Episode of Wound Infection

Running head: EPISODE OF WOUND INFECTION
EPISODE OF WOUND INFECTION
Name of the student:
Name of the university:
Author note:
Acknowledgement:
I would like to express my special thanks of gratitude towards my professor, unit head,
as well as our principal who helped throughout the development of this assignment. I would also
want to thank to my facilitator who helped me in gaining new knowledge and supported me
throughout my placement days.
Secondly, I would like to thank my parents as well as my friends who contributed in
finalizing this project within the limited period.

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EPISODE OF WOUND INFECTION
Introduction of the case:
Foot ulcers are one of the common complications that are faced by diabetic patients who
have unmanaged blood glucose level. Foot ulcers occur as a result of breaking of the skin
tissue and thereby exposing the layers underneath. They are usually common under the big
toes and the balls of the feet and can even affect to the range of bones (Yazdanpanah et al.,
2015). This assignment would be mainly based on caring for a patient named Martha who had
come to the ward with complaints of severely infected diabetic foot ulcer, seeking for support.
This assignment would mainly cover detailed data of the patient, pathophysiology and
inflammation of the wounds, nursing assessment and identification of the wounds. Nursing
diagnosis, interventions medicinal treatments and even clinical progress of Martha was also
covered in the assignment.
Status of the patient:
The patient is named Martha Samuels who is a female and is 65 years old. She lives
alone in her apartment and her immediate family members live in other cities. She is seen to
struggle with her diabetes management often forgetting her medications and not assessing her
blood glucose levels for long periods. She does not believe that any treatment can help her

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EPISODE OF WOUND INFECTION
overcome the issues and is quite hopeless because of her suffering for last twelve years. Her
parents were also diabetic. She had not gone through any surgeries in her entire life. She had
left her education midway and started working in a departmental store from young age. Her
education level was low with no health literacy about how to manage her diabetes. Currently,
she had visited the ward with the complaints of wounds in her feet not healing for many days
and worsening of its condition day by day. She was fearful of leg-amputation as she had heard
one of her friend whose fingers had to be amputed because of such infections.
Anatomy and physiology of the organ that affected the service user:
The foot is divided into three sections. The first part is the forefoot that includes toes,
phalanges and other 14 toe bones along with five metatarsals. They help in propulsions and
provide attachment to several tendons. The second part is the midfoot made up of five
irregularly shaped bones called tarsals. They help in forming the arch of the foot and help in
weight bearing. The third part is the hind-foot consisting of two large bones called talus and
calcaneus (Van Netten et al., 2016). Other parts are the muscles controlling the movements of
the foot, originate in lower legs, and attached to bones in the foot with tendons. Tensions and
ligaments help in smooth movement of the bones and joints helping in walking, balancing and
many others. Diabetic foot ulcer due to peripheral neuropathy occurs when the nerves in the
foot extremities become numb resulting in loss of feeling of sensation (Hinchliffe et al., 2016).
This lack of sensation reduces the awareness of the patients when the feet develop cuts,
blisters and sores. The skin tissues and muscles might be infected with germs resulting in
severe conditions. Similar has been found to have occurred with Martha.
Pathophysiology of the inflammation and infection to the wound:
Diabetic peripheral neuropathy can be described as the precipitating factor that is found
in almost about 90% of the diabetic foot ulcers. Studies opine that high blood glucose level
results in damaging of the nerves that often include sensory, motor and even autonomic nerves.
Even the condition also affects the immune system that results in impairment of the ability of the
body for fighting infection. Sensory nerves mainly help in enabling people to feel pain as well as
temperature and other sensations. When such nerves of a diabetic person gets affected, they
may no longer be able to feel the cold, pain in their feet (Skafjeld et al., 2015). Any cut or foot
sores as well as burn from hot water and even exposure to extreme cold might completely get
unnoticed by persons because of lack of sensation and numbness. The sore or the cut areas

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EPISODE OF WOUND INFECTION
can then become infected and might not heal properly because the impaired ability of the body
in fighting infection.
This condition also results in development of muscle weakness as well as loss of
reflexes mainly at the ankle region. This might cause various changes when the person walks
and lead to different types of foot abnormalities (Boulton, 2018). Similar such limping had been
noticed when Martha was asked to walk down in order to identify the pressure areas on her foot.
Studies are of the opinion that this plays an important role in the development of pathway of
diabetic foot ulcers because they result in contributing to abnormal pressures like that in the
plantar areas like heel and bottom predisposing it to ulceration. Often it has been seen that
shoes that no longer fits the new condition due to the abnormalities as well as deformed foot
ulcers the rates of the foot that are numb because of the sensory neuropathy. When such
conditions are not treated promptly, the ulcers are infected and spread to bone causing
osteomyelitis. However, Martha’s foot condition was not found to be such serious that surgery
was required as osteomyelitis had not occurred in her.
Inflammation is the first stage of wound healing procedure that mainly stops after
bleeding stops. It can be described as the procedure by which chemicals from the white blood
cells are released into the wound sites thereby causing symptoms like redness and warmth
(Bus et al., 2016). This action is important as inflammation helps in protection of the affected
areas in from harmful bacteria and viruses. Chemicals also cause leakage of the fluids causing
swelling and stimulation of the nerves that create pain that people feel during inflammation.
Studies opine that these are normal steps of wound healing. However, they also suggest that in
certain cases, inflammation may be excessive and this leads to many health complications with
excessive swelling, redness and other symptoms. In case if Martha, she complained that the
inflammation and swelling wee not reducing and the wounds were not healing at all.
Often many researchers have the query as to why diabetic ulcers cannot be healed
entirely. Proteases namely metalloprteinases cause degradiation of the extraclleular matrix so
that they can be remodelled into mature tissue with appropriate tensile strength. They help in
keratinocyte and fibroblast migration along with inflammation, tissue re-organisation and even
remodelling of the wounded tissue. Higher concentrations of pro-inflammatory cytokines in case
of diabetic foot ulcers cause the MMP activities to increase by 30 fold as in comparison to that
of acute wound healing (Rasmussen et al., 2015). MMP-9 and MMP -2 over-expression are the
main causes that result in non-healing of the wounds in diabetic foot ulcers balance in the ratio