Nursing Case Study: Pathophysiology, Nursing Priorities, and Management

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the Student:
Name of the University:
Author note:

1NURSING CASE STUDY
Introduction
Using the processes outlined in the Clinical Reasoning Cycle (CRC), the first section of
this paper will attempt to explore the pathophysiology of the underlying pathogenic condition of
the patient, the second section will highlight two nursing priorities, primarily: Management of
post amputation diabetic foot complications and enhancement of patient mobility, whereas the
third section of the paper will aim to outline nursing management in terms of this diagnosis
(Levett-Jones, Courtney-Pratt & Govind, 2019).
Question 1
Taking insights from the case study, it can be implicated that the underlying
pathophysiology of Mrs. Bacci’s post operative foot status can be associated with detrimental
metabolic processes of diabetic neuropathy, delayed wound healing in diabetes and peripheral
vascular disease (Armstrong, Boulton & Bus, 2017). Such disease associations can be attributed
via consideration of the patient situation as per the CRC where it is evident that the patient has
presented with a medical history of uncontrolled type 2 diabetes mellitus and peripheral vascular
disease (PVD). The associations between the patient’s current foot status and the pathologies
underlying the above mentioned disease conditions can be attributed to the nursing processes of
collecting cues of the patient. The process of cue collection underlying the CRC is associated
with obtaining relevant patient details such as disease history and essential blood reports (Levett-
Jones, Courtney-Pratt & Govind, 2019). Likewise, symptoms of cold feet and high blood glucose
levels evident in the patient establish the link between post amputation complications and
diabetes. Additional collection of lipid profiles and angiogram results may also establish links
between PVD and foot amputation complications (Barshes et al., 2016).

2NURSING CASE STUDY
Upon collection of the required cues, the associations between patient condition and
disease pathologies will further be evaluated by processing acquired knowledge, previous
experience and enhanced evidenced based health literacy by the nurse, as per the CRC (Levett-
Jones, Courtney-Pratt & Govind, 2019). Uncontrolled diabetes associated with excessively high
blood glucose levels, evident in the reports of Mrs. Bacci, are a key causative factor underlying
the emergence of exudate secretion, dehiscence and infectious necrotized tissue proliferation post
amputation (Volmer-Thole & Lobmann, 2016). Type 2 diabetes mellitus is associated with loss
of efficiency in insulin functioning resulting in decreased glucose metabolism, increased levels
of endothelial blood glucose circulation and resultant lipid metabolism leading to hindered
lipogenesis and enhanced adiposity. Lack of timely mitigation results in uncontrolled
aggravation of diabetic symptoms such as neuropathy and delayed wound healing, which persist
despite foot amputation (Bandyk, 2019). It is worthwhile to remember that neural and vascular
functioning are closely interrelated. While appropriate nerve impulse transmission is a key
determining factor underlying healthy endothelial functioning, the nervous system is also
dependent upon the circulatory system for adequate functioning. High levels of circulating
glucose within the blood vessels results in the endothelial constriction, blood vessel narrowing
further aggravating to thickening of the capillary basement membrane and hyperplasia of
endothelial cells (Hicks et al., 2016). This results in loss of adequate blood circulation, reduced
oxygen saturated and an emergence of hypoxia which further hinder loss of neuronal functioning
and the emergence of temperature loss, decreased pain perception to damage as evident in the
cold feet of Mrs. Bacci and her inability to recognize her post amputation status until nursing
identification (Noor, Khan & Ahmad, 2017). Additional, it must be considered that high blood
glucose levels are associated with loss of immunological functioning exerted by leukocytes -

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essential physiological drivers of tissue repair and infection prevention - which are processes
further critical to wound healing. This is can be attributed to the high blood sugar levels of the
patient and the resultant infectious symptoms associated with post the amputation of her foot.
The interlinked loss of hyperglycemia induced vasoconstriction further results in the decreased
circulation of essential oxygen and nutrients to the affected tissue which additionally contribute
to the emergence of post amputation complications and stump tissue necrosis in the patient
(Ibrahim, 2018).
An additional disease pathology which can be attributed to the complications associated
with the patient’s foot is the prevalence of PVD in the patient. Peripheral vascular disease is
characterized by the occurrence of atherosclerotic adipose tissue deposits in the blood vessels
lined in the lower limbs of the patient (de Franciscis et al., 2015). Such increased prevalence of
peripheral endothelial adiposity results in the trigger of macrocyte induced phagocytic
functioning resulting in adipose oxidation, calcium based fibrous tissue formation and possible
thrombus emergence, endothelial narrowing, hindered blood circulation and the repeated
continuum of hypoxia, inflammation and delayed healing of wounds as mentioned previously
(Malyar et al., 2016). Further, PVD induced thrombus formation particular in arterial access
endothelium points may induce possibilities of ischemia which is characterized by warming,
redness, tenderness, purple discoloration and tissue necrosis due to poor circulation in the
surrounding wound tissues - which have observed evidently in the patient (Brownrigg, Schaper
& Hinchliffe, 2015).