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Medical Surgical Nursing
[A CASE STUDY OF A PATIENT WITH DIABETES RIGHT FOOT ULCER]
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2.11 MANAGEMENT OF PATIENT WITH DIABETES FOOT ULCER
1. Objective of Management
• To correct hyperglyceamia and glycosuria
• To maintain normal weight and strength
• To prevent complication
• To promote wound healing
(A) MEDICAL MANAGEMENT AND TREATMENT
The management of diabetic foot ulcers required offloading the wound by using appropriate therapeautic foot wears, daily saline or similar dress to provide a moist wound environment, debridement when necessary, antibiotic therapy, if osteomyelitis or cellulitis is present, optimal control of blood glucose, and evaluation and correction of peripheral arterial insufficiency.
Wound coverage by cultured human cell or heterogenic dressing/ graft, application of recombinant growth factor and hyperbaric oxygen treatment may be beneficial at time, but only if arterial insufficiency is not present. Physician of diabeteic patient with ulcer most decide between the sometimes conflicting option
I. Performing invasive procedures (e.g angiography by-pass surgery) for limb salvage
II. Avoiving the risk of unnecessarily aggressive management in those patient who may have significant cardiac risk
MANAGEMENT OF SYSTEMIC AND LOCAL FACTOR
a) Wound coverage: after debridement apply a moist sodium chloride dressing or isotonic sodium gel (normal gel ). Optimal wound coverage requires wet-to-dry pressing which support autolytic debridement,absorb exudates,and protect surrounding healthy skin. A polyvinyl film dressing (opsite,tegadern)that is semipermeable to oxygen and moisture and impermeable to bacterial is a good choice for wound that are neither very dry nor highly exudative.
b) Vacum-assisted closure ,clean but healing deep cavity wound may respond to repeated treatment by application of negative pressure under exclusive wound dressing.
c) Hydrotherapy; intractable, infected, cavity wound sometimes improve with hydrotherapy using saling pulse lavage under pressure.skin graft;the autologos skin graft is the criterion standard for viable coverage of the partial thickness wound.The graft can be harvested under local anaesthesis as an outpatient procedure. meshing the graft allows wider coverage and promote drainage of serum and blood (Harrison, 2011).
MEDICATION SUMMARY
Many medications may have a role in treatment of diabetes,the complication of diabetes and the etiologies of diabetes ulcer’For example hemorheologic agent and anti-platelet agent are sometime used in the management of underlined arteriosclerotic disease. The role of aspirin however remain unclear.
 
(B) NURSING MANAGEMENT OF DIABETES FOOT ULCER
Diet, diet is a major factor in controlling diabetes ulcer. The diet should be individualized and based on the type of foot ulcer, possible complication, cultural, socio-economic factor and principle of good nutrition
Dietary plan should indicate daily calorie requirement based on the patient ideal weight, age, sex, activity, the presence of other complication e.g infection and insulin therapy
Obesed diabetes should be given reduce calorie to bring about gradual and stead lost of weight. Generally the acceptable proportion of calories in diabetes diet is approximated below
Carbohydrate 50%
Protein 15%
Fat 35%
In ensuring adequate supply of carbohydrate wheat grain bread, high fibre cereals, milk, fruit and vegetables are preferable than concentrated simple sugar such as, sugar sweet, ice cream, honey, cake, and sweeten beverages which are strictly restricted.
Fat selection should include only unsaturated fat because of the risk of developing arteriosclerosis and vascular lesions
ASSESSMENT
The admitting nurse should take a detailed history and perform a physical examination including skin and wound assessment. The admitting nurse should recommend dressing that would increase wound hydration(citation )
2.12 PREVENTION OF DIABETES MELLITUS FOOT ULCER
 Screening; frequent screening should be done (e.g urine testing)in order to detect early trace of diabetes.
 Genetic counseling; family disease should be ascertained before marriage to prevent occurrence of diabetes in the family.
 Proper diet; high intake of carbohydrate food should be minimized in order to prevent diabetes mellitus.
Order preventive measures and management of diabetic complication consist of the following;
I. Lifestyle modification
II. Blood pressure control
III. Lipid management
IV. Glycaemic control
V. Smoking ceasation
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ABSRACT - [ Total Page(s): 1 ]ABSTRACT IS COMING SOON ... Continue reading---
TABLE OF CONTENTS - [ Total Page(s): 1 ]TABLE OF CONTENTTitle page Certification Dedication Acknowledgement Table of content CHAPTER ONE INTRODUCTION Background of the study Purpose of the study Significant of the study CHAPTER TWOLITERATURE REVIEW OF DIABETES MELLITUS FOOT ULCER Definition of diabetic foot ulcer Causes of diabetes foot ulcer Risk factor for diabetes foot ulcer Foot ulcer assessment and classification Pathophysiology of diabetes foot ulcer Clinical manifestation of diabetes foot ulcer Complication ... Continue reading---
CHAPTER ONE - [ Total Page(s): 1 ]CHAPTER ONE1.0 INTRODUCTION1.1 BACKGROUND OF THE STUDYThis case study was carried on Alhaja A.H, a 60years old trader who has right foot ulcer, patient was brought to accident and emergency unit on 30th march, 2017 with clinical diagnosis of right foot ulcer and later transfer to ward 2. Approximately 15 to 20 percent of estimated 16million persons in the united state with diabetes mellitus will be hospitalized with a foot complication and also estimated in Nigeria (Har ... Continue reading---
CHAPTER THREE - [ Total Page(s): 2 ]CHAPTER THREE3.1 DEMOGRAPHIC DATA AND HISTORY OF THE PATIENT Particular of a patient with diabetes mellitus foot ulcer  Name Alhaja A.H  Age 60years  Sex female Ethnicity Yoruba State of origin Kwara state  Folder number 01-31- ... Continue reading---
CHAPTER FOUR - [ Total Page(s): 4 ]CHAPTER FOURMANAGEMENT OF THE PATIENT WITH DIABETES MELLITUS4.0 PHYSICIAN SYSTEMIC REVIEW The findings made on the patient based on systemic review are as follows  PHYSICAL EXAMINATIONPhysical examination of the extremity having a diabetic ulcer can be divided into 3broad categories  Examination of the ulcer and the general condition of the extremity  Assessment of the possibility of vascular insufficiency  Assessment for the possib ... Continue reading---
CHAPTER FIVE - [ Total Page(s): 1 ]CHAPTER FIVESUMMARY, CONCLUSION AND RECOMMENDATION5.1 SUMMARY This care study was carried out on a 65years old woman Alhaja A.H who was admitted on 28th march 2017 in to the female medical ward (ward2) of the Kwara state general hospital Ilorin, with diagnosis of right foot ulcer secondary to diabetes mellitus Different literature was reviewed based on the patient condition under the following headings:- definition of the diabetes mellitus, causes, incidence, anatomy and physiology ... Continue reading---
REFRENCES - [ Total Page(s): 1 ]REFERENCEMustapha, R.O (2010) Pharmacology for all health profession. 3rd Edition, Ilorin, Gorge Bullet LTDRoss, J.S & Wilson, K.W.J (2010). Anatomy and Physiology in Health and Illness. 9th edition, London, Harrison, R.O (2011) Textbook for Medicine with Relevant Anatomy and Physiology. 2nd Edition, Bougary Suffolk, Chaucer press ... Continue reading---
