Principal of Surgical Nursing - Acute Care Nursing

This article discusses the pathophysiology of diabetic foot ulcers and the nursing interventions and management strategies for their treatment. It also provides information on the case study of a patient with diabetic foot ulcer. Find study material and solved assignments on Desklib.

Running head: PRINCIPAL OF SURGICAL NURSING- ACUTE CARE NURSING
Principal of surgical nursing- Acute care nursing
Name of the student:
Name of the university:
Author note:

1Principal of surgical nursing-Acute care nursing
Introduction:
Mrs Gina Bacci., who is a 49 year old Italian lady. She has been suffering from multiple
disorders such as peripheral vascular disease, diabetic neuropathy and obesity. She underwent a
surgery for partial amputation of the fore foot and the first and great toes. The surgery went
under anesthesia. This report will focus on the case study of Mrs Gina Bacci. Due to the high
glucose level in the body, she has been suffering from foot ulcer (Schreiber et al., 2015). In this
report the pathophysiology of the wound is discussed and the risk factor involved in the wound
formation. Along with that, nursing intervention used in the case of diabetic foot ulcer is
explained and the nursing management strategy is also explained.
Patient’s situation consideration:
Mrs Gina Bacci, who is an Italian lady of 49 years old. From the last 6 years she has been
suffering from type 2 diabetes; her body glucose level is (12.6 mmol/l). She is unable to speak
English properly. Two weeks ago she reported that she has been facing pain due to the formation
of ulcer in her right food. She has ah past, medical history of type 2 diabetes and along with that
she has also been suffering from peripheral vascular disorder in which the arteries narrow down.
Recently, she has undergone a surgery for the partial amputation of the forefoot and on the great
and first toes of the foot. Her body glucose level is very high (12.6mmol/l) as compared with the
normal body glucose level (5.56 -6.69 mmol/l).she has been walking with the help of walking aid
(stick) and an offloading boot. Her respiratory rate is normal (18bbm) and her Sp02 is also
normal (97%). She is also obese with body mass index of 40.4m2 and her body weight is 110 kg.
Her feet and right toes are cold to touch. She has been prescribed with Novorapid TDS 12 units,
Lantus 30 units notce, Pregablin 75 mg mane and Paracetamol 1g QID. She has an open wound

2Principal of surgical nursing-Acute care nursing
on her right foot, which is warm and pain to touch (Javed, Alam & Malik, 2015). The wound in
the right foot has dehiscence associated along the suture line with some sloughy tissue. There is a
continuous discharge from the wound.
Pathophysiology of the diabetic foot ulcer:
Wounds and ulcer are common in the case of diabetic patient. Around 8% of the total
diabetic patient have foot ulcer and 1.8% have been suffering from amputation (Armstrong,
Boulton & Bus, 2017). The prevalence rate of the foot ulcer in diabetic patient is increasing day
by day. Foot ulcer is commonly observed in the patient suffering from peripheral vascular
disease. In patient suffering from diabetic neuropathy, the nerve damages due to the high blood
glucose level. In such cases, nerve damage is a long term impact which can lead to painless
ulcers (Noor, Zubair & Ahmad, 2015). Due to the nerve damage, the sensitivity of the nerve
responsible for pain transmission is reduced. Hence the brain is not able to determine the
rigorousness of the open wound. Due to which a small wound becomes a severe ulcers. The
formed ulcer is painless and in case of diabetic patient, the ulcers and wound are not healed
easily.
Cause of the patient’s post operative wound status:
After the operation, the wound or the foot ulcer is formed. It discharges continuously.
There is an island film dressing done along the incisional wound. The wound has dehiscence,
which is associated along the suture line which has some sloughy tissue. As in the case of patient
suffering from diabetic neuropathy, the brain is not able to detect the chronic nature of the
wound and hence does not transmit any response, due to which the wound is not healed properly
(Balcıoğlu & Müderrisoğlu, 2015). The patient is also suffering from peripheral vascular

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disorder, which is also one of the main reasons for foot ulcer. In case of patient suffering from
peripheral vascular disorder, the arteries starts narrowing which reduces the blood flow into the
body, hence the blood cannot reach to the feet which making it more difficult to heal and making
it more severe. Wearing offload boot is also one of the reasons for having foot ulcer in patient
suffering from diabetic neuropathy and peripheral vascular disorder (Gilron, Baron & Jensen,
2015, April).
Nursing intervention:
In case of patient suffering from diabetic neuropathy and peripheral vascular disorder, the
foot ulcer is very common and needs adequate nursing intervention on order to get the wound
healed as soon as possible.
Intervention Justification Rationale
Engaging in physical exercise
such as, aerobic exercise
(Karami et al., 2018).
In case of Mrs bacci, she has
been suffering from diabetes,
peripheral vascular disorder
and obesity. Hence, physical
exercise helps in minimizing
the severity of the ulcer
((Munshi et al., 2016).
In case of diabetic patient,
engagement in physical
activity helps in managing the
blood glucose level which is
considered as one of the main
hurdles for the wound healing
(Munshi et al., 2016).
As the patient is also suffering
from obesity, hence
engagement in physical
exercise such as, aerobic

4Principal of surgical nursing-Acute care nursing
exercise helps in lowering the
body mass index.
Peripheral vascular (Karami et
al., 2018).
In case of Mrs bacci, she is
also suffering from peripheral
vascular disease which is
caused due to the intake of
high cholesterol diet, high
blood glucose level and
obesity. This PVD is also
hiders the healing procedure
of the wound as due to
narrowing of the arteries,
blood is not able to reach to
the feet. Hence in such cases,
physical exercise such as
running, swimming also helps
treatment of PVD which
eventually help in wound
treatment (Marques et al.,
2017).
Treatment of wound (Marques Wound can be treated buy As in the case of Mrs Bacci,

5Principal of surgical nursing-Acute care nursing
et al., 2017). reliving the extra pressure
By using hydrogel for dressing
Avid standing for long time
(Van Netten et al., 2016).
she has been wearing offload
boot which might be one of
the reason for the wound.
Hence it should be removed
and she mist advised to wear
slippers instead of heavy
boots. Removing the excess
weight or pressure help in
quick healing of the wound
(Van Netten et al., 2016).
Gina Bacci is an obese hence,
it also exerts extra pressure on
the feet due to which the
wound does not get healed
easily (Marques et al., 2017).
As stated Gina Bacci is
overweight with a body mass
index of 42.4m2 and weight of
110 kg, hence if she stands on
place for a longer time it
creates pressure in the feet
which disrupts the ulcer
healing process. Hence,

6Principal of surgical nursing-Acute care nursing
standing for long time at
single place should be avoided
(Najafi, Patel, & Armstrong,
2018).
As the discharge is coming out
continuously from the wound.
It is required to use hydrogel
at the time of dressing.
Hydrogel hydrates the wound
and assists in quick healing of
the foot ulcer (Saco et al.,
2016).
Nursing management strategy:
Nursing management strategy is beneficial in the effective treatment of chronic and
severe disease. It is formulated by considering the past, medical history. Current health situation
and also the risk for that are involved in any future complication. It is formulated with the help of
multiple disciplinary team such also, physician, dietician, physiotherapist and consultant. Before
designing the nursing management strategy, registered nurse standard for practice are considered
so that patient gets all the benefits and should recover easily. Register nurse standard for practice
states that, a nurse should engage in therapeutic relationship with the patient (Nagle et al., 2017).
In this case the patient is not able to speak English properly which can become hurdle ion the

7Principal of surgical nursing-Acute care nursing
formulation of nursing management strategy. Hence it is required to involve her family in
designing the management strategy for better results.
Even though she has been suffering from multiple diseases, she sometimes does not take
her, medications as according to her perception she does not need nay medication. Hence in such
cases’ it is required to educate the patient about the importance of medications and also the
consequences if the medication is not taken regularly as prescribed by the physician (Najafi,
Patel, & Armstrong, 2018). To ensure that she does not miss any of her prescribed medicine her
family should also be aware about consequences of not taking medication.
As her main concern is the diabetic foot ulcer it should be treated properly by the help of
nursing intervention. To treat diabetic foot ulcer the risks factor and the factor which are further
deteriorating the ulcer or becoming hurdles in the process of ulcer healing is should be managed.
Gina Bacci is suffering from obesity hence; diet should be formulated with the help of dietician
which contains low cholesterol. For peripheral neuropathy also, the patient is suggested to take
low cholesterol diet (Nagle et al., 2017). As the body glucose level of Gina Bacci is much higher
than that of the normal BGL level. Hence diet containing, low sugar is suggested by the
dietician,
Wearing offloading boots and heavy shoes is also responsible for the foot ulcer. So the
patient is suggested to wear slippers instead of heavy boots. Apart from avoiding heavy shoes,
hydrogel is used for dressing which helps in the quick recovery of the patient. Dressing of the
wound is done regularly to avoid further deterioration (Pop-Busui et al., 2017).
Apart from all these, physical exercise such as aerobic exercise and running assists in the
management of the body glucose level. In addition, it also helps in lowering the cholesterol level

8Principal of surgical nursing-Acute care nursing
of the body. Hence, in the management strategy plan different types of physical activity such as
swimming, walking and running is involved in the nursing management strategy plan.
Apart from the registered nurse practice standard, Guidelines formulated by the American
Diabetes Association is used in the management strategy plan (Pop-Busui et al., 2017).
All the management strategy is formulated by considering the patient’s past and current
health situation with the help of multiple disciplinary teams. Awareness regarding the severity of
the disease should be created among the patient and their family.
Conclusion:
From the above essay it can be concluded that foot ulcer is common in the patient
suffering from diabetic neuropathy. Nerve damage due to the high blood glucose is one of the
major reasons responsible for the diabetic foot ulcer. Peripheral vascular disorder and obesity
also causes foot ulcer. In the case peripheral; vascular disorder, the arteries narrows down and
hence the blood flow decreases. By considering the entire situation, nursing intervention is
formulated. In nursing intervention, engagement is physical activity is encouraged and the
wound management in intervention arte explained. To conclude, the nursing management
strategy is formulated with the help of multiple disciplinary teams such as, physician, consultant,
dietician, physiotherapist and registered nurses. With the help of nursing management strategy,
further deterioration of the patient health is avoided.

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References
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