Diabetic Foot Ulcer: Pathophysiology, Nursing Care, and 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 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.