Type II Diabetes: Pathophysiology, Causes, and Nursing Management

This essay focuses on the case scenario of Mrs. Gina Bacci, an Italian woman with Type II Diabetes and Peripheral Vascular Disease. It discusses the pathophysiology and causes of her wound status post-operatively, identifies nursing priorities, and outlines safe and appropriate nursing management.

Running head: TYPE II DIABETES 1
NRSG 258 ASSESSMENT TASK 1
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Introduction

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The essay will focus on the case scenario of Mrs. Gina Bacci who is an Italian woman
aged 49 years. She has a positive history of Obesity, Type II Diabetes, and Peripheral
Vascular Disease. She had a partial amputation following a complication of right foot ulcer.
The essay will provide an analysis and discuss the pathophysiology and the causes of the
wound status of the patient post-operatively. Secondly, the paper will identify two nursing
priorities for the patient providing a justification and rational for the priorities. Thirdly, from
the two priorities, the paper will outline and justify the safe and appropriate nursing
management for the patient.
Critical Analysis and Discussion of the Underlying Pathophysiology and Causes of the
Wound Status of the Patient Post-Operatively
Type II diabetes is a chronic medical condition that influences the metabolization of
sugar in the body and its characterized with constantly high levels of blood glucose. Its
pathophysiology is commonly characterized by impaired regulation of the hepatic glucose
production, peripheral insulin resistance, and decline in Beta-cell function which
consequently lead to its failure (American Diabetes Association. 2015).
With reference to the case study, Mrs Bacci has an history of Peripheral Vascular
Disease and type II diabetes which are primary contributors of her complication of foot ulcer
on her right food leading to partial amputation of the forefoot and toes. High Blood Glucose
levels in type II diabetes results in nerve damage which impairs the integrity of the skin.
When the patient develops skins ulcers, it becomes hard for the wound por ulcer to heal due
to nerve damage which makes the skin not to repair itself properly. With reference to the case
scenario, Mrs Bacci developed a right foot ulcer which could not health easily leading to
partial amputation (American Diabetes Association. 2016).

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According to the case scenario, the condition of Mrs Bacci’s wound was not good
since on examination it was noted that the wound has some dehiscence along the suture line
and some sloughy tissue. The skin around that wound was warm, painful to touch, and dark
pink. Wound dehiscence is a common complication of surgical wounds which involves the
breaking of surgical incision along the suture line. Typically, the closures or sutures around
the edges of the wound should be intact during the formation of new tissues, the granulation
tissues, for faster healing of the wound. However, the occurrence of wound dehiscence makes
the edges of the wound to separate thus making the wound to reopen other than healing
closed as expected (Hinnouho et al., 2014).
Wound dehiscence results from multiple factors including poor surgical techniques
like improper suturing, inappropriate sutures, over-tightened sutures (Kahn, Cooper, & Del
Prato, 2014). The dehiscence could have resulted from increased stress or pressure on he
wound area due to heavy lifting and poor healing or infection secondary to the entry of
bacterial or other pathogens in the wound. The presence of infection in the wound leads to
inflammation in the surrounding areas making them warm, painful, and dark pink. Pain is
also associated with dehiscence.
From the case study, the patient was examined at the outpatient department and it was
discovered that she had some sloughy tissue along the suture line. Sloughy is one of the types
of necrotic tissues whereby the tissue separate itself from the wound site and is always stingy.
A sloughy tissue is a sigh of poor healing of the patient’s wound. The sloughy tissue is dead
and always grey, yellow, or whit in color. A slough is non-viable and fibrous tissue which
forms due to damage tissue or infection in the wound area (Leenders et al., 2013).
The presence of slough in a wound is an indication that the wound is stuck in the
phase of inflammation. It may also be an indication that the body is trying to clean the bed of

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the wound in preparation of the process of wound healing. In most instances, slough is a
combination of bacteria, leucocytes, debris, and devitalized tissue. The slough usually has a
shiny stringy appearance. In the process of wound healing, the exudate is essential in the
provision of a moist-environment, oxygen, and nutrients to the tissues which are newly
developing and removal of toxins and waste products. Mrs.Bacci’s wound has a serous
exudate which is normal (Wu, Ding, Tanaka, & Zhang, 2014).
Type II diabetes is associated with high levels of blood sugar which impairs the
functioning of the white blood cells thus making it them unable to fight bacteria. Type II
diabetes results in poor blood circulation thus slowing down the movement of red blood cells
thus hindering the delivery of nutrients to the wound site. This may result in slow healing of
the wound or sometimes the wound may fail to heal. Additionally, the condition also weakens
the production of the hormones used in grown and wound healing, decreases the production
and repair of the newly formed blood vessels, weakens the skin barrier, and decrease collagen
production. Some of these factors may lead to slowed wound healing (Ozougwu, Obimba,
Belonwu, & Unakalamba, 2013).
Two Main priorities of care for Mrs. Bacci and their justification and rationales.
1. Glucose control and maintenance-Based on the history of Mrs Bacci of Type II
diabetes, it is essential to control the blood glucose levels to prevent further
complications. For example, from the case study, the patient presents with Blood
Glucose Levels of 12. 6mmol/L which is on the higher side. High and uncontrolled
blood glucose levels put the patient’s health at risk of multiple complications such as
cerebrovascular accident, heart disease, nerve damage, tissue necrosis, skin problems,
and eye damage (Zaccardi, Webb, Yates, & Davies, 2016). Other health issues that
may result from elevated blood glucose levels include vomiting, trouble breathing,

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high ketone in the urine, increased frequency of urination, flushed or dry skin, and
confusion. From the case scenario, Mrs. Bacci is on Novorapid TDS 12 units and
Lantus 30 units nocte which she seems not be adhering to since she admits
forgetfulness on taking the medications and she also seem not to understand the
reason for taking all the medications. This could have resulted in poor adherence thus
causing an elevation in her BGL. Based on this, it would be essential to prioritize
glucose control and maintenance to prevent further complications and improve her
health status for a positive outcome (Korat, Willett, & Hu, 2014).
2. Wound care/management- This would be wound care which is essential in her
condition. According to the case scenario, Mrs. Bacci developed a complication of
right foot ulcer secondary to Type II diabetes. Following the complication, she
underwent a partial amputation of the forefoot and the first and great toes. Upon
reporting to the outpatient department for further assessment and management of her
wound, her wound was examined and was found to have some dehiscence and
sloughy tissue along the suture line. Additionally, the surrounding areas of the wound
were warm, painful on touch, and dark pink in color (Martin-Timon, Sevillano-
Collantes, Segura-Galindo, & del Canizo-Gomez, 2014). These are signs of poor
wound healing which required immediate action to prevent other complications such
as gangrene, nerve damage, and septic wound that may lead to the amputation of the
entire limb. Additionally, the patient was in pain, therefore, it would be essential to
prioritize on this to ensure the patient is comfortable thus improving her health
condition through the implementation of the most appropriate measures.
Outline and justification of the appropriate and safe nursing management for
Mrs.Bacci.

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For an effective management of the patient, multidisciplinary approach should be
implemented to ensure that she gets a holistic and individualized care. There are multiple
interventions of medical management which should be implemented. The first one is
normalization of insulin activity to reduce the risk of development of neuropathic and
vascular complications. From the case study, the patient has been put on Lantus and
Novorapid which are essential in glucose control and maintenance. There should be intensive
treatment which involves three or four injections of insulin, frequent monitoring of glucose,
and contacts with the diabetic educators on weekly basis (Ley, Hamdy, Mohan, & Hu, 2014).
Effective nutritional management should be implemented since it forms the
foundation of the management of type II diabetes. The foundations include meal planning,
nutrition, and weight control. The team involved in the management of the patient should
consult a professional such as a registered dietician who should design and teach them on the
therapeutic planning aspect. The patient should be enlightened on weight loss to improve her
levels of blood glucose. Other options that should be implemented for the patient include
behavioral therapy, group support, diet education, and ongoing nutritional counselling
(Schellenberg, Dryden, Vandermeer, Ha, & Korownyk, 2013).
In meal planning, there should be criteria which must put into consideration the
patient’s lifestyle, food preferences, cultural and ethnic background, and usual eating times.
The nurse should thoroughly assess and review the diet history of the patient to identify her
lifestyle and eating habits. The patients should be enlightened on the importance of
consistency of eating habits, provision of a personalized meal plan, and relationship between
insulin and food. The nurse, as the patient’s advocate, should effectively communicate the
pertinent information to the nutritionist and reinforce the patient for clear understanding
(Chrvala, Sherr, & Lipman, 2016).

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Other additional dietary concerns recommendable in the case of Mrs Bacci are alcohol
consumption, reducing hypoglycemia, physical activity and exercise which reduced improves
the utilization of insulin and glucose uptake by the body muscles thus lowering the levels of
glucose in the blood. From the case study, the patient admits that she forgets to take the
prescribed medications and she does not even see the need of taking all the medications
(Mirmiran, Bahadoran, & Azizi, 2014). This shows knowledge deficit on the importance of
adhering to the medications. The patient should therefore be educated on the importance of
complying with the prescribed medications with regard to her health condition. The patient
should be educated on glucose monitoring at home according her parameters of identifying
and managing glucose variations. The patient should be encouraged to read labels especially
when choosing foods to ensure that she chooses foods with low content of fact, higher fiber,
and low glycemic index.
Based on the wound status of the wound, interventions such as wound cleaning and
dressing should be implemented. The patient should be given antibiotics to prevent infections
and painkillers to reduce pain at the surrounding skin of the wound site. For an effective
wound care, the patient should be enlightened on various strategies of self-wound
management to promote healing. The patient should be educated on the risk factors of poor or
delayed wound healing such as poor nutrition, poor hygiene, engagement in strenuous
physical activities, and other factors which can cause injury to the wound (Klein, Jackson,
Street, Whitacre, & Klein, 2013).
The patient should be scheduled for regular check-up and dressing of the wound in the
outpatient department for an effective monitoring of the condition and healing progress of the
wound. Additionally, the nurses and other healthcare personnel should always apply aseptic
techniques to prevent further infections and complications of the wound. Lastly, since the
patient’s wound resulted primarily from her diabetic condition, it would be essential to

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control patient’s BGL and ensure its at the optimum range to promote healing and reduce the
risk of other complications (Sapkota, Brien, Greenfield, & Aslani, 2015).
Conclusion
The paper has properly analyzed the case scenario of Mrs. Gina Bacci who presented
with a right foot ulcer secondary to Type II diabetes and Peripheral Vascular Disease.
Following the ulcer, the patient was partially amputated and presented to the outpatient
department for further assessment and management of her wound. The paper has discussed
the underlying pathophysiology and the causes of the wound status of the patient post-
operatively. The paper has identified two main nursing priorities of patient’s care and
justification and their rationales. Lastly, the paper has outlined and justified the safe and
appropriate nursing management for Mrs. Bacci.

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