Nursing Assignment: Wound Management and Diabetes Mellitus

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

1NURSING ASSIGNMENT
Introduction:
While devising a nursing care for a patient, a number of factors have to be taken into
consideration. It should be noted in this regard that an effective nursing plan is governed by
the identification of proper care priorities. According to Levett-Jones (2018), the proper
identification of the care priorities and the application of appropriate nursing intervention
strategies help in promoting positive patient outcome. This paper intends to critically analyse
two clinical priorities for the patient Mrs. Gina Bacci who is a 49 year old, Italian lady who
has presented with the complaint of Diabetic foot ulcer. The clinical priorities would be
identified on the basis of the Levett Jones Clinical Reasoning Cycle. The patient problems
would be clearly identified and accordingly nursing goals would be set to acquire positive
patient outcome.
Response to Question 1:
According to the information provided by the case study it has been mentioned that
the patient’s wound site is located at the left foot and is cold to touch. Further, it has also
been mentioned that the capillary refill time is 2 to 3 seconds against the normal capillary
refill time being less than 2 seconds. Therefore, the high capillary refill time and the low
body temperature at the wound site indicates that there is a decreased flow of oxygen at the
wound site. This further indicates there is a decreased peripheral perfusion. Studies suggest
that a decreased rate of oxygenation and wound healing restricts the amount of blood flow at
the wound site (Amin & Doupis, 2016). As stated by Stoekenbroek et al. (2014), a decrease
in the blood flow at the wound site indicates a reduction in the infiltration rate of the blood
platelets as well as the blood plasma. Therefore, the process of the wound healing is delayed
due to the reduction in the infiltration rate of blood plasma as well as infiltrates. In addition to
this an increased oxidative stress on account of the extensive generation of reactive oxygen

2NURSING ASSIGNMENT
species (O3-) could be held accountable for enhancing the severity of the foot ulcer and this
would ultimately delay the process of wound healing (Stoekenbroek et al., 2014).
In addition to this the unmanaged TIIDM could be held accountable for the wound.
As can be deduced from the case study, it can be mentioned that the patient had been
suffering from Type II Diabetes for the past 6 years. In accordance to the patient objective
data it can be mentioned that the high BMI (40.4 m2) and high body weight (110 kg with the
height being 165 cm) at the age of 49 years and the high level of blood glucose level (12.6
mmol/L against the normal being 5.4 mmol/L) suggests that the patient’s Diabetes is
unmanaged. As mentioned by Tobe et al. (2013), high blood glucose level directly suggest
that the condition of TIID is unmanaged in a patient. The prescribed medication of the patient
includes daily dosage of Novorapid TDS and Lantus which are basically synthetic insulin
medication. Further, the unhealthy lifestyle habits of the patient could be held accountable for
triggering TIIDM. In addition to this, research studies mention that uncontrolled management
of Diabetes leads to problems such as the development of a Diabetic foot ulcer. Higher level
of blood glucose level for a long period of time has been studied to disrupt normal
neurotransmission functioning which subsequently leads to diabetic neuropathy which is also
known as Diabetic foot ulcer. (Byant et al., 2019)
Research studies indicate that higher blood glucose level affects the normal process of
fat disintegration (Bullock & Hales, 2019). The fatty acids or the triglycerides are directly
converted to low density lipo-protein and this LDL is deposited inside the arteries. The
accumulation of the LDL within the arteries leads to a condition of Arthrosclerosis (Bryant et
al., 2019). The condition causes the narrowing of the arteries and this delays the process of
wound healing. The delay in the wound healing process is critically indicated by the signs of
dehiscence near or adjacent to the suture lining with a presence of sloughy tissues.