Case Study: Pathophysiology and Nursing Care for Diabetic Foot Ulcer

This assignment presents a case study of Mrs. Gina Bacci, a 49-year-old patient with a diabetic foot ulcer, peripheral vascular disease, and obesity, who underwent partial foot amputation. The assignment analyzes the pathophysiology of diabetic foot ulcers, detailing the complications arising from diabetes, neuropathy, and vascular disease, emphasizing the impact of obesity and metabolic syndrome. It identifies priority nursing interventions, focusing on wound management, regular patient screening, and comprehensive foot examinations to prevent further complications. The rationale for these priorities is justified through evidence-based practices and guidelines, highlighting the nurse's role in early intervention, wound care, and patient education to improve patient outcomes and prevent limb amputation. The assessment includes a review of the clinical reasoning cycle, action taking, and evaluation of outcomes, all geared toward enhancing the patient's condition and preventing future complications.

Pathophysiological assessment and nursing care priorities on
Case study review
Patient Bacci state, and the path physiology assessment has discussed relating to the patient
situation, cues of action and information processing based on the indications presented.
Priority nursing interventions has been assessed using the identification of patient problems
and establishing goals of care (Hunter & Arthur, 2016). Identified priorities entail an
examination of diabetic foot ulcer and wound care management. Finally, justification of
nursing priorities reviews action taking and evaluation of outcome stage of clinical reasoning
cycle.
Patient Mrs Gina Bacci depicts a state of diabetic foot ulcer with the previous history of type
II diabetes, peripheral vascular disease and obesity. The evaluation of the patient foot ulcers
is critical. The pathophysiology arises from various complications occurring from multiple
causes. The damage of the weak foot muscles has to lead to an imbalance of flexion-
extension of the foot causing the skin to break down and forming the ulceration (Formosa,
Gatt & Chockalingam, 2016).
Infection is a serious medical condition, which threatens the state of Patient Bacci due to
these consequences of deep infection. In the foot ulcers, the complications tend to increase.
The difficulties arise from intercommunication and the spread of the infection; with low pain
detection, leads to the continuation of the ambulation further expand the range. Thus, the
combination of various factors such the obesity, glucose level intolerance, and peripheral
disease worsens the state of the disease (Zhang et al., 2017).
Patient Bacci body mass status indicates that the presence of obesity is imminent. This
facilitates insulin resistance. The development of insulin resistance develops to type II

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diabetes leading to metabolic syndrome. This has led to patient development of type II
diabetes, leading to elevated levels of sugar levels in the blood. During the diabetic state of
the patient, there is an increased risk of worsening state of diabetic foot ulcers (Jaiswal et al.,
2016). The wound healing disorder affects the treatment process which further exacerbates
the patient state of infection. Skin damage on the foot ulcer is imminent which result from
shift change of pressure points (Brennan et al., 2013). This will proceed to form skin damage
developing into ulcers. The underlying neuropathy lowers the state of oil glands and sweater
making the foot moisture to reduce and hence increasing susceptibility to injury, while
sensory neuropathy decreases the sensation of wound pain. Status of the immunopathy
reflects the underlying causes (Jupiter et al., 2016).
With Patient Bacci diabetic mellitus state, there is decreased healing of the soft tissue leading
to ulcers. During the advanced stage of diabetes, skin structure tissue, nerves, and blood
vessels are damaged hence there is no control of blood, this slow progress of wound healing
in the wound lower risk of wound complication (Barshes et al., 2016).
The patient state of neuropathy remains to be primarily an underlying condition for type II
diabetes. The occurrence of tingling, pain, and numbness are clear symptoms of peripheral
neuropathy, leading to vulnerable infections thus exacerbating the contamination of the
patient. The weakened immunopathy of the patient is further worsening the healing process
of the patient also declining the state of foot ulcers causing more infection (Tokuda et al.,
2018).
The diabetic foot ulcer increases the condition associated with peripheral arterial disease of
Patient Bacci, coupled with neuropathy, ischemia, and infection. Compromised metabolic
mechanism elevates the risks of infection and wound healing for the patient. This is
exacerbated by peripheral vascular disease, ulceration, and gangrene formation. Further, the
declined state of the immunopathy of the patient leads to more susceptibility of infections.

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The associated metabolism syndrome impairs the synthesis of portions, fibrinogen, and
collagen. Research has shown that immune system impairment occurs among patients with
lower blood glucose level tolerating infection worsening wound state (Clerici & Faglia,
2016).
The autonomic neuropathy complications lead to diminished sweating, with underlying skin
becoming dry and susceptible to developing an infection. The occurrence of the external
conditions of Patient Bacci worsens the state of the patients. Peripheral disease occurrences
are the significant manifestation of type II diabetes presented the patient. Often peripheral
vascular disease occurs at all levels of the arterial tree and bifurcation sand bends of the
artery, located in the hemodynamic shear stress is low. In the diabetic state, the distal vessels
such as the anterior, posterior tibias and perinea are inclined (Jupiter et al., 2016).
Identification of nursing priorities of care for this patient, justification and rationale
Nursing priorities in the nursing process of Patient Bacci are critical for wound management.
The following nursing priorities are essential for the patient are the periodic examination and
patient screening and Wound management care. Rationales wound management care is the
improvement of nursing care is a crucial aspect of managing the state of the patients.
According to the WHO, nurses play a critical role in reviewing patient status as they are the
most significant component of health care. The nurse’s role includes prevention of the disease
and health promotion on Patient Bacci state (Clerici & Faglia, 2016). The nurses offer a
combination of these care services and seek to eliminate and provide health services, which
aim to reduce physical, emotional and mental needs of the patient.
Regular wound screening and examination
These diabetic foot ulcers management can often result in various risks factors which need
urgent attention. Thus causes detachment from the skin and impair the wound healing for the
patient. The state of the peripheral neuropathy can lead to excessive pressure, and further

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ischemia can lead to increased susceptibility of ulceration impairment on the peripheral of the
patient (Ali, Ozdemir & Hinchliffe, 2018).
With the increasing prevalence of diabetes and the associated complications, there is need to
have focussed nursing priorities which target on the patient symptoms such as obesity and
management of wound and medication management of the type two diabetes (Noronen,
Saarinen, Albäck & Venermo, 2017).
Diabetic foot presents a common cause of hospitalisations of patients; thus nursing role is
dedicated towards the prevention and diagnosis of complications linked to diabetic for.
Nurses in the care team need to focus on enhancing the patient ability and to provide
adequately for wound for the patients (Brownrigg et al., 2016).
Appropriate and safe nursing management of the patient during this time
Nurse’s role in the management of diabetic foot ulcers of Patient Bacci is essential in the
early stages of management of care. The role of nurse entails foot examination, dressing of
the wound and encouraging the patients to enhance and follow treatment. The critical goal of
screening is to identify foot problems with a focus on identifying those at risks and aiming at
reducing risks of ulcers (Normahan et al., 2018).
The presence of peripheral neuropathy, vascular disease, and infection occurring on the
wound of the patient is the top significant factors for the patient. These are threatening factors
which cause gangrene and amputation to the patient. Peripheral neuropathy has been
observed to produce 80% of the foot ulcers among diabetic patients. This shows that
neurological assessment is the critical aspects of the management of care. Screening of the
patient is an essential aspect; thus the emphasis on the nurse's role in the evaluation of
diabetic foot ulcers is of great importance (D’Souza et al., 2015).
Screening facilitates identification of Patient Bacci underlying asymptomatic state. The key
to managing diabetic feet is key to prevention. The development of diabetic foot ulcer often

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leads to high risks development of below-knee amputation Reference??. Limb amputation is
the most significant risks factors associated with foot ulcers, thus the needed for critical
nursing care on screening and examination for early identification of patient complications as
observed from the case study patient (Elgzri et al., 2015).
Diabetic foot examination plays a fundamental role in managing the patient. Nurses require
patients to remove any socks covering to assess the status of the wound and determined high
risks status and to offer the needed management of the case. Diabetic foot examination is a
routine management practice for nurses in managing diabetic foot ulcers, (Elgzyri et al.,
2015). Diabetic foot assessment is not limited to foot alone, vascular status evaluation with an
estimate of some pressure, the temperature of the foot and evaluation of the associated foot
problems, in this way diabetes foot ulcers will be assessed and identified easily (He et al.,
2017). Thus, enhancing screening and examination is fundamental in nursing care.
Attending to wound care is vital and essential; enhancing wound management care is critical.
Research has shown that between 15%-20% of patients will develop a foot ulcer, with a risk
of limb amputation being high for patients with a diabetic foot ulcer. The associated risks of
foot ulcer can improve through offering high-quality care which entails management of
glycemic control, offering podiatry intervention which prevents trauma from pressure and
monitoring in the early stages (Armstrong, Boulton & Bus, 2017).
Wound management is essential for nurses. However, it is challenging in that it carries high
risks complication — the associated complexity linked to various issues that need to address.
Nursing care on the microvascular can lead to diminished blood flow to the foot leading to
ischemia and other neuropathic changes, which reduced the moisture of the skin (Game et al.,
2016).
Thus, key-nursing action will entail foot wound management to prevent further cross
infection, reducing the debridement of dead tissue and proper dressing action of the wound.

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Nurse’s work on cross infection will entail the prevention of cross infection through the
adoption of precautionary measures such as hand washing and usage of gloves. Further
removal of the dead tissue around the wound is critical in alleviating trauma and injury
(Yazdanpanah , Nasiri & Adarvishi, 2015 ) . Removal is essential for aiding visibility,
promoting adequate assessment and facilitating appropriate treatment. The dead skin often
attracts pathogens which affect the healing process of the wound (Noronen, Saarinen, Albäck
& Venermo, 2017).
Research has shown that the use of appropriate dressing promotes the healing process. This
evidence further suggests that warmth on the wound and moisture facilitating actual wound
healing process (Game et al., 2016). Thus nursing action on the choice of dressing material
which maintains moist wound with no maceration on the tissue is essential. Appropriate
nursing action on the wound can facilitate proper infection diagnosis by reducing the
susceptibility of the patient through the use of proper microbial activity (American Diabetes
Association, 2015).
Conclusion
The situation of the patient signifies diabetic foot infection coupled with various
complications arising from the patient state. The patient is experiencing different conditions
with significant diabetic condition with a history of amputation. Post-surgical management is
of critical importance to the patient. There is the presence of significant effects on the
neuropathy of Patient Bacci, worsening of diabetic foot ulcers and obesity management
affecting care process. Focusing on patient care is imminent, thus focus goals on managing
the wound, close examination and screening of the wound are essential. These key foci are
essential in ensuring that Patient Bacci does not develop further complications thus gearing
towards improving the patient status.

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