a poor knowledge of English
was hospitalized with a surgical complication of foot ulcer in her right foot. She was operated
under anesthetic for amputation of her toes and forefoot (Pilla, Desai & Kokiwar, 2019). Her past
medical history showed that she was diagnosed with type 2 diabetes 6 years ago followed by
obesity and peripheral vascular disease and her diabetic condition was worsening her condition
in the hospital. She was discharged from the hospital and was under out-patient department of
the hospital for further assessment and management of the wound. In this essay, a detail analysis
will be focused on the health condition of the patient with underlying pathophysiology of her
wound that was not becoming dehiscence. The nursing care plan is discussed in this essay stating
the required nursing care priorities for improving her health condition (Lim, Ng & Thomas,
2017). The essay will also encompass the appropriate safe nursing management approaches that
will be suitable for the patient to recover soon. Hence, it was evident from the symptoms that the
patient was suffering from diabetic right foot ulcer and required an effective nursing care.

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Critical analysis of the present case scenario:
The critical analysis of the patient’s condition include the first phase of clinical
reasoning cycle, which highlights the current medical information and status of the patient. The
patient had undergone surgery of right foot as she was suffering from ulcer. She had a prolong
history of type II diabetes and had to take insulin to keep her sugar level in control. After her
discharge, she visited the doctor in the out-patient department were she was assessed to improve
her health condition (Waaijman et al., 2015). She was administered with Novorapid TDS 12
units, Pregabalin 75mg mane, Lantus 30 units note and Paracetamol 1g QID, but sometimes she
often used to forgets to take her medications on time and also was thinking that she doesn’t
require administration of all the medications. She has a normal blood pressure of 120/70 mmHg,
a normal pulse rate of 88bpm and a normal respiratory rate of 18bpm, SpO2 at 97% and body
temperature of 37.8 degree Celsius. The patient was facing an issue in her wound area as an
island film was developed near the incisional wound and was continuously wet due to serous
exudate discharge (Barun et al., 2014).
Pathophysiology of the wound:
Mrs. Bacci’s wounds was not healing and was warm and painful to touch, a serous
exudate discharge from her body was making the wound wet with some dehiscence beside the
stitch line stating the presence of few sloughy tissue. After further analysis, it is observed that
Mrs. Bacci was suffering from diabetic foot ulcers. It is an open painful area or wound on a
person’s foot occurring due to numerous factors like atherosclerotic marginal arterial infection,
peripheral neuropathy and any changes in the conformation of the foot bone architecture
(Armstrong, Boulton & Bus, 2017). These factors effects with higher intensity and frequency

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among the diabetic population. The major reason of developing foot ulcer in diabetic population
is due to peripheral diabetic neuropathy. The nerve responsible to transmit the pain sensation of
the foot does not function effectively in a diabetic patient hence, inhibiting the brain to
understand any kind of damage in the foot. Wearing any kind of tight shoes or cuts, bruises and
blisters will develop later into diabetic foot ulcer (Noor, Zubair & Ahmad, 2015). In case of a
diabetic patient, the arteries are narrowed down hence decreasing the blood flow in the feet,
which can later impair or damage the ability of the foot to heal the wound effectively or properly
(Ogrin et al., 2015). This ineffectiveness of the foot to heal on time develops into an ulcer as the
blood sugar level of the patient is high it will disable the property of the skin to repair itself due
to nerve damage. Therefore, any kind of mild injury will also result into a type of ulcer (Alavi et
al., 2014).
Cause of the post-operative wound:
The ulcer normally forms on the bottom portion of the foot. Diabetic foot ulcer
occurrence is observed in around 15% of individuals with diabetes. The risk of occurrence of
foot ulcers in patients suffering from diabetes increases with increasing age (Van Netten et al.,
2016). The wound of Mrs. Bacci condition was also an outcome of the diabetic foot ulcer, as she
underwent a surgery related to amputation of forefoot and great and first toes where her wound
was in the case of diabetic patients, the capability of the body to recover from wounds decreases
(Braun et al., 2014). The reason behind the issue is nerve damage and lower limit of blood flow
due to peripheral artery disease (Mishra et al., 2017). The patient was already diagnosed with
peripheral vascular disease that result in narrowing of arteries circulating blood throughout the
body, which was majorly responsible for not permitting the wound to heal.

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Nursing care priorities:
In such situations, the nurse will provide primary treatment along with examination and
screening of the disease and will educate the patient regarding the issue, treatment process and its
positive and negative outcomes and the medications that are provided and their dosage (Whyte,
Quaglia & Hopkins, 2016). The nursing intervention comprising of nursing priorities of care are
demonstrated below with appropriate rationale for effective care of the patient suffering from
diabetic foot ulcer.
Intervention Rationale
Evaluate feet for color, temperature, sensation
and pulses (Holt, 2014).
Keep the routine of the patient as constant as
possible and encourage the patient’s active
participation in activities of daily living
(ADLs) (Ren et al., 2014).
To observe neuropathy and peripheral
perfusion.
Help the patient to be in trace with the reality
thus maintain coordination within the
surroundings.
Evaluate the overall appearance of the patient
right foot (Orgin, Houghton & Thompson,
2015)
Wound infection related to foot lesions is
considered as the most common cause of
hospitalization in case of the patient suffering
with diabetes mellitus (DM). The feet of the
patient is accurately examined at every
appointment. The patient might be
unconscious of the wounds due to decreased
perception resulting from peripheral
neuropathy. Decreased apparition from

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diabetes mellitus may decline the capability to
examine the feet.
Safe nursing management:
The nurse needs to study the past medical history of the patient carefully to avoid any
kind of medication error and injury (Nigam & Knight, 2017). The main role of the nurse is to
provide Mrs. Bacci with the primary treatment that is required to cure her wound, which
occurred after her surgery and the impurity she has been witnessing also make sure that she
doesn’t skip or stop the administration of her medications until she is recommended to do so by
the surgeon and other healthcare facilities she is receiving treatment from. The management and
administration of diabetic foot ulcer is grounded on the philosophies of wound identification,
debridement and supervision of contagion, the practice of bandages in order to preserve a moist
environment that will upsurge the healing process and redistributing or offloading away the
pressure of the wound (Albikawi & Abuadas, 2015). American Diabetes Association (ADA) has
recommended certain protocols as the preventive approach to manage the prevalence of diabetic
foot ulcer that is effective care form multidisciplinary team (MDT). Multidisciplinary team
(MDT) will aim to reduce the rate of amputation, cost of treatment and prevention of any
complication. In case of the patient Mrs. Bacci, professional nurse were considered from the
members of multidisciplinary team and they were responsible for developing an effective nursing
care plan. The nurse will play various roles for effectively managing the patient that includes
(Azuma et al., 2014):
 Providing health care

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 Care connector
 Educator
 Consultant
 Leader
 Researcher
 Supporting the patient
The nurse will educate the patient with effective foot care plan, which will involve
prevention strategies of lower limb amputation and foot ulcers. It is very important for the patient
suffering from diabetes to be familiar and understand the basics of effective foot care. The nurse
will assists the patient on methods of physical examination and strategies to take care of the feet
(with ulcer) on a regular basis in order to prevent any recurrence. The strategies included in foot
care plan include inspecting the shoes in advance or before wearing, keeping the feet clean
including the skin and the nails of the foot (Yosuf et al., 2015). From the case examination it was
evident that the patient Mrs. Bacci used to forget to take medicines on time and also used to
think that it is not mandatory for her to take all her medicines, which was in a way worsening her
health condition. Hence, to overcome that issue it was very important for the nurse to educate the
patient with diabetic foot care education program that will state the health consequences of the
patient due to ulcer. The patient was already diagnosed from peripheral vascular disease that is
considered as a sole cause of foot ulcer in 80% of the diabetic population. The nurse should
encourage the family and the patient to continue the effective foot care plan with regular follow-
up (Lowe et al., 2015). Foot examination is conducted by the nurse to examine the patient’s feet
to screen for any high risk of ulcer. Another important responsibity of the nurse for effectively
managing the patient is selection of appropriate dressing of wound depending on the type of

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ulcer. An appropriate wound dressing will result in fast recovery as the wound will be moist,
clean and free from any contamination. Hence, the nurse should effectively evaluate and
examine the patient with proper management nursing plan (Eraydin & Avsar, 2018).
Conclusion:
The essay concludes that it was very important for the patient Mrs. Bacci, to take up the
effective nursing care in order to recover soon. The patient suffering from diabetes, occurrence
of foot ulcer is very common and any surgery during diabetic condition is a suffering process, as
the wounds take a lot of time and medication to heal as compared to a healthy person. Thus it is
important to follow proper measures to restore from such conditions. In this essay, a detail
insight was given on the pathophysiology of developing foot ulcer in a diabetic patient
underlying the causes of the wound. The patient was already diagnosed with peripheral vascular
disease and type 2 diabetes, which was in a way delaying the healing process of foot ulcer.
Effective nursing intervention was explained in this essay highlighting appropriate and safe
nursing management of the patient in order to recover from the condition as soon as possible.

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