DIABETIC ULCER

Diabetic Ulcer



Diabetic Ulcer

Overview of the patient/client

Name: Sadie Juruli

Age: 64yrs

Occupation: Community elder & retired on pension.

Living situation: Lives with husband, daughter aged 32yrs & three grandchildren aged 16yrs, 15yrs & 10yrs. Husband retired on pension. Daughter works full time.

Ethnicity: Indigenous Australian

Leisure: growing vegetables in garden

Comorbidites: Smokes 15 cigarettes /day; Diabetes mellitus-type 2; Hyperlipidaemia; Hypertension

Health history: Recurrent respiratory infections.

A week ago, Sadie was tending to her vege garden and wearing her daughter's outdoor shoes which were a little tight across the plantar area. Last evening, when she lay on the couch rest at the end of the day, her granddaughter noticed a large sore surrounded by callous formation on the ball of her foot. She had no pain. Her daughter bought her to the Emergency department last night for assessment. The Dr diagnosed an infected diabetic neuropathic foot ulcer, admitted her for treatment and commenced her on an IV infusion of NaCl 0.9%, 1 litre 12 hourly, and antibiotics.

Now, being a nurse, I am allocated to Sadie's this morning. On assessment of her foot ulcer, I have observed that the ulcer is an irregularly shape, red at the base, with eschar at the top right and bottom centre of the periphery. The remaining edges are creamy in colour and dry. There is evidence of tunnelling at 10 o'clock. There is a slight pungent odour and on receiving the lab report there is pseudomonas in the wound. Sadie reports no pain, but is upset that she has to use crutches to mobilise with my assistance. Her vital signs are: T 38¡ÆC; BP 128/90; P 84; RR 18.

Foot infections are soft tissue infection most common in diabetics and can lead to osteomyelitis, amputation or death. The spectrum of infections ranging from localized cellulitis to necrotizing fasciitis infections with deep and / or osteomyelitis. The presence of local inflammation, pus or crepitus indicates infection, but their absence does not rule out osteomyelitis and can be seen under a non-inflammatory ulcer. Moreover, the existence of signs of inflammation in non-ulcerated foot can correspond to a Charcot arthropathy. Systemic symptoms such as fever or chills, like leukocytosis, are only present in one third of cases of infection. Hyperglycemia is common instead.

Describe the process and tools you would use to conduct a comprehensive assessment of the client's wound(s) or pain.

The tool I would use for the patient's ulcer treatment is TcPO2. Transcutaneous oxygen tension measures oxygen tension in areas adjacent to a wound and has been suggested as a diagnostic tool for assessing the probability of wound healing. TcPO2 measurements aid in selecting patients with foot ulcers who may benefit from the addition of hyperbaric oxygen (HBO) therapy to heal chronic wounds.

The diabetic foot ulcer is a sore or open wound which generally occurs in the foot in approximately 15 percent of patients with diabetes. Six percent of diabetics who have a foot ulcer need to be hospitalized due to infection or other ulcer-related ...