Assessment and Management of Mr. Thompson’s Diabetic Foot Ulcer

Risk Factors for the Development of Diabetic Foot Ulcer in Mr. Thompson

1. Poor Glycemic Control: Mr. Thompson’s elevated fasting blood glucose level (240 mg/dL) and hemoglobin A1c of 9.5% indicate chronic hyperglycemia, which can impair the healing process and increase the risk of infections.
2. Neuropathy: Diminished sensation in his right foot suggests peripheral neuropathy, which can prevent Mr. Thompson from noticing injuries or ulcers until they become severe.
3. Peripheral Vascular Disease: The weak dorsalis pedis pulse indicates potential vascular insufficiency, which can limit blood flow to the foot and delay healing.
4. Obesity: With a BMI of 32, Mr. Thompson is classified as obese, which can contribute to poor circulation and increase pressure on the feet.
5. Sedentary Lifestyle: Lack of physical activity may contribute to overall poor health and can exacerbate complications related to diabetes.
6. Financial Constraints: Non-adherence to diabetic medications due to financial issues can lead to poor disease management and increased risk of complications.

Signs and Symptoms of the Diabetic Foot Ulcer in Mr. Thompson

1. Ulcer Characteristics: A deep, irregularly-shaped ulcer measuring approximately 3 cm x 4 cm located on the plantar surface of the right foot.
2. Drainage: Presence of purulent drainage with a foul odor, indicating possible infection.
3. Surrounding Skin: Erythema (redness), swelling, warmth to touch, and maceration of the surrounding skin.
4. Pain: Reports of pain associated with the ulcer.
5. Sensory Changes: Diminished sensation in the right foot, increasing the risk of further injury.
6. Vascular Signs: Weak dorsalis pedis pulse, indicating possible vascular compromise.

Other Assessments to Prioritize for Mr. Thompson’s Diabetic Foot Ulcer Management

1. Wound Assessment: Detailed evaluation of the ulcer’s size, depth, and appearance, including signs of infection or necrosis.
2. Peripheral Vascular Assessment: Further examination of vascular status, including assessing capillary refill time and temperature differences between limbs.
3. Neurological Assessment: Comprehensive evaluation of sensory and motor function in both feet to assess the extent of neuropathy.
4. Glycemic Control Monitoring: Regular monitoring of blood glucose levels to assess the effectiveness of diabetes management strategies.
5. Nutritional Assessment: Evaluation of dietary habits to ensure adequate nutrition for wound healing.

Nursing Interventions for Mr. Thompson’s Diabetic Foot Ulcer Management

1. Wound Care: Clean the ulcer using appropriate sterile techniques, apply suitable dressings that promote a moist healing environment, and change dressings as needed.
2. Pain Management: Administer prescribed analgesics as needed and assess pain levels regularly.
3. Glycemic Control: Collaborate with Mr. Thompson to develop a plan for better diabetes management, including medication adherence, dietary modifications, and blood glucose monitoring.
4. Patient Positioning: Educate Mr. Thompson on minimizing pressure on the affected foot, possibly through offloading techniques or using specialized footwear.
5. Infection Prevention: Monitor for signs of infection and educate Mr. Thompson on proper foot hygiene and care to prevent further complications.

Patient Education for Mr. Thompson Regarding Diabetic Foot Ulcer Management

1. Foot Care Practices: Instruct Mr. Thompson on daily foot inspections for cuts or blisters, proper cleansing, and moisturizing methods to prevent skin breakdown.
2. Importance of Glycemic Control: Educate about maintaining stable blood glucose levels to promote healing and prevent further complications.
3. Medication Adherence: Discuss strategies for managing medication costs and emphasize the importance of adhering to prescribed treatments.
4. Lifestyle Modifications: Encourage a more active lifestyle that includes safe exercises tailored to his abilities.
5. Signs of Complications: Educate Mr. Thompson about recognizing early signs of infection or worsening condition that would require immediate medical attention.

Interdisciplinary Team Members Involved in Mr. Thompson’s Diabetic Foot Ulcer Management

1. Physician/Endocrinologist: To manage diabetes treatment and optimize glycemic control.
2. Podiatrist: To provide specialized foot care and assessment for diabetic foot ulcers.
3. Wound Care Specialist: To assist in advanced wound management techniques and dressing selection.
4. Dietitian/Nutritionist: To help develop a meal plan that supports blood sugar control and promotes wound healing.
5. Physical Therapist: To assist in developing an exercise program that fits Mr. Thompson’s needs while considering his foot condition.

By addressing these aspects of care, a comprehensive plan can be developed to manage Mr. Thompson’s diabetic foot ulcer effectively while promoting overall health and well-being.