Nursing Care Report: Managing Diabetic Foot Ulcer in Mrs. Gina Bacci

This report provides a comprehensive overview of the nursing care required for Mrs. Gina Bacci, a 49-year-old Italian woman with a history of Type II diabetes, peripheral vascular disease, and obesity, who underwent surgery for a diabetic foot ulcer. The report addresses the patient's current medications, including insulin, pregabalin, and paracetamol, and discusses the importance of medication adherence and patient education. It emphasizes the application of the Clinical Reasoning Cycle, encompassing assessment, diagnosis, planning, implementation, and evaluation, and highlights the need for proper wound care, diet, and exercise. The report also explores the role of home health monitoring, mental support, and various therapies, such as hyperbaric oxygen therapy, in promoting healing and preventing complications, ultimately focusing on improving the patient's quality of life.

Running head: NURSING CARE 1
Nursing Assignment
Student’s Name
Professor’s name
Institutional Affiliation
Date

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Question One
Various long-term medical complications are as a result of pre-existing diseases in the
patient’s body which might have been treated and failed to be destroyed by the body cells,
hence might lead in continuous surgery attempts some, leaving unhealed tissues or scars on
the body of the victim. These cases require not only proper surgery that encampuses
injections with continuous usage of medicinal drugs but also proper nursing skills as per the
renowned Clinical reasoning cycle which involves gathering clues, getting in terms with the
patient’s problem, looking for its solutions and learning from it henceforth as it will be
discussed below.
The patient, in this case, has undergone surgery as a result of foot ulcers which can be
established as a cause of previous diabetes infection (Hale, Vicks, LaSalvia, Giurini,
&Karchmer, 2018)Earlier on, the patient had been diagnosed with Diabetes II which is
usually in two forms; Cardiovascular &Liraglutide . The peripheral vascular disease, which
was found in her body may be as a result of large deposits of fats on the arteries (Treat-
Jacobson, McDermott, Bronas, Campia, Collins, Criqui). This resulted to low flow of blood
pressure interfering with the proper supply of blood this explains why she experiences low
levels of blood pressure that prevent the effective supply of food nutrients too that hinder
proper healing of the wounds (Dangardt, Charakida, Georgiopoulos, Chiesa, Rapala, Wade,
&Sattar, 2019). Her case of obesity can also be traced from the existence of diabetes earlier.
The obesity would be a result of under-nutrition or environmental factors (when young) that
continuously developed other mechanisms which may be carried along to adulthood
(Wadden, & Bray, 2018).
The cost of treatment on an outpatient, in this case, includes foot ulcer which tends to
be so expensive. The patients need quite a good sum of money for proper treatment which

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includes regular visits to the hospital and the purchasing of drugs too. According to some
reports brought forward earlier by the World Health Organisation (WHO) showed that a
certain population of these victims tend to lack enough weight on their pockets which may
hinder them from accessing proper if not best medical attention. Lack of good treatment, in
this case, might lead to an amputation: a double loss on the patient’s side, isn’t it? Patients
who receive an outdoor form of medical treatment due to foot ulcers tend to visit the hospital
approximately 14 times a year and may end up in hospital beds 1.5 times in a year (Edmonds,
Bodansky, Boulton, Chadwick, Dang, D’costa, & Serena, 2018).
Besides the proper allocation of medicinal drugs to foot ulcers patients, we need to
come in proper terms with the five stages of this diabetic disease. The five stages which
include (Biessels, &Despa, 2018):
 Normal foot
 High-risk foot
 Ulcerated foot
 Necrotic foot
In our case of study, the patient has been given proper medicinal drugs as per the doctor’s
view.
1. Novo Rapid TDS – This is insulin contents which act so fast lowering sugar level in
less than 10 minutes with an aftermath effect of 3 and at most 5 hours. The insulin
type present in it is calledan aspart.
2. Lantus – less effective compared to Novo Rapid TDS; with 3.6milligrams of insulin
glargine.

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3. Pregabalin- this lowers the degree of pain conveyed by the nerves destroyed inside the
body. As seen in various diabetic reports, the diabetic foot ulcers tend to cause
wearing out of the body nerves resulting in severe pain in the body of an individual.
4. Paracetamol - this generally acts as a pain reliever that reduces pain in a maximum of
4 hours.
Mrs. Gina Bacci needs to make sure she completes her medications to lower the severity
of the diseases enclosed with foot ulcers, to ensure proper healing of her wounds too. The
normal blood pressure (120/80mmHg) could be achieved through continuous assessment of
the patient to ensure improvement with subsequent hospital follow-ups. Her stability will be
slightly adjusted to the normal state with continuous exercise but not excessive exercise that
would lead to extra straining of her nerves, and this would at some point cause pain on her
body. The care on dehiscent wounds could be propagated by the patient avoiding so much
contact with watery surfaces. Also, Mrs. Bacci should avoid exposing her wounds to
excessive sunlight, too she should ensure that she keeps herself just warm enough to prevent
the cold which will utterly lead to the pain of her nerves inside the body, this especially
mostly during the morning.
Question two
Mrs. Gina Bacci needs to receive proper nursing skills in this study case since the patient
has been visiting the hospital(s) for an approximate period of 6 years. We all know that it’s
not quite easy to battle with a certain infection for so long as it will at most cases tend to
hinder us from performing our daily activities. Such might even result in low self-esteem and
isolation in such a case as obesity in some environs ‘fat’ people are even looked down upon.
Based on my research, the appropriate nursing techniques for Mrs. Bacci includes as
discussed below.

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The patient needs to have proper knowledge about her disease and the medications she is
being given by the party responsible. Her lack of proper understanding in English might be
her hindrance to keeping up with the drugs policy we allocated to her. With a proper
understanding on the importance of each drug prescribed for her, she will have quite a
positive mindset: making sure that she takes her dosage at the right amount and time as
clearly prescribed by the doctor. Mrs. Bacci needs to be given awareness of how she can be
able to offset her level of blood pressure when it rises or drops at a certain point; she can
achieve this by being given additional medicinal drugs (a-just-in-case). I’d propose additional
drugs like Thiazide diuretics (prevents oedema) or Calcium channel blockers (lowers blood
sugar level through preventing entry of calcium into the heart cells and blood levels).
Mrs. Gina Bacci needs to have a well-balanced diet and some little exercise which would
assist her physical fitness. This can be achieved by regular contact with the patient reminding
her of what she needs to eat. Also, a food timetable can be put in place for her depending on
the depth of her pockets too, but she will need to amerce quite an amount of paper when it
comes to picking out her diet. For better healing of her wounds, Mrs. Gina Bacci will need
some eggs, milk, beans, poultry meat and cheese which are mostly available in the state.
The patient in this study case will show signs of improvement if she adheres and
collaborates with the nursing period. She will automatically adapt to her new diet (if given by
the nurse). In most cases, patients tend to stop using their medicinal drugs when the effects
are so severe. But when the drugs do not react as expected, the patient will need to contact the
nurse or doctor for further advice.
Question three
As per the Medical Clinical Recycling Cycle, it is well affirmed that the recovery process
is essential and boosted with the Nurse’s proper knowledge on how to go about the ailing

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condition (Croft, Gilligan, Rasiah, Levett-Jones, & Schneider, 2018). The safety monitoring
system study ensures that the patient’s health is well taken care of. Having come into terms
with what is going on in the patient’s healthy life, coming up with solutions to the problem
the patient faces is key here. Also, the Home health monitoring system can be applied in this
case; Home Health monitoring system is where a patient can sit at home and covey the health
changes such as blood pressure electronically to the doctor.
Good communication between the patient and me is very important. There will be enough
freedom for the patient to relay whatever health changes she undergoes. As a nurse, I’m
supposed to ensure that Mrs. Bacci feels free and accept her condition for the rest of the years
to come. Mental support is a key aspect in ensuring faster healing of the patient (Simpson,
Oster, & Muir‐Cochrane, 2018). Enough time must be set aside for the patient and the nurse
to facilitate bonding of the two parties.
Proper therapy is required for the patient for her to get her stability back which will aid in
the healing of her wounds too (Yamada, Shojima, Noma, Yamauchi, &Kadowaki, 2018). In
this case, hyperbaric oxygen therapy is considered the best form of therapy. Hyperbaric
oxygen therapy reduces the chances of the patient having an amputation, it also fastens the
closure of wounds and shortens the healing period to barely six weeks (Thistlethwaite,
Finlayson, Cooper, Brown, Bennett, Edwards, 2018). The Australian state provides laws on
how therapy should be incorporated for the recovery of a certain patient.(Kalra, Czupryniak,
Kilov, Lamptey, Kumar, Unnikrishnan, &Araz, 2018).
Proper diet is essential in the healing process of Mrs. Bacci. In this case, vitamin A will
be very useful. Vitamin A contains High fibre and is contained mostly in legumes,
vegetables, and fruits. Fibre is also responsible for the repair of worn out tissues. The patient
also requires green tea which is the most used variety of tea in the world (Suzuki, Y.,

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Miyoshi, N., &Isemura, M.2012) which is a booster in a diabetes treatement(Yang, Wang, &
Sheridan, 2018). Diet should also be complemented with some form of exercise. These
exercises are also therapeutic tools and should be conducted under the guidance of a well-
trained therapist or the nurse spearheading the healing process of the patient. Obesity could
also be reduced by eating just the right amount of food and avoiding meals with more fat
content. This will help reduce the extraordinary form of growth exhibited by the body hence
minimal cases of blood pressure since there will be adequate blood movement in the body
systems,
From well-affirmed knowledge based on the knowledge of the clinical reasoning cycle, it
can be concluded with no doubt that the patients healing process is squarely based on the
interaction between the patient and them. Literally, the patient needs a maximum time of
bonding and understanding with the nurses. Also, patients ought to complete all their
medications as described by the doctors at the specified amount and time. Keeping intouch
regularly with my client in order to be well versed with any slight change of health, negative
signs in most cases. Hospitals should also work hand in hand with the government to ensure
that proper equipment is brought to the premises at the right amount and time to avoid cases
of a patient succumbing, mostly in some quite remote areas. The patients should also ensure
proper communication with their nurses and doctors about their medical progress. A proper
diet is essential in the healing process.

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References
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Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot UlcerJournal of
the American Podiatric Medical Association, 108(6), 528-531.
Treat-Jacobson, D., McDermott, M. M., Bronas, U. G., Campia, U., Collins, T. C., Criqui, M.
H., ... & American Heart Association Council on Peripheral Vascular Disease
Circulation, 139(4), e10-e33.
Dangardt, F., Charakida, M., Georgiopoulos, G., Chiesa, S., Rapala, A., Wade, K., ...&Sattar,
N. (2019). Association between fat mass through adolescence and arterial stiffness.
The Lancet Child and Adolescent Health.
Wadden, T. A., & Bray, G. A. (Eds.). (2018). Handbook of obesity treatment. Guilford
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Edmonds, M. E., Bodansky, H. J., Boulton, A. J., Chadwick, P. J., Dang, C. N., D'costa,
R., ... & Serena, T. E. (2018). Multicenter, randomized controlled, observer‐blinded
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Wound Repair and Regeneration.
Biessels, G. J., &Despa, F. (2018). Cognitive decline and dementia in diabetes mellitus.
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