Understanding Diabetic Foot Ulcers

The assignment delves into the complexities of diabetic foot ulcers, examining their underlying causes, potential complications for bones and tissues, and various treatment strategies. It emphasizes the importance of early detection, proper wound care, offloading interventions, and the role of patient education in managing this serious complication of diabetes.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

1NURSING
Answer 1
Toula Giannopoulos, a 56 year old female has been admitted to the surgical ward for
ongoing management of infected diabetic ulcer on her right foot. Before planning care plan for
Toula, the important nursing assessment that would be necessary for Toula would include:
 Conducting physical assessment and reviewing comprehensive health history of patients
 Physical examination of affected limbs in relation to location, classification of foot ulcer.
Length, depth and width of wound. The nurse will also assess exudates and odour of
wound
 Nursing assessment and documentation of pain in Toula by considering the pain history,
location, intensity and patient’s understanding of pain
 Assessment of ADLs (activities of daily living) in Toula by observing gait abnormality in
patients and ability to exercise (Alavi et al. 2014)
In response to pain assessment and assessment of ADL in Toula, the important nursing
intervention for Toula would be to provide non-weight bearing devices such as crutches or
wheelchairs to patient to reduce pain and reduce pressure in foot. This would facilitate healing
of diabetic foot ulcers (Bus et al. 2017). In addition, management and care of wound in the right
foot would also be essential to prevent infection and promote healing. The Enrolled nurse will
also play a critical role in educating Toula to prevent injury and take care of the diabetic foot.
Another important nursing intervention would be to provide appropriate medication to patient
to manage pain and promote recovery of wound (Dimitriadou and Lavdaniti, 2017).
Answer 2
The review of medical history of Toula has revealed that she suffered from uncontrolled
Type 2 Diabetes, hypertension and obesity. Uncontrolled diabetes is the main risk factor that
has contributed to the development of her diabetic foot ulcer. This is because uncontrolled
diabetes is one of the major risk factor for diabetic foot ulcer. About 10% people with diabetes
are likely to develop ulcer loose normal nerve functioning due to peripheral diabetic

2NURSING
neuropathy. Due to this condition, patients like Toula loose pain sensation in foot and they
cannot sense any damage to their foot in case of bruises or cuts (Strauss et al. 2016). Hence,
small cuts or bruises eventually develop into diabetic foot ulcers because blood flow to the feet
is restricted in diabetic patients and it has a negative impact on healing process.
Answer 3
Debridement is one of the treatment options for patients with diabetic foot ulcers to
prevent further complication and increase the pace of ulcer healing. After the process of
debridement in Toula, there are chances of many negative or positive implications in patient.
The first implication might be that ulcer healing process may enhance and patients might be
discharged early from hospital. However, there is also chance of acute infection in patient after
the debridement process due to poor hygiene standards in hospital setting. MRSA (Methillin-
resistant S. aureus) is often a causative agent in diabetic foot infections in hospitalized patient
because of contact with other patient with MRSA. The implication of MRSA infection is that the
characteristics of wound will change in patient and their discharged may be delayed (Edmonds
2009). Such infection will also create treatment challenges for clinicians. Toula also developed
MRSA infection after debridement evident from the assessment of wound swab. Hence, she
had to be hospitalized again to manage the infected diabetic ulcer.
Another implication of debridement is that debridement will have an impact on living
arrangement and ability to perform ADLs. The patient may lose normal capacity to mobilize and
they may require walking aid and other mobility devices to reduce pressure on foot. Toula
experienced mobility issues due to excessive pain in her right foot after MRSA infection post
debridement.
Answer 4.
Toula had a wound at her foot which had aggravated and formed ulcer. This can be
treated by the help of dressings. The dressings reduce the moist environment of the wound and
helps in curing the wound (Mills, Cowin, and Kaur 2013). Simple gauze is used along with the

3NURSING
hydrogels which is effective in drying the ulcers by holding the tissue and helps in dying of the
cells. The ability of absorption of the dressing must be according to the amount of the wound
which can reduce the maceration of the skin surrounding the wound. The purpose of the
dressing is assisting the process of the healing and preventing the bacterial proliferation. These
bacterial proliferations are generally harmful for the formation of the healthy tissue. Hence the
regular dressing is needed to cure the wound (Baltzis, Eleftheriadou, and Veves 2014).
Answer 5
Toula was prescribed with some of the medications such as:
Metformin – The dose prescribed to Toula is 1g BD (twice per day). It is used to control the high
level of sugar in blood. It is generally prescribed to the patients those who are having type-2
diabetes. This medicine controls the blood sugar and prevents the damage in kidney, reduces
risk of blindness, reduction in nerve problems, and sexual dysfunction. The most common side
effects of this medicine are diarrhea, abdominal discomfort, irregular breathing and many
more. The nurse must look after the patient (Potter et al. 2016).
Metoprolol – The dosage prescribed for Toula is 50mg BD. It is used for treating angina and
hypertension to prevent heart attack. The side effect of this medicine is shortness of the breath,
blurred vision, pain in chest irregular heart beat and many more. The nurse must take care of
the patient.
Panadeine forte – The dosage prescribed is 2 tablets PRN (as needed). It is used to treat, control
and prevent the fever, flu and various other pains. For toula it had been prescribed to reduce
the pain of the foot ulcer. The side effects of panadeine forte are nausea, vomiting,
constipation, dizziness, rashes, sweating and other symptoms as well. The nurse should take
care that the medicine does not cause any severe effects (Koutoukidis, Stainton, and Hughson
2016).
Endone – The dosage provided is 10 mg PRN. It is to relieve from moderate to severe pain. The
side effects of Endone are nausea and vomiting, dizziness, indigestion, hypotension and
confusion. As this medicine causes some problems so the nurse must be careful while giving the

4NURSING
medicine to Toula and must provide proper amount of medication so that she must not face
any problems that are been caused from the medication.
Benzyl penicillin – Dosage of Benzyl penicillin prescribed to Toula is 1.2g BD. It is used to treat
for most of the wound infections, infections of skin, tissue, nose, throat, respiratory tract and
many more. The side effects of this medicine are reactions in the injected site, mild rashes in
skin, vomiting, stomach upset and so on. The nurse generally used to inject the into the body,
so they must be careful and take care of the patient so that the infection.
Answer 6
After the detection of MRSA infection in Toula 7 days post debridement, there is a need
to provide range of treatment options to her. This includes the following:
 Firstly, Toula needs to be given appropriate medication for pain relief and infection
control. The Enrolled Nurse can provide appropriate pain medication to patient as
ordered by clinician. To treat MRSA infection in Toula, there is also a need to provided
antibiotics to patients such tetracycline drugs and Rifampin to cure skin and soft tissue
infection due to colonization of MRSA in wound site (Chen, Giurini and Karchmer 2016).
 Acute pain was one of the major problem in Toula as the physical assessment of pain in
Toula has revealed a pain score of 8/10. Her pain was found to worsen on movement
and she was not able to bear weight too. In such scenario, another treatment option for
Toula is pain management. To address the problem of weight bearing, one of the
possible solutions would be to provide pressure offloading intervention to Toula. Some
of the strategies for pressure offloading include proving bed rest, wheel chair half shoes,
therapeutics shoes or crutch-assisted gait to Toula. This will help in pressure
modulation, reducing pain and healing of plantar diabetic foot ulcers (Wu et al. 2008).
 Pain in patients after MRSA infection had affected her ability to mobilize. Hence, this
disability may affect her ability to perform ADLs. In such case, it would be necessary to
refer Toula to appropriate services that can help her in improving her gait pattern.

5NURSING
Complementary treatment like physiotherapy, exercise and shoe modification will be
essential to improve her gait pattern (Turan et al. 2015).
Answer 7
Toula can be referred to the following services following discharge from hospital:
 Physical therapy and rehabilitation service to improve mobility and quality of life.
Rehabilitation service will support Toula in preventing further complications and regular
assessment of foot. Physical therapy may also promote reducing debridement effect
and improving blood flow to the feet.
 Orthopedic service to detect chances of spreading of foot ulcer or its impact on bones
and other tissues (Turan et al. 2015).

6NURSING
Reference
Alavi, A., Sibbald, R.G., Mayer, D., Goodman, L., Botros, M., Armstrong, D.G., Woo, K., Boeni, T.,
Ayello, E.A. and Kirsner, R.S., 2014. Diabetic foot ulcers: part II. Management. Journal of the
American Academy of Dermatology, 70(1), pp.21-e1.
Baltzis, D., Eleftheriadou, I. and Veves, A., 2014. Pathogenesis and treatment of impaired
wound healing in diabetes mellitus: new insights. Advances in therapy, 31(8), pp.817-836.
Bus, S.A., Deursen, R.W., Armstrong, D.G., Lewis, J.E.A., Caravaggi, C.F. and Cavanagh, P.R.,
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(S1), pp.99-118.
Chen, S.Y., Giurini, J.M. and Karchmer, A.W., 2016. Invasive Systemic Infection Following
Hospital Treatment for Diabetic Foot Ulcer: Risk of Occurrence and Effect on Survival. Clinical
Infectious Diseases, p.ciw736.
Dimitriadou, A. and Lavdaniti, M., 2017. Foot Care Education for Diabetes Mellitus
Patients. Journal of Nursing Science, 3(1), pp.1-4.
Edmonds, M., 2009. The treatment of diabetic foot infections: focus on ertapenem. Vascular
health and risk management, 5, p.949.
Koutoukidis, G., Stainton, K. and Hughson, J., 2016. Tabbner's Nursing Care: theory and practice.
Elsevier Health Sciences.
Mills, S.J., Cowin, A.J. and Kaur, P., 2013. Pericytes, mesenchymal stem cells and the wound
healing process. Cells, 2(3), pp.621-634.
Potter, P.A., Perry, A.G., Stockert, P. and Hall, A., 2016. Fundamentals of Nursing-E-Book.
Elsevier Health Sciences.

7NURSING
Strauss, M.B., Moon, H., La, S., Craig, A., Ponce, J. and Miller, S., 2016. The Incidence of
Confounding Factors in Patients With Diabetes Mellitus Hospitalized for Diabetic Foot
Ulcers. Wounds: a compendium of clinical research and practice, 28(8), pp.287-294.
Turan, Y., Ertugrul, B.M., Lipsky, B.A. and Bayraktar, K., 2015. Does physical therapy and
rehabilitation improve outcomes for diabetic foot ulcers?. World journal of experimental
medicine, 5(2), p.130.
Wu, S.C., Jensen, J.L., Weber, A.K., Robinson, D.E. and Armstrong, D.G., 2008. Use of pressure
offloading devices in diabetic foot ulcers. Diabetes Care, 31(11), pp.2118-2119.