Nursing Assessment and Interventions for Leg Ulcer and Type 1 Diabetes Mellitus

This article discusses the nursing assessment and interventions for a patient suffering from leg ulcer and type 1 diabetes mellitus. It covers the health assessment framework used, the problems identified, and the interventions that can be implemented. The article also highlights the importance of accurate and complete assessment before making a final clinical decision.

Running head: NURSING
NURSING
Name of the Student:
Name of the University:
Author Note:

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The patient here is Mr. Trevor Wilkins, who is a 37 years old male who is being
attended by a registered nurse, Jess for his leg ulcer. His leg ulcer has not been healing. While
he was intoxicated, the patient suffered a fall. The past clinical history of the patient shows
that he has been suffering from type 1 diabetes mellitus. He is a social drinker. There is also
no record of any drug allergies that is known. On examination of the vitals of the patient, the
results were as followed: HR 112, BP 98/58, RR 18, T 37.6, SpO2 99%. The weight was
97kg. The height of the patient was 167cm and the Blood Glucose Level was 13.6mmol/L.
The patient is comfortable with doing the activities of daily life independently. On
examination the registered nurse found out that his wound area had turned red and there was
slight odour in the wounded area. Mr. Wilkins lacked family support since he had no close
family or friends.
For this case, the health assessment framework used is the National Clinical
Assessment Framework (Attard, Baldacchino & Camilleri, 2014). The framework comprises
of the following aspects which are as follows:
Areas Aspects of performance
Preliminary health check HR 112, BP 98/58, RR 18, T 37.6, SpO2
99%. The weight was 97kg. The height of
the patient was 167cm and the Blood
Glucose Level was 13.6mmol/L
Comprehensive health and
developmental assessment
The wound area of the patient had turned
red and there was slight odour in the
wounded area.
It was perceived that Mr. Wilkins lacked

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family support since he had no close family
or friends.
His past clinical history of the patient shows
that he has been suffering from type 1
diabetes mellitus.
Ongoing, age appropriate assessments
and health monitoring
The patient is comfortable with doing the
activities of daily life independently.
However he needed care from the registered
nurse regarding his leg ulcer, which had not
been healing from a long time.
In accordance to this framework the normal finding were that that patient was
independent enough to perform his activities of daily life. His vitals were also under control.
However he was a little obese as perceive by his body mass index. The abnormal findings
were that he was diabetic as shown by his blood glucose level results. His leg ulcer had not
been healing now for a long time. Additionally his wound area has now turned red and there
was odour discharging from the area. He lacked any emotional support from his family and
friends hence had no support.
Part B
After the registered nurse conducted a focussed assessment on the patient, she
identified several problems that were evident with the patient. One of the major problems was

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the leg ulcer which was not healing in spite of the ongoing treatment, additionally the wound
area was becoming red and odour was discharged from the area. The next problem was his
medical history of type 1 diabetes mellitus. Finally he suffered from social isolation as he
lacked ant support from close family or friends.
The open ended questions that were asked to the patient are as follows:
For leg ulcer:
When was the first signs and symptoms of the ulcer occur?
What do you think caused the ulcer?
How long have you been on medication for this problem?
For type 1 diabetes mellitus:
How long have you been suffering from the disease?
When was the first signs and symptoms of diabetes occur?
What medication are you right now in order to control the type 1 diabetes mellitus?
Social isolation
Do you have any immediate family?
If yes, where are they?
What has made you distant from your family and friends?
In order to assess leg ulcers, the following interventions might be implemented:
 Taking the full medical history of the patient
 Enquiring about the lifestyle of the patient
 Observe the leg and skin appearance

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 The peripheral pulses needs to be detected. Certain assessment needs to be carried out
in terms of ABI, pain, typical location of the wound, appearance of the wound bed,
shape of the wound and its depth, the exudates of the wound and finally the peri-
wound appearance.
 In orde to detect and understand the type 1 diabetes mellitus on a patient completely,
certain diagnostic tests needs to be performed. These includes the Glycated
hemoglobin (A1C) test, along with random blood sugar test and the fasting blood
sugar test. The Glycated hemoglobin (A1C) test is useful in indicating the average
level of the blood sugar. It detects the percentage of the attached blood sugar to the
haemoglobin. In case the A1C level is 6.5 percent or higher then it indicates presence
of diabetes. In case of fasting blood sugar level, if it is less than 100 mg/dL (5.6
mmol/L) the results are normal. If the fasting blood sugar level from 100 to 125
mg/dL (5.6 to 6.9 mmol/L) then it is considered as prediabetes. Finally if it's 126
mg/dL (7 mmol/L), then the patient is confirmed having diabetes (Tallis et al., 2013).
 In order to detect loneliness, the CEL's 2015 guidance can be used. This comprises of
three 3-question scale in addition to the Giervald 6-question scale along with the
UCLA 3-question scale and single-item scales. In case of social isolation, Duke Social
Support Index (DSSI) can be used along with Lubben Social Network Scale (LSNS).
The Social Disconnectedness can also be implemented in this case (Weber & Kelley,
2013).
Part C
With the increase of acuteness of the condition of a patient, it becomes very important
for the nurses to prioritise the care of the patients. The assessments conducted by the nurses
needs to be built on a priority based setting that will highlight the skills of the qualifying
nurses. Observation conducted by the nurses on the patients aim to monitor the progress of

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the patients and to ensure the rapid detection of the evens that might have an adverse effect
on the recovery of the conditions of the patients. In the context of nursing triage, it is
perceived that the nurses assesse the patients initially and the priority of the order is involved
in which they are perceived by the clinical staff. According to the guidelines provided by the
Australian Commission on Quality and Safety in health care, 2012 and the Nursing and
Midwifery board of Australia, 2016, it is expected that the nurses should be effectively
proactive while undertaking medical assessment (Rooke, 2014). It is the job role of the
nurses to ensure that the initial examination is being carried out accurately. This is true
especially in cases of wounds where the nurses have to properly examine the wound and
decide which type of dressing is required for the particular wound. The nurses are also pivotal
while carrying out the fall assessments. There is a requirement of proper physical assessment
along with the development tissues and training which needs to the addressed appropriately.
In case of respiratory assessments, there is a scope of the nurses to expand their practise.
Basic assessments are required which needs to be conducted appropriately (.Kleinpell, 2013)
While the nurses conduct health assessments on an individual, there is a requirement
for significant knowledge and data collection techniques that might be subjective as well as
objective data. It includes the facts the patients say about themselves along with data
collected from the physical assessments and inspection of the conditions along with
percussion and palpation occurring during the examination. It is evident from literature that if
the data collected through these assessments are incorrect it might lead to wrong diagnosis
which in turn might end up with wrong treatment of the patient. The guidelines of the
Nursing and Midwifery Council (NMC) (2002), urges all nurses involved in medical
assessments to play their job role in a professional manner (Kitson et al., 2013). They should
abide by the policies that is set out by the organization they work in. This should be followed
in accordance to the Code of Professional Conduct. Additionally the code of conduct suggests

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that the nurses should be involved in proper recording and documentation of the information
that is acquired through the assessment of the patients. Inn case of any deviation from the
actual results, there might be potential consequences. According to the guidelines, the health
assessment should follow the purpose of making a call of judgement or diagnosis since most
of the decisions are based on the data that are collected during assessment. It is important that
there is accurate and complete assessment conducted before making a final clinical decision
(Hemingway et al., 2013). The assessments should focus on the needs of the patients at the
time of examination. The assessment should be accurate and fair in terms of the individual
and the life of the individual. The aim of overall assessment should be to delve deeper into
the patient’s illness and preventing more problems from arising.
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