Diabetic Foot Ulcer Research Paper

In the following case study, the author will discuss the issues surrounding a seventy-year-old female with a chronic neuropathic ulcer on the sole of her right foot and the rationale and implications of

Wound management is one of the cornerstones for nursing care however, effective wound care extends far beyond the application of the wound itself. Nurses may be required to assess, plan, implement, and evaluate wound care; therefore, order to fill these roles it’s critical to have an understanding of the several different areas of wound care such as, integumentary system, classification of wounds, wound procedures, and documentation. Knowledge in each of these areas will allow nurses to make well informed decisions about wound care, and as a result play an active part in wound healing.

I have significantly developed my skill in wound care assessment and dressing, in developing this skill I now recognize the importance of documenting each dressing. Morison (2001) supports this in saying that by detailing pressure ulcer assessment it provides a basis for deciding the effectiveness of the current treatment.

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

Jane presented with a wound to her lower left leg which, following a holistic assessment (appendix 2), was diagnosed as a venous leg ulcer. The assessment was conducted in accordance with Local PCT Leg Ulcer Guidelines (appendix 3) as well as RCN Guidelines (RCN 2006) to rule out other possible aetiology such as arterial ulceration, diabetes or malignancy (Moloney and Grace 2004). Although traditionally considered uncommon, recent studies suggest that malignant ulcers are more prevalent than previously thought (Miller et al 2003, Taylor 1998) therefore even though initial assessment suggests an uncomplicated venous ulcer, if Jane’s wound fails to heal following appropriate treatment then specialist advice will be sought. Between 17% and 65% of people with a leg ulcer experience severe or continuous pain with a major impact on quality of life (Briggs and Nelson, 2003) and effective pain relief is important to maximise quality of life, to enable mobilisation and improve appetite to facilitate wound healing. Fortunately, Jane experienced no pain from the leg ulcer prior to or at the time of assessment. However, careful review and monitoring of any pain will be important throughout the treatment process as the first line of treatment for uncomplicated venous leg ulcers are compression systems (RCN 2006) and although compression counteracts the harmful effects of venous hypertension and

venous leg ulcers and diabetic foot ulcers. Canadian Association of Wound Care (CAWC) has published

After the initial investigation, the BSN nurse would then research current treatments for pressure ulcers as they relate to diabetic patients. To properly care for a diabetic foot ulcer, the BSN nurse would suggest debridement and a dressing to prevent tissue dehydration, absorb excess fluid, and to prevent wound contamination (American Diabetes Association 2006). Patient education would also be necessary to ensure she does not bear weight on the affected limb to promote healing. According to the American Diabetes Association, the biggest challenge for healing a diabetic wound is keeping the patient from bearing weight on the affected limb. The BSN nurse may be equipped to handle the patient education better than the ADN nurse due to the amount of research done on the subject.

The goal to treat an ulcer in a diabetic patient is to heal the wound faster to prevent infection, pressure has to be take off the area by “offloading” the foot, remove dead tissue by the process of debridement, apply to dress per doctors order, and focus on managing the patient’s blood sugar effectively to promote healing. In addition, to prevent infection, the patient must keep the dressing clean, cleanse the wound daily and change the bandage and dressing, the patient must also avoid walking on barefoot.

The recommendations for change to practice at the level of the provider would include first treating the underlying problem that Mrs. Smith was admitted for. According to the literature, a progressively worsening diabetic foot ulcer involves implementing a multitude of strategies to prevent amputation of the limb. This allow for decreased rates in mortality and can increase quality of life. Adequate wound management such as debridement, and offloading techniques should be instilled. Furthermore, education by the provider would be of critical importance for Mrs. Smith in terms of consistent foot care and management of her disease process (Yazdanpanah, Nasiri, & Adarvishi, 2015). Due

During the first six sifts of my clinical practice at Eagle Ridge Hospital I provided care to a 62 year old male patient with bilateral below the knee amputation. The patient has a history of osteomyelitis related to the poorly controlled diabetes type II. The left foot was amputated two years ago. The left stump was well healed. However, the patient had been suffering from the phantom limb pain controlled by gabapentin. The right foot was amputated a month ago. The right stump was healing well. The edges of the wound were well approximated, with small amount of serous exudate. The dressing was to be changed daily as per doctor's order. The type of dressing was specified by the wound care nurse.

Diabetic Peripheral Neuropathy (DPN) is one of the most common microvascular complications in diabetes and can result in foot ulceration, ampuation and an impaired quality of life(Carrington AL, et al 2002,Boulton AJ,et al 2004). The reported prevalence of diabetic peripheral neuropathy ranges from 16% to as high as 66%2 and its prevelance is believed to increase with the duration of diabetes and poor glucose control.(Boulton AJ.et al 2000) It’s accounts for 50–75% of non-traumatic amputations in diabetic patients.(Holzer SE, et al 1998, Boulton AJM, 1998,Malay DS, et al 2006)

Living with annoying venous painful wound leg ulcers is so miserable, it seems it would be endless, leads you wanting to be alone and having unwanted life. In spite of current mountainous researches work in the management of this type of wound, still the problem persisted and continuously affecting certain populations. Venous legs ulcer has great impact in life; physically, mentally and psychosocially.

Rustvang, D. (2009). The relationship between hemoglobin A1c values and healing time for lower extremity ulcers in individuals with diabetes. Advances In Skin & Wound Care, 22(8), 365-372. doi:10.1097/01.ASW.0000358639.45784.cd

Research question: What are the contributing factors in developing a diabetic foot ulcer in Type 2 diabetics in the community?