Treatment of Diabetic Foot Infections †Free Samples to Students

Question: Discuss about the Treatment of Diabetic Foot Infections. Answer: Introduction: Toula Giannopoulos, a 56 year old female has been admitted to the surgical ward for ongoing management of infected diabetic ulcer on her right foot. Before planning care plan for Toula, the important nursing assessment that would be necessary for Toula would include: Conducting physical assessment and reviewing comprehensive health history of patients Physical examination of affected limbs in relation to location, classification of foot ulcer. Length, depth and width of wound. The nurse will also assess exudates and odour of wound Nursing assessment and documentation of pain in Toula by considering the pain history, location, intensity and patients understanding of pain Assessment of ADLs (activities of daily living) in Toula by observing gait abnormality in patients and ability to exercise (Alavi et al. 2014) In response to pain assessment and assessment of ADL in Toula, the important nursing intervention for Toula would be to provide non-weight bearing devices such as crutches or wheelchairs to patient to reduce pain and reduce pressure in foot. This would facilitate healing of diabetic foot ulcers (Bus et al. 2017). In addition, management and care of wound in the right foot would also be essential to prevent infection and promote healing. The Enrolled nurse will also play a critical role in educating Toula to prevent injury and take care of the diabetic foot. Another important nursing intervention would be to provide appropriate medication to patient to manage pain and promote recovery of wound (Dimitriadou and Lavdaniti, 2017). The review of medical history of Toula has revealed that she suffered from uncontrolled Type 2 Diabetes, hypertension and obesity. Uncontrolled diabetes is the main risk factor that has contributed to the development of her diabetic foot ulcer. This is because uncontrolled diabetes is one of the major risk factor for diabetic foot ulcer. About 10% people with diabetes are likely to develop ulcer loose normal nerve functioning due to peripheral diabetic neuropathy. Due to this condition, patients like Toula loose pain sensation in foot and they cannot sense any damage to their foot in case of bruises or cuts (Strauss et al. 2016). Hence, small cuts or bruises eventually develop into diabetic foot ulcers because blood flow to the feet is restricted in diabetic patients and it has a negative impact on healing process. Debridement is one of the treatment options for patients with diabetic foot ulcers to prevent further complication and increase the pace of ulcer healing. After the process of debridement in Toula, there are chances of many negative or positive implications in patient. The first implication might be that ulcer healing process may enhance and patients might be discharged early from hospital. However, there is also chance of acute infection in patient after the debridement process due to poor hygiene standards in hospital setting. MRSA (Methillin-resistant S. aureus) is often a causative agent in diabetic foot infections in hospitalized patient because of contact with other patient with MRSA. The implication of MRSA infection is that the characteristics of wound will change in patient and their discharged may be delayed (Edmonds 2009). Such infection will also create treatment challenges for clinicians. Toula also developed MRSA infection after debridement evident from the assessment o f wound swab. Hence, she had to be hospitalized again to manage the infected diabetic ulcer. Another implication of debridement is that debridement will have an impact on living arrangement and ability to perform ADLs. The patient may lose normal capacity to mobilize and they may require walking aid and other mobility devices to reduce pressure on foot. Toula experienced mobility issues due to excessive pain in her right foot after MRSA infection post debridement. Toula had a wound at her foot which had aggravated and formed ulcer. This can be treated by the help of dressings. The dressings reduce the moist environment of the wound and helps in curing the wound (Mills, Cowin, and Kaur 2013). Simple gauze is used along with the hydrogels which is effective in drying the ulcers by holding the tissue and helps in dying of the cells. The ability of absorption of the dressing must be according to the amount of the wound which can reduce the maceration of the skin surrounding the wound. The purpose of the dressing is assisting the process of the healing and preventing the bacterial proliferation. These bacterial proliferations are generally harmful for the formation of the healthy tissue. Hence the regular dressing is needed to cure the wound (Baltzis, Eleftheriadou, and Veves 2014). Metformin The dose prescribed to Toula is 1g BD (twice per day). It is used to control the high level of sugar in blood. It is generally prescribed to the patients those who are having type-2 diabetes. This medicine controls the blood sugar and prevents the damage in kidney, reduces risk of blindness, reduction in nerve problems, and sexual dysfunction. The most common side effects of this medicine are diarrhea, abdominal discomfort, irregular breathing and many more. The nurse must look after the patient (Potter et al. 2016). Metoprolol The dosage prescribed for Toula is 50mg BD. It is used for treating angina and hypertension to prevent heart attack. The side effect of this medicine is shortness of the breath, blurred vision, pain in chest irregular heart beat and many more. The nurse must take care of the patient. Panadeine forte The dosage prescribed is 2 tablets PRN (as needed). It is used to treat, control and prevent the fever, flu and various other pains. For toula it had been prescribed to reduce the pain of the foot ulcer. The side effects of panadeine forte are nausea, vomiting, constipation, dizziness, rashes, sweating and other symptoms as well. The nurse should take care that the medicine does not cause any severe effects (Koutoukidis, Stainton, and Hughson 2016). Endone The dosage provided is 10 mg PRN. It is to relieve from moderate to severe pain. The side effects of Endone are nausea and vomiting, dizziness, indigestion, hypotension and confusion. As this medicine causes some problems so the nurse must be careful while giving the medicine to Toula and must provide proper amount of medication so that she must not face any problems that are been caused from the medication. Benzyl penicillin Dosage of Benzyl penicillin prescribed to Toula is 1.2g BD. It is used to treat for most of the wound infections, infections of skin, tissue, nose, throat, respiratory tract and many more. The side effects of this medicine are reactions in the injected site, mild rashes in skin, vomiting, stomach upset and so on. The nurse generally used to inject the into the body, so they must be careful and take care of the patient so that the infection. After the detection of MRSA infection in Toula 7 days post debridement, there is a need to provide range of treatment options to her. This includes the following: Firstly, Toula needs to be given appropriate medication for pain relief and infection control. The Enrolled Nurse can provide appropriate pain medication to patient as ordered by clinician. To treat MRSA infection in Toula, there is also a need to provided antibiotics to patients such tetracycline drugs and Rifampin to cure skin and soft tissue infection due to colonization of MRSA in wound site (Chen, Giurini and Karchmer 2016). Acute pain was one of the major problem in Toula as the physical assessment of pain in Toula has revealed a pain score of 8/10. Her pain was found to worsen on movement and she was not able to bear weight too. In such scenario, another treatment option for Toula is pain management. To address the problem of weight bearing, one of the possible solutions would be to provide pressure offloading intervention to Toula. Some of the strategies for pressure offloading include proving bed rest, wheel chair half shoes, therapeutics shoes or crutch-assisted gait to Toula. This will help in pressure modulation, reducing pain and healing of plantar diabetic foot ulcers (Wu et al. 2008). Pain in patients after MRSA infection had affected her ability to mobilize. Hence, this disability may affect her ability to perform ADLs. In such case, it would be necessary to refer Toula to appropriate services that can help her in improving her gait pattern. Complementary treatment like physiotherapy, exercise and shoe modification will be essential to improve her gait pattern (Turan et al. 2015). Toula can be referred to the following services following discharge from hospital: Physical therapy and rehabilitation service to improve mobility and quality of life. Rehabilitation service will support Toula in preventing further complications and regular assessment of foot. Physical therapy may also promote reducing debridement effect and improving blood flow to the feet. Orthopedic service to detect chances of spreading of foot ulcer or its impact on bones and other tissues (Turan et al. 2015). Reference Alavi, A., Sibbald, R.G., Mayer, D., Goodman, L., Botros, M., Armstrong, D.G., Woo, K., Boeni, T., Ayello, E.A. and Kirsner, R.S., 2014. Diabetic foot ulcers: part II. Management.Journal of the American Academy of Dermatology,70(1), pp.21-e1. Baltzis, D., Eleftheriadou, I. and Veves, A., 2014. Pathogenesis and treatment of impaired wound healing in diabetes mellitus: new insights.Advances in therapy,31(8), pp.817-836. Bus, S.A., Deursen, R.W., Armstrong, D.G., Lewis, J.E.A., Caravaggi, C.F. and Cavanagh, P.R., 2016. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.Diabetes/metabolism research and reviews,32(S1), pp.99-118. Chen, S.Y., Giurini, J.M. and Karchmer, A.W., 2016. 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