They have diminished inflammatory response even when extreme soft tissue and bone infection are present. Identification of foot infections in the patient with diabetes mellitus requires vigilance because the signs of infection may not be present ( Baranoski and Ayello, 2003,p.327). The most common bacteria found in non-limb threatening infection are Staphylococcus and Streptococcus. These infections should be treated with oral antibiotics. If the limb is threatened with the infection, parenteral antibiotics and surgical debridement of necrotic tissue needs to be executed. Most limb threatening infections are polymicrobial. Staphylococcus aureus, group B atreptococci, Enterococcus, and facultative Gram-negative bacilli are the major pathogens involved in these types of
It is estimated that 387 million people, globally live with diabetes (Phillips & Mehl, 2015). According to Medical News Today [MNT], diabetes is a metabolic disorder; which causes patients to be extremely thirsty and produce a lot of urine. Diabetes arises due to high blood pressure, due to the body not being able to produce enough insulin or because the body does not respond well to high insulin levels (MNT, 2016). There are four types of diabetes; there is the pre-diabetic stage, type 1 diabetes, type 2 diabetes and gestational diabetes. In 2014, 29 million people died due to diabetes. This equates to 1 diabetic patient dying every seven seconds due to preventable complications (including complications affecting lower limbs) caused by diabetes. It is said that 20-40% of health care costs are spent on the treatment of lower limb complications due to diabetes. The risk of a diabetic patient developing a foot ulcer is 25% and foot ulcers account approximately 85% of lower limb amputations. Diabetic complications that affect lower limbs are caused by both type 1 and type 2 diabetes (Phillips & Mehl, 2015). It is said that the World Health Organization described diabetic foot syndrome as including all possible complications in relation to the feet of a diabetic patient. Diabetic foot syndrome is defined as the ulceration of the foot, from the ankle downwards. Causes of foot ulceration include peripheral sensory neuropathy, vascular disease (ischaemia) and infection
The second research article covered a screening tool for Diabetics. This tool would be a great way for nurses to do a quick 60-second screening to detect the high-risk diabetic foot and help prevent complications in the future (Oxman, M. 2011). The tool is a paper that the patient and nurse to work through with yes or no questions ranging from the history of any ulcers, to the nurse seeing any deformities (Oxman, M. 2011). I think that this would be a great assessment tool for all diabetic patients to start doing even before they start to have symptoms. This way if symptoms do
According to Healthy People 2012 there are more then 800,000 new cases of diabetes each year, with the numbers on the rise. With this in mind, Healthy People 2012 has identified diabetes as their number five focus area. In order to reach their goal of improving the quality of life for people with diabetes they have identified diabetes teaching as their number one objective. Furthermore, in order to reduce the number of complications of diabetes, Healthy People 2012 has identified foot ulcers as their ninth objective. Through patient education Healthy People 2012 hopes to reduce the number of foot ulcers in people with diabetes, as diabetes is the number one cause of nontraumatic amputations in the United States. In order to
The early diagnosis of neuropathy is crucial to stop progression to advanced stages, and further complications. (Toopchizadeh V., et al.2016) Early intervention can protect diabetic patients from a risk of foot ulcers and amputation, improve the quality of life (Vlckova-Moravcova E, et al 2008.Van Schie CH. 2008, Ismail K, et al 2007) and mitigate the socioeconomic consequences of diabetic foot disease. (Davis WA,et al 2006,Lavery LA,et al 2007,Gordois A,et al 2003 )
Most of the patients were on insulin but different types and doses namely rapid-acting, short-acting, intermediate-acting, long-acting, and pre-mixed depending on the individual’s response to insulin (WebMD, 2014). The incident that helped me achieve my learning need was when a diabetic patient in his late thirties known as patient A, was admitted with a diabetic foot ulcer medically referred to as a neuropathic foot ulcer. Krentz and Bailey, 2001 in their research found that neuropathic foot ulcers generate when diabetes causes nerve damage in the feet and alters the ability for the feet to feel pain. This causes unnoticed ulcers on the affected feet which later develop into bigger ulcers. On the morning of my third day, after handovers, I went on drug rounds with my mentor and for patient A, I noticed that he had 6 different types of drugs for his diabetic condition. Most of the drugs that were administered to him were also given to other diabetes patients on the ward. I told my mentor what I had noticed and he confirmed that those 6 drugs were commonly used for diabetic patients. I listed down those drugs in a small pocket diary I always carried along on that ward. Later that day during lunch break, I sat with my mentor and discussed my learning needs with him making mention of this particular one and discussed measures that would help me achieve my objectives.
There are many people in the United States who have diabetes but do not know it. According to the American Diabetes Association, nearly 25.8 million people are living with the disease (American Diabetes Association, 2011), and
Individuals that have been diagnosed with type 2 diabetes are cared for by a variety of people like podiatrist, district nurses, DSNs, GPs, and practice nurses. Good communication between these professionals and the person with type 2 diabetes can lead to better insight into the individual’s life, therefore helping to plan and provide the best care for that person. This can reduce repetition, improve quality of care for people with diabetes type 2 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.
I chose this objective since it is important Tina stay off the foot to allow healing and since she is a fall risk while ambulating with crutches. This objective would be designed to state: By the completion of home activity instruction, the patient will be able to relay two (2) reasons to limit ambulation and three (3) ways to reduce the risk of injury in the home. Offloading the diabetic foot ulcer is the key treatment to healing the ulceration (Piaggesi, Goretti, Iacopi, Clerici, Romagnoli, Toscanella, & Vermigli, 2016. The teaching method I would use is handouts for healing the diabetic wound and safe ambulation which the patient would be able to take home. Additionally, I would discuss with the patient ways to gather necessities to keep close by and limit the need to ambulate. The barriers I would anticipate are lack of wound healing knowledge and reluctance to limit ambulation. I would assess the patient learning by having the patient write out the answers, consequently this would include having the patient write a list of items they use often and should keep close by. I chose the handout and written test since Tina is educated well enough to read and having the handout and test would be a good reminder for her. These are teachings I use in the wound center when I come across a patient who has every excuse why they can’t offload a foot wound. My goal with the patient is to find a way to discount every barrier they hand me. The hardest barrier to overcome is the patients need to work. We offer to supply disability justification for work, along with continued support should the patient not be able to miss
The number of people with diabetes is greatly increasing around the world. A large percentage of this population can be expected to develop diabetic foot ulcers. During the mid-19th century the problem of diabetic foot ulcers was discovered and discussed for the first time (Naves, 2016). In the mid-19th century, diabetic foot ulcers were treated by prolonged bed rest, although it was only a temporary fix because they started to notice that the ulcers would come back once they were back on their feet again. It is not until Frederick Treves (1853-1923), famous for performing the first appendectomy, suggested a different approach for the treatment of foot ulcers which is using sharp debridement of callus (Naves, 2016). After debridement, antiseptic
Diabetes is associated with wide range of complications such as chronic renal failure, blindness, amputations, heart disease, high blood pressure, stroke, and neuropathy (Alotabi, A., et al., 2016). There is no known cure for diabetes, but the disease can be controlled through health management that includes multiple perspectives of care such as medications, blood glucose monitoring, diet, nutrition, screening for long-term complications and regular physical activity (Alotabi, A., et al., 2016). Managing diabetes may be complicated and requires the knowledge and skills of both healthcare providers and the clients. Studies have shown that to prevent or delay diabetic complications due to diabetes, counseling and other lifestyle interventions are the effective therapy. Even with many policies set up for diabetes, 8.1 million Americans are undiagnosed with diabetes mellitus, and approximately 86 million Americans ages 20 and older have blood glucose levels that considerably increase their risk of developing Diabetes Mellitus in the next several years (CDC, 2015). For diabetes care to be successful there needs to be a good understanding of the disease and management by both patients and healthcare providers,
Diabetes is a serious medical condition that can also be a risk factor for the development of many different diseases and conditions including dementia, heart disease, and CVA. Thus, effective management of diabetes is very important. Patient compliance can be difficult to achieve if the person affected with diabetes is not educated about the illness or treatment, has not fully accepted the diagnosis or its severity, will not change habits or believes that the prescribed treatment regime is too difficult or ineffective, has cultural beliefs conflicting with the treatment regime, experiences stressful events, lacks social support, or suffers from psychiatric issues unrelated to diabetes (Gerard, Griffin, & Fitzpatrick, 2010). As one may expect, adequate education programs are essential tools when dealing with diabetics. Solid education will provide the patient with information as well as teaching the necessary skills to manage the disorder. The primary focus of any diabetes education program must be to empower patients as a part of the multidisciplinary team. This team should be focused at integrating diabetes into the lives of the patients and this focus should be based on the decisions made by the patient, otherwise the treatment plan can be looked on as forced (Gerald et al., 2010). Every patient stricken with diabetes has the right to benefit from an education program of this type. First, basic education and facts should be administered directly following the diagnosis of
Diabetes has become an epidemic in today’s society. Diabetes affects almost every system in the body, and with an estimated 346 million people in the world with diabetes, healthcare has been heavily affected by the disease (Ramasamy, Shrivastava, P., & Shrivastava, S., 2013). One of the biggest issues for healthcare workers when it comes to diabetes, is that it is such a complicated disease. With so many different systems being affected, medical professionals have had to learn how the disease process works, what causes diabetes to work through the systems, and the best treatments to address all these issues. Through much research, the healthcare system has grown very knowledgeable on diabetes. One important aspect of treating diabetes has been in the introduction of diabetic education. In the past, nurses and dieticians had been responsible for educating patients on diabetes, but now that role is also extended to other people in the healthcare team, including the patient (Tomky, 2013). In fact, patients taking an active role in the education process, including learning to self-care has now become a priority in diabetes treatment. The following paper will discuss diabetic education, the importance of self-care and how this affects a patient’s compliance.