Type II Diabetes: Pathophysiology, Causes, and 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,