The Treatment Of Diabetic Foot Ulcers

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

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

In the research study "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors," authors and research proponents Gorecki et al (2012) explored the different dimensions (factors) that contribute to improved health-related quality of life among patients of pressure ulcers, or PUs. In the study, the proponents developed a qualitative research design to achieve the objective of discovering and identifying contributing factors to improved health-related quality of life. Using the in-depth interview methodology, they collected information about the PU patients' profiles, PU severity level, coping mechanisms, wound management, and social support systems.

On assessment, the wound was slightly exudates, odour, sloughs and dry skin patches on the surroundings. Sprakes (2010) state that, holistic assessment of patient and the wound are essential in order to facilitate the wound healing process. Ousey and McIntosh (2010) points out that, chronic wounds are exacerbated by a sequence of misdiagnosis, neglect, incompetence or inappropriate treatment strategies. I observed that, M’s wound was with exudates and sloughs; this

Pressure ulcers that occur in the long term care setting are increasing in the number of incidences each year in the United States. Consequences and complications of pressure ulcer development include pain, sepsis, cellulitis, bone, and joint infections. Pressure ulcers are also associated with an increased morbidity and mortality rate, negative emotional and physical effects on patients and caregivers, and are the second leading cause of litigation in long term care facilities. The cost of treatment for pressure ulcers in the United States is estimated at 11 billion dollars annually. This has led to many programs that focus on education and intervention to prevent the development of pressure ulcers, even being addressed in public initiatives such as Healthy People 2010. Appropriate information and education for healthcare providers, patients, and families has proven to be a key factor in the prevention of pressure ulcer development. Wound management is an area of healthcare that must include a comprehensive plan for the best outcome. A care plan that includes a well-educated care team composed of various disciplines working together for holistic care of each patient has seen the best results for patients who suffer from pressure ulcers.

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

Pressure ulcers are a commonly seen problem among elderly hospitalized patients. Despite new findings about the causes and approaches to treatment, the incidence of these wounds is still increasing. Scott, Gibran, Engrav, Mack and Rivara (2006) revealed that during the thirteen years of their study, the incidence of pressure ulcer development has more than doubled. As our elderly population becomes greater in number, and older in age, this problem is expected to escalate. It is of great importance for the patients as well as for the

It has been shown that in studies that pain management is not always touched with wound care (Maddox, 2012). Uncontrolled and untreated pain has a negative impact on the healing process thus having a negative in quality of life. When nurses conducted a research study on the experience patients with venous ulcers, what led the patients to consult practitioners was pain (Maddox, 2012). This study led to the realizations that pain was being properly addressed by doctors and nurses. This was the constant recurring physical symptom in venous ulcers, acute and chronic. Even in some cases the pain was so severe that it interfered with activities of daily living, and normal tasks such as walking became

In the UK, there are 200,000 patients, who have slow healing wounds, which costs National Health Services £2.3-£3.1 billions per year and it reduces patients’ quality of life and mobility (Posnett & Franks, 2008). In addition, patients may have sleeping difficulties due to painful wound (Posnett & Franks, 2008). Patients may become depressed, isolated and have impaired body image due pain and embarrassment of unpleasant wound odour (Santy, 2008).

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

The surveys were conducted between 1989 and 2005 predominantly in the US and showed an increase of 4.4% in number of nosocomial pressure ulcer prevalence rated with increase 6.3% in overall pressure ulcer prevalence rates. Nosocomial pressure ulcer prevalence rates were highest in long-term acute care facilities with anatomical location of greatest number of pressure ulcers being sacrum, hells and buttocks. The surveys also revealed that majority of Stage IV pressure ulcers were related to patients with dark skin: N=447,930 (total number of patients in survey), n1=1024 (dark skinned patients), n2 = 164 (dark skinned patients with Stage IV pressure ulcers). The incidence rates of pressure ulcers averaged at 5.4% which correlated with contributing factors of Braden Scores less than 18, serum albumin levels less than 3, fecal/urine incontinence, fragile skin and

Skin tears are traumatic wounds, which usually occur on the extremities of the elderly. Not to mention the amount of deaths that occur when skin breakdown doesn’t get treated. The article, “Preventing in –facility Pressure Ulcers, “ states that, “60,000 U.S. patients will die from complications related to hospital-acquired Pus”. (Preventing, 2013). When you think about all the different diseases and illness that can kill someone, pressure ulcer don’t normally come to mind. If we have less skin breakdown with the elderly, we can keep our facilities safer, less life-threatening problems, and have a more successful career as a nurse. There are many ways that you can treat pressure ulcers or skin breakdown in general, but people need to realize what patients are at more risk to develop skin integrity, the ways to prevent skin breakdown from the beginning, and how to treat skin tears when they appear before they can say that they know what skin integrity is. This concept paper will provide the key points on what to know about skin integrity. Who is more at risk, how to prevent them from occurring, and what to do if it does happen.

The first couple of paragraphs include an explanation of what is considered a complex wound and the current available treatments. It is beneficial that the authors include an explanation of what the problem is so that the reader can have a better understanding of why this issue is of concern. The paragraphs then transition towards the types of treatments available for the problem and a description of why the current treatments are not sufficient for restorative care.

The aim of this essay is to analyse the reasons attributed to my patient’s non-concordance with compression therapy for the treatment of venous leg ulcer (VLU) and its effect on the treatment and potential ways of dealing with non - concordance issues.