Diabetic Foot Ulcers: A Case Study

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

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.

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)

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

Structural abnormalities that can occur in the feet of diabetic patients may cause elevated plantar pressure, leading to formation of an ulcer. Therefore, the development of diabetic foot ulcer at the patient’s right heel must be given utmost attention and care to prevent further complications to this precious remaining foot. Left untreated, the ulcer can become infected leading to another amputation and subsequently further limiting this patient’s function and

Management involves establishing that the neuropathy is caused by diabetes instead of other underlying causes and aiming for strict glycemic control. Many diabetics suffer amputations to limbs as a result of diabetic neuropathy. "The symptoms typically start in the toes, gradually ascending to the lower limbs. In advanced cases, it spreads to the upper limbs (glove-stocking sensation) and also the abdominal wall (Rajan , 2013)." Diabetics are prone to having diminished circulation in their limbs. Diabetes causes the blood vessels of the feet and legs to narrow and harden. Some of the causes of increasingly diminished blood flow can be controlled, such as smoking, high blood pressure and high cholesterol. " In addition to being a diabetic, the risk of developing and progression of diabetic neuropathy also depends on the duration of diabetes, glycemic control, presence of comorbidities like hypertension, hyperlipidemia, obesity, and smoking (Rajan, 2013). One of the consequences of poor circulation is a slowed or insufficient healing process. This problem requires diligent inspection of the feet especially. Poor circulation and thus poor healing often leads to wounds that are more prone to becoming infected. If a wound is not felt, it is often noticed only when it has already become seriously

Provide all necessary equipments and functions in compliance with BC’s regulatory licensing agency and in accordance with the policies and guidelines of CSC. This must include Biological indicator strip testing as required.

Foot ulcer is one of the most significant complications of diabetes, and is defined as a foot affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a patient with diabetes.

1.A diabetic ulcer is an open sore or wound that occurs in approximately 15 percent of all patients with diabetes and is commonly located on areas that have limited movement and easily trap heat and sweat. A more common name for a du is simply a bed sore and more often called such. Below are two examples of such sores. The image located to the left is located on the bum while the left is located on the left foot.

Diabetic foot ulcers are considered one of the most problematic developments in diabetics (Shokoh, Mahvash, and Mohammad, 2013). The deterioration of the foot has been proven by research to be associated with the debridement of skin tissue and impaired blood circulation to the lower extremities (Huether & McCance, 2012). With

Diabetes is a major concern in many countries. It is a condition that is associated with the sugar level in a person’s blood in their body. Diabetic foot is a common issue associated with diabetes. This issue causes a multitude of health concerns, due to a correlation between diabetic foot and bacteria. This can lead to ulceration and sometimes amputation due to bacteria.

The literature will be found from search engines such as medline, Embase, Google scholar and the reading list supplied. I will also be looking at the current NICE guidelines and other government guidelines. The findings will be discussed and critically evaluated.

The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. Measurements on clinical data, morbidity and mortality are not capable of expressing all those dimensions on health. Health-related quality of life (HRQOL) measures, though, are multi-dimensional and take a person’s subjective perspective of their well-being through different health domains including, but not limited to, physical, mental and social functioning.

The participants were selected from the diabetic clinic of St. Thomas Hospital both in the outpatient department and those admitted with diabetic foot ulcer. Total 180 participants were selected randomly and assigned to control group (conventional treatment) and experimental group, informed consent was obtained. (The details are given in chapter

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