Nursing Assignment-Diabetic Case Study

This nursing assignment discusses the case study of Mrs. Gina Bacci, a patient with type II diabetes and peripheral vascular disease. It analyzes the pathophysiology and causative factors of her post-operative wound status, identifies two nursing priorities for her care, and outlines the appropriate nursing management. The assignment also provides information on blood glucose regulation and wound management.

Running head: TYPE II DIABETES 1
NURSING ASSIGNMENT-DIABETIC CASE STUDY
Student’s Name
Institutional Affiliation
Course
Instructor
Date

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Introduction
The essay will discuss the case study of Mrs. Gina Bacci who is 48 years and has been
amputated following a complication of right foot ulcer. She has a history of obesity, Type II
diabetes, and Peripheral Vascular Disease (PVD). Due to exacerbation of diabetes, she is
currently on insulin regimen. With regard to the case study, the essay will apply the Clinical
Reasoning Cycle to first, analyze and discuss the pathophysiology and causative factors of
Mrs. Bacci’s status of the wound after operation. Secondly, using the same concept, the paper
will identity two major nursing priorities for care of Mrs Bacci. Thirdly, the paper will
outline and discuss the appropriate nursing management for the patient.
Question 1: Based on the case study, critically analyse and discuss the underlying
pathophysiology and causes of the patient’s post-operative wound status
On assessment, the patient’s wound has an Island of film dressing wet from a serous
exudate along the incisional wound and some dehiscence and sloughy tissue along the suture
line. Additionally, the skin area around the wound was warm, painful when touched, and dark
pink. These findings are an indication of infection and poor wound healing. Dehiscence is
one of the surgical wound complications whereby there is a rapture along the surgical
incision. Some of the risk factors for the development of a dehiscence include obesity,
diabetes, and infection. Slough tissue is a necrotic tissue which has separated from the wound
and it’s a sign of an infection in a surgical wound. Generally, the condition and healing
process of the wound is poor (Ley, Hamdy, Mohan, & Hu, 2014).
The poor healing process of the patient’s wound can be attributed to her history of
obesity, PVD, and type II diabetes. These conditions impact the wound healing process in
different ways. In type II diabetes, the high levels of glucose in blood inhibits the ability of
the body to effectively regulate glucose thus making the patient have difficulties in the
maintenance of an optimum level of blood sugar (Al-Goblan, Al-Alfi, & Khan, 2014). The

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elevated levels of blood glucose damages multiple body systems. The high level of blood
glucose results in narrowing of the blood vessels, stiffening of arteries, and diabetic
neuropathy. These conditions result in nerve damage in the entire body especially the limbs.
The impacts of the body changes increase the risks of development of wounds and
complications in the diabetic wound healing. Consequently, this results in poor healing of the
wound and sometimes the wound may fail to heal (Ley et al., 2014).
Neuropathy is one of the primary causes of wounds in patients with type II diabetes
and complications in the diabetes wound healing. The damaged nerves due to high levels of
blood sugar never regenerate thus resulting in poor and slow process of wound healing. Type
II diabetes is associated with circulation problems. For a proper healing process of a surgical
wound, blood circulation is critical. The narrowing of the blood vessels impairs the healing
process of the diabetic wound since there is less oxygen reaching the wound and the souring
tissues (Kahn, Cooper, & Del Prato, 2014).
Limited supply of oxygen may lead to death of some tissues causing skin
pigmentation where some areas are dark pink and black. Additionally, the elevated blood
glucose levels reduce the functioning of the erythrocytes which is transportation of nutrients
to the wound area or tissues. This also limits the effectiveness of leukocytes fighting the
infections. The inefficiency of the body’s immune system contributes to the condition of the
patient’s wound. High levels of blood sugar lower the ability of the body to fight infections
since the immune cells are not effectively functioning in the case of diabetic wound healing.
The poses the body to greater risk of various infections especially bacterial infections
(Dangwal et al., 2015).
Chronic inflammation involved in the process of healing of diabetic wound lasts for
long thus making the wound to be chronic and difficult to heal. When the wound becomes

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chronic, the level of balance existing between the processes of production and degradation of
collagen is usually lost thus making the wound to heal slowly or fail to heal (Dangwal et al.,
2015). Slower movement of the leukocytes in the wound area along with immune responses
which are less effective increases the risk of infections in diabetic wound healing. Increased
infections secondary to the longer duration of the wound being open results in complications
and poor healing. These underlying mechanisms results in development of infections and
complications of a surgical wound thus causing poor healing of the Mrs. Bacci with reference
to the case study (Inzucchi et al., 2015).
Question 2: Identify 2 main nursing priorities of care for this patient and provide a
justification and rationale for each
1. Regulation and maintenance of optimum Blood Glucose Level (BGL). From the case
study, Mrs. Bacci has a BGL of 12.6mmol/L, which is high. It is crucial to control the
patient’s levels of blood glucose to prevent other multiorgan complications. Type II
diabetes is primarily characterized with high levels of blood glucose and a marked
increase in risk of development of Cardiovascular Disease (Inzucchi et al., 2015). The
high risk of CVD results from a distinct cluster of metabolic problems or
abnormalities such as hypertension, dyslipidemia, hyperglycemia, and insulin
resistance. Other complications that may result from uncontrolled high levels of blood
glucose are eye disease, nerve problems, and kidney problems (Powers et al., 2017).
To reduce the risk of occurrence of some of these complications, intensive glycemic
regulation and control would be essential. Regulation and maintenance of the level of
blood glucose of the patient would help in the improvement of her general health
condition (Kadirvelu, & Sivalal Sadasivan, 2012).
2. Wound management-With reference to the case study, Mrs. Bacci has had a partial
amputation of the forefoot and first and great toes secondary to complications

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resulting from the right foot ulcer. This indicates that she has a surgical wound which
should be given a priority in nursing care. From the examination of the wound, the
wound has some sloughy tissue and dehiscence along the suture line with the
surrounding skin being warm, painful when touched, and dark pink (Paneni,
Beckman, Creager, & Cosentino, 2013). The dehiscence and infections are the two
major complications of the surgical wound which should be prioritized when planning
for the care of the patient to ensure her comfortability though improved healing and
pain relief. It would be essential to assess and management the wound first to prevent
other complications such as septic wound which may result in the amputation of the
whole limb of the patient. This would also important to ensure the patient mobilizes
comfortably without the use of walking stick and offloading boot (Inzucchi et al.,
2015).
Question 3: From your identified priorities, outline and justify the appropriate and safe
nursing management of the patient during this time
From the identified priorities of nursing care for Mrs. Bacci, the implementation of
appropriate interventions for maintenance of optimum blood glucose levels would be
essential. One of the most appropriate intervention is regular monitoring of the patient’s
blood glucose to ensure that is lies within the expected target range. The key to this is
ensuring balance between food, diabetes medications, activity, and lifestyle. Monitoring the
blood glucose can help the nurse understand the connection between food, insulin, exercise,
and the patient’s blood glucose (Haas et al., 2012).
To control and maintain the glucose levels, the patient should be given insulin
regimen which in this instance is Lantus and Novorapid. One of the factors that may
influence the efficiency of the medication is adherence. From the case, the patient admits that

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she sometimes forgets to take the medications and she does see the need of taking all the
medications that she has been prescribed to use (Steinsbekk, Rygg, Lisulo, Rise, & Fretheim,
2012). At this instance, the nurse should comprehensively educate the patient on the
importance of the medication in relation to her health condition and the importance of
adhering to the regimen. The nurse should enlighten the patient on the possible complications
or outcomes associated with non-compliance to medication.
The nurse and other involved healthcare providers should enlighten the patient on
other techniques of lowering or maintaining blood sugar levels to reduce the risk of
occurrence of complications (Schellenberg, Dryden, Vandermeer, Ha, & Korownyk, 2013).
These techniques include close monitoring of glucose levels at home, reduced carbohydrate,
and consumption of foods with low glycemic index such as sweet potatoes, low-fat milk,
legumes, meets, nuts and seeds, fish, leafy greens, and guinoa. The patient be educated on
increased intake of dietary fiber since fiber slows down the rate of breakdown of
carbohydrates thus reducing the rate of absorption of sugars by the body. The recommendable
sources of soluble fibre include legumes, vegetables, fruits, and whole grains (DeFronzo,
Eldor, & Abdul-Ghani, 2013).
The patient should be enlightened on the maintenance of a healthy weight since loss
of weight contributes to the control of blood sugar levels. Obesity increases the risks of
occurrence of insulin resistance thus worsening the diabetic condition of the patient.
Education on regular exercise or physical activity would be beneficial to the patient since it
causes weight loss thus increasing insulin sensitivity. Additionally, exercise increases the
consumption of sugars by the body muscles thus lowering its levels in the body (Fisher et al.,
2012).

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Regarding the current status of the patient’s surgical wound, the nurse should assess
the patient for any signs of infection and complications. The assessment would enable the
nurse to know the progress of the process of wound healing (Fisher et al., 2012). According
to the case study, on assessment, the wound had sloughy tissue and dehiscence which
indicates infections and poor healing process.
The nursing intervention should be focused on management of the surgical wound to
prevent further breakdown of the skin. The wound should be open and aseptically cleaned
while removing the sloughy tissue and dehiscence. The patient should be given antibiotics
and analgesics to cure infections and relieve pain. The patient should be educated on the
general hygiene and cleanliness of the wound and the entire surgical site (Jalilian, Zinat
Motlagh, & Solhi, 2012
Conclusion
The paper has critically analyzed the case study of Mrs.Gina Bacci with a history of
obesity, Peripheral Vascular Disease, and Type II diabetes and has had a complication of
right foot ulcer which led to amputation of her first and great toes and the forefoot. The paper
has critically analyzed the case scenario and discussed the pathophysiological mechanisms
and the causative factors of the wound status of the patient after operation. The paper has
highlighted the two major nursing priorities for patient’s care based on her current condition.
Lastly, the essay has outlined and discussed the appropriate management for Mrs. Gina Bacci
depending on her current health situation.

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