Wound Assessment and Management Plan for Diabetic Foot Ulcer Patient

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the student:
Name of the University:
Author’s note

1NURSING ASSIGNMENT
Introduction:
For patients with diabetes, the diagnosis of foot ulcer is a complex and
challenging issue for patient. Recognition of signs of deterioration and early treatment of
wounds can help to prevent infection and provide a high quality of life to such patients.
This report reviews the scenario of Fraser, a patient with foot ulcer in the left leg and
conducts a wound assessment process to develop a wound management plan for
patient.
Diagnosis of the chosen resident:
Fraser is a 50 year old Maori, who was diagnosed with type one diabetes when
he was 8 years old. The reason for his current admission to hospital is an infected left
foot and hyperglycaemia. Due to poor circulation of blood to his feet, he has developed
infected ulcer on his left foot. Diabetic foot ulcer is a major complication found in almost
15-20 of patients with diabetic foot ulcer. It is caused due to diabetic neuropathy, a
condition leading to nerve damage and lack of sensation in the feet and lungs. Hence,
any kind of cut or bruises to the foot results goes unnoticed in such patient and loss of
sensation leads to delay in treatment. This often leads to serious consequences such as
ulcer, infection and joint pain (Noor, Zubair & Ahmad, 2015). Fraser also developed foot
ulcer because of diabetic polyneuropathy. As diabetic ulcer takes time to heal, strict
wound care regimen and adequate treatment is needed for Fraser. Apart from poorly
controlled diabetes, there are no other medical issues for the patient.
Evaluation of the wound:
Diabetic foot ulcers are complex wounds that have adverse impact on the
mortality and morbidity of patients like Fraser. To prevent the foot ulcer from
deteriorating and increasing chances of amputation, proper evaluation and assessment
of wound is necessary. The process of assessment starts from the analyzing detailed
history of the presenting illness and past medical history in patient (Hinchliff et al.,
2015). Ulcer is the presenting illness for Fraser and poor management of diabetes and
history of smoking are past medical history details of Fraser. This can help to identify
whether the patient is at risk of amputation or not. Furthermore, physical examination of
the ulcer may help to determine the size, depth and location of wounds, assess the
status of wound bed, identify signs and evaluate consistency of exudates. This process
can help to appropriately document ulcer characteristics and develop a baseline for
planning treatment and proper intervention for patient. The following are the details
regarding wound assessment process for Mr. Fraser:
Wound bed status:

2NURSING ASSIGNMENT
On wound assessment, the area around the ulcer has been found to be red and
swollen. Red and swollen foot is a sign of life threatening complication in the foot.
Unusual swelling and redness are early sign and symptoms of diabetic foot ulcer.
According to Gardner, Hillis & Frantz (2009), erythema or redness is the sign of
inflammation. The wound was also found to be granulated indicating the contribution of
peripheral neuropathy to ulceration. This type of signs are specific to secondary wound.
As redness and swelling has been observed in Fraser even after initiating treatment for
foot ulcer, this is a negative sign which suggest the need to change antibiotic to control
infection.
Wound measurements:
The wound assessment process also measures the length, depth and width of
ulcers. Engaging in accurate measurement of length and width can help a nurse to track
progress in outcome and determine the effectiveness of treatment process. In addition,
measurement of depth is necessary to evaluate wound healing process. The wound
measurement with relevant tools revealed extensive erythema deeper than the skin
(Brownrigg et al., 2016). This revealed signs of serious infection in Fraser’s foot ulcer.
The severity of the infection was determined by the PEDIS scales and grade III revealed
extensive and severe ulcer. The depth of ulcer also revealed deterioration of ulcer as
Fraser’s foot ulcer had almost reached subsequent layers of foot. The advantage of
using PEDIS scale in the wound assessment process is that it is a standardized and
efficient tool and it helped to correctly identify degree of risk for complications in patients
with diabetic foot ulcers (Chuan et al. 2015).
Condition of surrounding skin:
Another step during the wound assessment process was to observe the condition
of the surrounding skin near the lesion. The surrounding skin assessment was done to
measure skin colour and temperature, identify signs of callus formation and induration
and edema in Fraser. The skin around the ulcer was found to be slightly warm and red
in colour. Redness indicates prolonged inflammation and increase in temperature near
the ulcer shows signs of infection in the wound (Sibbald et al., 2012). Presence of the
symptom of edema and abnormal firmness of the tissue surrounding the ulcer also
revealed severe infection in the wound.
Wound exudates:
Characterising the type of exudates coming out from wound is also necessary to
check the status of wounds and identify signs of infection. The colour, type and odour of
wound exudates is checked to check for changes in bacterial balance. Healthy wound
has no odour and necrotic wounds have offensive odours. In case of Fraser, there was
no discharge from wounds and pain, swelling and redness was the main issue for him.
Physiology of the healing process:
The above assessment of Fraser’s wound and its characteristic reveals poor
healing process and presence of infection. Healing process might have been hampered
despite treatment because of poorly controlled diabetes, age of the resident or the