Medical Surgical Nursing
[A CASE STUDY OF A PATIENT WITH DIABETES RIGHT FOOT ULCER]

Hyperglycemia produce oxidative stress on nerve cell and lead to neuropathy. Additional nerve dysfunction follows from glycosylation of nerve cell protein, leading ischemia. these cellular changes manifest in motor,  autonomic, and sensory component of neuropathic foot ulcer. Damage to motor neuron of the foot musculature may lead to an imbalance of flexors and extensors, anatomic deformities, and eventure skin ulcerations.Damage to autonomic nerves impairs sweat gland function,and the foot may develop decreased ability to moisturize skin,leading to epidermal cracks and skin break down.Lastly patient may not notice foot wound because the blood supply require to heal diabetes foot ulcer is greater than that needed to maintain intact skin, chronic ulceration can develop.
(Hopkin. J. (2010).
Vascular changes that lead to diabetes foot ulcer correlate with hyperglycemia-induced-changes in peripheral artery of foot and begine on the cellular level.Endothelia cell dysfunction lead to a decrease in vasodilator also.Plasma thromboxane A2 levels become elevated.The result is vasoconstriction and plasma hypercoagulation in peripheral arteries leading to ischemia and increased of ulceration.
Fryberg, (2011)
2.60    CLINICAL MANIFESTATION OF DIABETES FOOT ULCER
According to Ross and Wilson (2010)  said that diabetes foot ulcer posses several manisfestation which are as follows
    Polyuria  excessive passing of urine
    Polypesia excess thirst due to fluid lost
    Glucouria
    Polyphagia
    Dehydration
    Pruritus vulva
    Weakness
    Fatique
    Weight loss
    Blurred visision
    Numbness and tingling sensation in the extremities resulting from peripheral neuritis
2.70    COMPLICATION OF DIABETES FOOT ULCER
According to Harrison (2011) complication of diabetes foot syndrome include the following
    Infection, this is one of the complication boils carbuncles, cystitis, pylonephristis and pneumonitis.  Monllial infection of the vulva causes pruritus vulvae
    Renal disease, pylonephritis, diabetes kidney (kimmelotiel Wilson-syndrome)  a chronic degeneration of the glumeruli which causes albuminuria and finally renal failure
    Retinopathy i.e hemorrhage exudates and micro- aneurism in the retinal and optic atrophy which may lead to blindness
    Neuropathy, damage to the peripheral nerves and it causes tingling in the fingers and toes, lost of tendon reflexes and painless ulcer of the skin.  Untreated pregnant diabetes may have large babies, abortion or still birth
    Coma, this may occuer in a patient receiving insulin or hypoglyceamic drugs
    Cardiovascular disturbances, diabetes mellitus is a significant risk fact for cardiovascular disorders.  Changes in blood vessels (angiopathies).  May still occur when the disease is well controlled.
2.80    WOUND HEALING
    According to Mustapha (2012), Woundhealing either by first (primary)intention or secondary (seconday)intention.nevertheless, the healing process is identical .the only difference is the quantity of tissue require to heal the wound.
             Wound heal by first intention expercially in incised wound where the skin edges cause by sharp object are in a position require only thin line of tissue to produce healing. Healing by second intention take place in gaping wound where the edges of the wound are not in apposition duew too  much lost of tissue by injury or disease,thus requiring larger quantity of new tissue to fill the gap.
               The process of wound healing occure in stages as belo
1.    TRAUMATIC OR INFLAMMATORY STAGE
       This occur between time of injury up to 24hours,and it is the process by which the body react to an irritant which may be chemical or mechanical injury caping the wound whenever the skin is incised ,This mean that the epidermis and the dermis of the skin and the blood vessel have been damaged. Histamine is then release by the damage tissue to stimulate the capillaries to dilate to enable more blood to flow to the area and to become more permeable to phygocyte and plasma proteins. Blood then escape from this injured vessel to fill the gap.AS at this time, signs and symptoms of inflammation will appear at the wound site.
2.    REGENERATIVE OR REPAIR OR PROLIFERATION STAGE
        This is the process by which damage cell are been replaced similer cells.This take place between 2-5days.within some few minute following inflammatory stage,the blood clothing mechanism begin,headind to the formation of gluerlike met of cell called fibrin and blood cloths.Fibrin help to bind the edges of the wound together.cellular debris from epidermis move the blood to the wound to fill the gap.The phygocyte neutrophil and monocyte move from the blood vessel to demolish the blood clot by ingesting the micro-organism, cellular debris and forign matter within the blood clot. less then 24hours later, the cloted area dehydrated forming a scab on wound surface.