Evidence-Based Care on Diabetic Foot Ulcers

Evidence-Based Care on Diabetic Foot Ulcers
University
Name
Tutor
Date

2
Diabetic Foot Ulcer
Introduction
A diabetic foot ulcer is a serious disease characterized by ulceration associated with
neuropathy and peripheral artery disease of the lower limb among patients with diabetes. The
prevalence of diabetic foot ranges between 4%-10% among diabetic patients, with adverse
effects being observed among the elderly. About 5% of the diabetic patients with a history of
diabetic foot with ulceration while the overall life risks of complication development are
about 15%. Studies have estimated that 60%-80% of foot ulcers heal while 10-15% remains
activated and 5%-24% most likely progresses for limb amputation within 6-18 months after
initial evaluation (Lauterbach, Kostev & Kohlmann, 2010).
The occurrence of neuropathic wounds are highly likely to heal after 20 weeks, while
ulcers related to neuro ischemic often take the long and more likely lead to amputation
(Moxey et al., 2011)
Diabetic foot ulcers are currently responsible for more hospitalizations compared to
other diabetic complications. The risks associated with the ulceration of the foot ulceration
and amputation of limb increases with age. Ulcers foot prevention is evident, in view of
consideration of the harmful impact on the patient’s life quality and underlying economic
consequences on the health care system. It is a public health concern and its nursing often
involve a multidisciplinary team (Prompers et al., 2008).
Case study
This report is based on a case study involving 80 years old patient, with history of
diabetes type 2 NIDDM under regular drug management. The patient was admitted with
bilateral diabetic foot, with foul smell meaning from the right foot and previous history of
auto amputation of the 3rd toes as a result of gangrene. Examination reveals that the patient is
restless with pulse rate of 100/minute, temperature 37 degrees Celsius, BP of 130/85. Local
examination indicates gangrene of heel and auto amputation of the 3rd toes. The patient blood
sugar level ranges between fasting of 150mg% to 170mg%. The patient has prio amputation
history of amputation on the lower knee side. Further, stump reshaping was performed after
development of flap necrosis.

3
Patient assessment
Patient assessment of the general signs of toxicity is necessary. Occurrences of
symptoms of sepsis are essential for active disease. Observation focuses on the fungal
infection, skin fissures, and deformity on the nails. Feeling of the temperature on the foot is
key in assessing patient temperature change. Cold temperature status reflects ischemia while
increased warmth-ness reflects redness and swelling suggesting the presence of acute
cellulitis presence (Miller et al., 2014).
Coupled with foot associated assessment on the patients, medical history data is often
considered. The condition of comorbid physiologic conditions and the contributing factors
are assessed. Some of the patient’s assessment includes diabetes mellitus, metabolic
disorders, deformity history, nutritional stage, renal disease, and autoimmune disorders.
Further, this patient has prior non-traumatic amputations thus is at a greater risk of
continuous amputation. Thus getting the patient history of surgical correction, previous
amputations, the presence of vascular surgery are often taken into considerations.
Patient history assessment is thus crucial in assessing the medical comorbidities,
previous history of complications and blood glucose levels. Obtaining glucose levels on the
patient is crucial in proving the primary clinical assessment of the general glycemia control of
the patient (Giovinco & Miler, 2015). Comorbidities needed urgent attention for the patient
includes hypertension, hyperlipidemia, peripheral vascular disease, visual impairment and
diabetic neuropathy (Miller et al., 2014).
Further subjective symptoms of the patients need to be addressed which indicate the
risks factors of any presence of peripheral neuropathy. These symptoms are further included
in the subjective assessments such as tingling, shooting pain, burning, and numbness which
causes concerns for peripheral neuropathy or intermittent symptoms.
Wound assessment
Physical assessment of diabetic foot ulcers on the skin type of musculoskeletal,
vascular, neurological systems and. Examination perfume don the dermatology often includes
inspection visually on skins of the feet and legs especially the lower sides (Tseng et al.,
2011). Notable observations entail skin peeling and skin maceration. The physical assessment