Clinical Study Of Wound Healing Effects Of Novel

Diagnosis of the chosen individual: 

Presenting Problem:

The given scenario involves an elderly (70 year old) male patient, Mr X (name withheld) suffering from Diabetic foot injury. The patient has a large wound on the left great toe and under the heel, and is accompanied by bleeding (from the injured site) and pain in the left foot. The wound is also accompanied by swelling and discharge of exudates, and a bad smell. The wound is on the plantar and lateral aspects of the foot and toe.

Other Medical Conditions:

The patient has a history of Diabetes type 2, as well as hypertension, obesity and renal dysfunction.  The patient also suffers from terminal neuropathy, which was caused due to Diabetes, and has resulted in a reduced sensation in the lower extremeties such as the foot.

The type of wound and how it occurred

The patient experienced an accidental injury to his left foot while walking. However, due to his terminal neuropathy caused by Diabetes, he never felt the injury, and subsequently led to the infection of the wound, bleeding and pain (Feldman et al., 2017). The injury was aggravated by the improper foot protection worn by the patient at the time of injury.

Evaluation of the wound

Wound bed status:

The wound bed is dark red in color, and bleeds upon contact. The wound shows signs of unhealthy granulation and infections. The wound bed is also covered with necrotic tissue, which produces a pus like exudate, and produces a rotting smell.

Wound measurements:

The 2 inches in length and 1 inch wide, and 0.1inch deep

Condition surrounding skin

The skin surrounding the injury shows a discoloration, and swelling. The peri wound skin also shows signs of maceration and excoriation. The skin is however intact around the wound.

Wound exudates

The wound also produces brownish yellow exudates, and is accompanied by a putrid smell. The exudates are also sticky in nature, with high viscosity, and contain necrotic materials.

 Table 1: Wound assessment; Source: (Greatrex?White et al., 2015; Logan, 2015).

Actual or potential impacts of the wound:

Due to the nature of the diabetic foot injury and ulceration, the life of the patient is affected by different factors caused by the injury/ulcer, such as:

Effect on the quality of life

The diabetic foot injury have resulted in a drastic reduction in the quality of life of the patient, due to a loss of mobility (as the patient finds it increasingly difficult to move about because of the foot injury) and thus perform simple activities like leisure activities, and socializing with others. The patient is no longer able to meet his friends or go on walks with his wife. This has also made the patient more irritable and depressed (Pickwell et al., 2017).

Pain

The chronic pain associated with the injury/ulcer has also made the patient over cautious to walk, and the constant pain has also made it difficult for the patient to focus on anything or enjoy anything properly. The pain has also resulted in anxiety and irritability exhibited by the patient. The patient also is unable to perform the activities of daily living due to the pain.

Physiology of the healing process and how different factors impacts the process

Healing of a wound is a complicated process that occurs in several stages, that involves the process of blood clotting in which activated platelets and fibrin in the blood produces a blood clot on the wound, followed by an inflammation phase where white blood cells destroy the cellular debris and releases various growth factors. These growth factors then cause proliferation of the cells, which promotes the growth of new tissues and is finally followed by maturation and remodeling of the cells, which marks the completion of the healing process of the wound (Singh et al., 2017).

Factors that affects the normal healing process of the wound includes: a) Poor blood circulation which prevents proper circulation of blood in the foot, making wounds harder and longer to heal. b) Hyperglycemia or high blood sugar also slows down the healing process c) diabetic neuropathy reduces the sensitivity of the foot pain and thus of foot injuries (causing painless wounds, which develops to ulcers) d) Age also causes reduction in the healing process and thus can prolong ulcers e) Loss of balance and improper gait can also increase the risks of injuries to the foot (Harper et al., 2014; Wong et al., 2015).

Evaluation of Wound management plan:

Dressings

Different dressing can be used for diabetic foot injuries such as:

1.Low Adherence: which is simple and inexpensive hypoallergic dressing, however has minimal absorbency.

2. Hydrocolloid dressing which can be left for several days and used to aid autolysis, however can cause maceration, unpleasant odours and can be ineffective on infected wounds.
3. Iodine preparations which can be used as antiseptics however can cause iodine allergy and discolored wounds.

(Jeffcoate et al., 2018)

Frequency of Dressings and change

The dressing is to be changed daily, and the status of the wound should be checked every time.

How the wound is cleaned

The wound can be cleaned by the process of debridement. For debridement surgical removal of necrotic tissue as well as usage of fly larva can be utilized as well as autolytic and hydro surgery procedures. Surgical debridement can allow the removal of the necrotic tissues, reducing pressure, can allow the drainage of exudates and pus and promote healing (Bilyayeva et al., 2017).

Progress made

The progress can be evaluated from improvement in the condition of the wound and signs of healing of the wound.

Changes that occur to the plan during clinical placement

Changes to the care plan would depend on the status of the wound as well as that of the chronic condition(s) the patient is suffering from.

Table 2: Wound care

Health Education that can be provided to the individual in regards to the wound:

The patient can be educated to keep the blood glucose under check, keep the wound clean and properly bandaged, cleaning the wound regularly and changing the bandages, avoiding walking barefoot, and wearing appropriate footwear. The patient can also be educated on healthy diet options, which can help to reduce the risks of co morbidities (like obesity, diabetes, renal dysfunction and hypertension) and advise on the types of activities the patient can involve in in order to meet the daily exercise requirements. The patient can also be educated on strategies to self care the wound and also reduce the incidence of further such wounds. Exercise routines focused on improving the gait and balance of the patient, and reduce obesity, and meditative practices to alleviate hypertension can also be suggested top the patient, as well as other methods which can help to improve the diet (such as choosing food rich in fibre and low in saturated and trans fat. It is also essential for the patient be educated on healthy and unhealthy fats, and their sources, and how they affect the body, especially in relation to the co morbidities and clinical diagnosis of the patient (Margolis et al., 2015; Baba et al., 2015; Dorresteijn et al., 2014).

Pain management related to the wound:

Table 3: Pain management medications

Wound Care Assessment Plan

Table 4:Wound care assessment

References:

Baba, M., Duff, J., Foley, L., Davis, W. A., & Davis, T. M. (2015). A comparison of two methods of foot health education: The Fremantle Diabetes Study Phase II. Primary care diabetes, 9(2), 155-162.

Bilyayeva, O. O., Neshta, V. V., Golub, A. A., & Sams-Dodd, F. (2017). Comparative clinical study of the wound healing effects of a novel micropore particle technology: effects on wounds, venous leg ulcers, and diabetic foot ulcers. Wounds: a compendium of clinical research and practice, 29(8), 1-9.

Dorresteijn, J. A., Kriegsman, D. M., Assendelft, W. J., & Valk, G. D. (2014). Patient education for preventing diabetic foot ulceration. The Cochrane Library.

Feldman, E. L., Nave, K. A., Jensen, T. S., & Bennett, D. L. (2017). New horizons in diabetic neuropathy: mechanisms, bioenergetics, and pain. Neuron, 93(6), 1296-1313.

Greatrex?White, S., & Moxey, H. (2015). Wound assessment tools and nurses' needs: an evaluation study. International wound journal, 12(3), 293-301.

Harper, D., Young, A., & McNaught, C. E. (2014). The physiology of wound healing. Surgery-Oxford International Edition, 32(9), 445-450.

Jeffcoate, W. J., Vileikyte, L., Boyko, E. J., Armstrong, D. G., & Boulton, A. J. (2018). Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes care, 41(4), 645-652.

Logan, G. (2015). Clinical judgment and decision-making in wound assessment and management: is experience enough?. British journal of community nursing, 20(Sup3), S21-S28.

Margolis, D. J., Hampton, M., Hoffstad, O., Scot Malay, D., & Thom, S. (2015). Health literacy and diabetic foot ulcer healing. Wound Repair and Regeneration, 23(3), 299-301.

Pickwell, K., Siersma, V., Kars, M., Apelqvist, J., Bakker, K., Edmonds, M., ... & Piaggesi, A. (2017). Minor amputation does not negatively affect health?related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study. Diabetes/metabolism research and reviews, 33(3).

Singh, S., Young, A., & McNaught, C. E. (2017). The physiology of wound healing. Surgery-Oxford International Edition, 35(9), 473-477.

Wong, S. L., Demers, M., Martinod, K., Gallant, M., Wang, Y., Goldfine, A. B., ... & Wagner, D. D. (2015). Diabetes primes neutrophils to undergo NETosis, which impairs wound healing. Nature medicine, 21(7)