Wound Management

Running head: WOUND MANAGEMENT
Wound Management
Name of the Student
Name of the University
Author Note

1
WOUND MANAGEMENT
Client presentation and significant clinical history
Mrs Y was an aboriginal man who is 55 years old. He was admitted to hospital in the
surgical unit 2 weeks ago in order to treat the complications in his left foot ulcer. The
presentation of wound of Mr. X with the diabetic foot ulcer in the right leg occurred with
swelling and discoloration of the skin at the site of the wound. The wound was warm to touch
with pungent smell coming from wound. Discharge was seeping from the wound. Mr. X was
reporting pain at the wound site along with fever and chills. There was formation of callused
or thickened skin surrounding the wound. At the time of admission it was found that his nails
were large and filled with dirt. He underwent surgery of his right foot ulcer under normal
anaesthesia for partial amputation of the forefoot, great and toes. He was diagnosed with type
2 diabetes mellitus (T2DM) 5 years ago. He is also suffering from peripheral vascular disease
(PVD) and obesity (BMI 44.4 m2 and height 172 cm and weight 115 kilograms). In order to
manage his high blood glucose level (hyperglycemia), he has been on insulin upon her
admission to hospital.
On the next day post surgery (24 hours), her blood pressure was 120/70 mmHg, pulse
rate was 88 bpm, with respiratory rate 18 bpm and level of oxygen saturation within the body
is 97% RA. Body temperature is 37.8. Both her feet, right and left was cool to tough with a
capillary refill time 3 to 4 seconds. Mr. X states that he normally has cold feet and used to
wear socks at home. His blood glucose level (BGL) is 12.6 mmol/L (normal: 4.0 to 5.4
mmol/L). Upon examination of the wound, during replacement of the Island film dressing
along the incisional wound, it was found that the wound site is wet with sight redness along
with yellow or greenish colour pus or cloudy drainage. The wound has dehiscence along the
suture line. There was presence of some sloughy tissue at the site of the wound. The skin
surrounding the wound is warm to touch and painful to tough and dark pink.

2
WOUND MANAGEMENT
The medication list reported by Mr. X include novorapid ( a modern analogue of
insulin that has rapid acting effect), lantus (insulin glargine that is used as long acting insulin)
and pregabalin (used for the treatment of the generalised anxiety disorder and neuropathic
pain and restless leg syndrome) (Bryant et al. 2019). Mr. X reported that he feed on whatever
food he gets and mainly leads to sedentary life and lives alone.
Mr. X English was poor and he was found comfortable in communicating in
Aboriginal language. He stated that after surgery was completed he was lying and was
anxious about his health. He was becoming restless due to his addiction towards alcohol and
smoking and was feeling homesick. Mr. X used to work as a truck driver at present he is
jobless because he has developed problem in his eye sight (dual vision: diabetic retinopathy).
Results of holistic assessment
The wound presentation of Mr. X during the time of hospital admission showed that it
is an acute wound that is the wound and the formation of callus tissues surrounding the has
generated during a considerable period of time. Unmanaged T2DM leads to persistent high
blood glucose level (BGL). Increased blood glucose leads to micro and macro-vascular
complication of diabetes. Diabetic foot ulcer is a macro-vascular complication of diabetes.
High BGL for a considerable period of time hampers neurotransmission (peripheral
neuropathy) and hampering the flow of the blood, oxygen and other nutrients at the periphery
of body (Pop-Busui et al. 2017). The damage in the blood vessels at the peripheral region of
the body (peripheral neuropathy) along with poor supply of oxygen leads to development of
diabetic neuropathy. Pain and encountered by Mr. X at the time of hospital admission is due
to damage in veins. The formation of callus and wound increase the tendency of bacterial
infection leading to formation of fever. The restless in leg might be due to tingling sensation
of pain (Pop-Busui et al. 2017).

3
WOUND MANAGEMENT
The management stage of diabetes along with the development of diabetic foot ulcer
is due to long unmanaged health condition. The unhygienic condition of his feet further
highlighted his lack of self-management skills. One social indicator of the aboriginals in
Australia is lack of proper hygienic status and poor sanitization. This is the reason why
majority of the Aboriginals suffer from poor oral health with unmanaged nails. The direct
present in the nails along with long and sharp nails might have been the reason behind wound
formation and infection in the wound (Gray and Tesfaghiorghis 2018). Aboriginal culture
mainly gives importance to the use of the traditional medicine. Mr. X reported during the
time of hospital admission that he do not believe in taking medications and prefers to rely on
traditional medicine. This is the reason why he did not seek help during the initial phase of
the infection development (Oliver 2013). Traditional medicine fails to improve the chronic
stage of the diabetic wound and high BGL increases the severity of the wound further leading
to the formation of callus tissue at the site of wound (Armstrong, Boulton and Bus 2017).
His obesity and high BMI is the reason behind his disability and loss of job has further
impose a state of sedentary life. The social status of the aboriginal people is poor as they
belong to poor socio-economic background. Social exclusion, lack of proper employment
opportunity along with substance abuse hampers their social status further leading to the
developing of depression and anxiety. Mr. X was also suffering from anxiety lack of
employment and psychological distress leads to increased BGL (Hackett and Steptoe 2017).
The aboriginals in Australia suffer from poor health care awareness and this is the reason
why they follow unhealthy diet. Mr. X lives alone and feed on whatever food he gets handy.
Uncontrolled intake to food increase fat deposition in the body and thus increasing the BGL.
Mr. X lost is job and at the age of 50 with dual vision, he is unlikely to get any new job. In
relation to this, it can be said that avenue for getting a fixed salary at the end of every month
is less for Mr. X. Lack of employment opportunity and financial unrest increase stress and