MANAGEMENT OF LOWER EXTREMITY WOUNDS TO PREVENT AMPUTATION IN TYPE II DIABETES

It affects the way in which sugar (glucose) is metabolized in the body. This condition causes the body to either resist the effects of insulin in the body or not produce enough insulin that is required to maintain sugar balance in the body. It is most common in adults, but, with the increase in obesity rates, children have also been reported to having the condition. Apparently, there’s no cure for Type 2 Diabetes. However, with a proper diet, adequate exercise and maintaining the appropriate weight, the condition can be managed. The Spirit of Inquiry Ignited The condition can very easily be ignored, especially when in its early stages when one feels fine. However, many vital organs, including the heart, blood vessels, nerves, eyes and kidneys, are usually damaged.

This is why it is important to control the blood sugar levels. Even though these complications develop over time and are long-term, they can cause disabilities and, even sometimes, death. Diabetes increases the likelihood of developing cardiovascular complications including angina (coronary heart disease with chest pains, heart attack, atherosclerosis (narrowing of the arteries, stroke or high blood pressure. As stated earlier, Type 2 diabetes damages the blood vessels that feed the nerves. This causes a tingling, burning and painful feeling in the toes and fingers, that could spread to the entire body that if not treated early enough could lead to loss of sensation in the limbs. Damage of the nerves in the feet and even poor circulation of blood to the feet could increase the complications in the foot.

If cuts, bolsters and other wounds are left untreated, they become really infectious leading to poor healing. In severe cases, the damage could also lead to amputation of the toes, feet or legs. Since most of the studies reviewed did not give comments on the allocation method, other than just stating that the subjects were randomly picked, allocation concealment was not used to select absence of bias. The external validity was also analyzed, and considered adequate only if the population that was assessed represented the entire target population, or if there was no significant differences between the participants of the population and the nonparticipants. Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented The positive effects of self management on the knowledge, frequency and accuracy of diabetic lower extremity wounds were demonstrated with studies showing the impact of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control in patients that were followed up for about six months.

The effects of local wound care with venous and arterial vascular interventions when necessary, with a longer follow-up have shown considerable results. Educational interventions and involving patients might be more effective in wound management than medication. This results in lower extremity ischemia in which the arch (forefoot) experiences pain when resting, especially during the night, a condition known as claudication. In other cases problems such as absent popliteal or posterior tibial pulse, thinned or shiny skin and absence of hair on the lower leg and thickened nails, and redness of the affected area, may also occur (Garrod, 2014). A third cause is the poor control of glucose which delays the healing process of wounds in the body. During the healing process in diabetes, two main factors are involved including intrinsic and extrinsic factors.

Intrinsic factors contribute in the granulation tissue and collagen formation, poor tensile strength in deep wounds, capillary ingrowths that tend to be deficient as well as defective immune function, and they include hyperglycemia and deficiency of insulin. In case the bone ad skin move in opposing directions when walking, or if a sprain occurs, when one is walking, the resulting shearing stress causes injury in the foot (Williams, Powell-Chandler, Qureshi, Zaidi, & Whitaker, 2017) In addition, a history of foot ulcers or lower extremity wounds could also result in foot damage as these patients could have alterations in foot dynamics and abnormal distribution of plantar pressure. Patients who have obesity and gain excessive weight, are prone to foot injury as they increase the pressure in the plantar surface of the foot.

Moreover, walking on hot sand or cool waters without foot wear, being unable to find out about foot problems early enough due to poor vision as well as ignorance about foot complications and care of foot wounds are contributing factors to lower extremity wounds (Dalla, 2013, pp. Lower extremity wounds in diabetes are classified into five different stages, Stage 1 to Stage 5. The first stage is the normal foot. 118) The forth stage is where infections caused by bacteria, fungi and other microorganisms occur. In this stage, the control of microorganisms is essential. If the infection is severe, intravenous antibacterial treatment together with urgent assessment whether there is need for a surgery to drain debride the wound, are very important. Severe microbiologically infected wounds certainly advance to necrosis, if left untreated.

The last stage is necrosis, the most advanced stage of lower extremity wounds. Seamless sock and lined boots help keep the patient warm especially if the feet are cold during the winter season (Talarico, 2014). Diabetic patients should wash their feet using a dry clean cotton cloth, and warm water before going to bed, and moisturizers applied, though not between the toes to help prevent cracking. The patient can be advised to use a pumice stone to rub the foot in one direction to help remove dead cells from the sole of the foot. Inspecting one’s foot and between the toes, with the help of a mirror by oneself should be done regularly. A combination of this with the cutting the feet nails straight across, and trimming the toe nail with nail file, not to cut corners of the nails to prevent ingrown of nail and palpation of pulses in foot done by the nurses helps prevent further damages on the foot.

This gives one the opportunity to walk freely and helps avoid injury to the toes and nails. A very loose fitting shoe, on the other hand, causes stress on the skin which could be injured if straps come into contact with it. In the one might get blisters. To ensure that the toes are well accommodated and rest on a flat surface without being cramped, the front of the shoes should be wide enough. If the fitting of the shoes is narrow, then corns at the tip of the toes or between them could develop. However, with appropriate preventive measures together with patient education, ulcer formation and the frequency in amputation will be reduced greatly and also cut down healthcare costs.

The general health of diabetics is known through the feet all over the world. It is the responsibility of the nurses to enhance education on foot care as soon as diabetes is detected. Appropriate action should be taken to ensure that patients with diabetes get the best possible foot care. References Berlanga-Acosta, J. , & Bisdas, T. Validation of the Wound, Ischemia, foot Infection (WIfI) classification system in nondiabetic patients treated by endovascular means for critical limb ischemia. Journal of Vascular Surgery, 64(1), 95-103. doi:10. 1016/j. 0042c. x Edmonds, M. Chapter-17 Advanced Wound Healing Products and Techniques. Contemporary Management of the Diabetic Foot, 153-158. doi:10. 109/WON. 0000000000000405 Garrod, K. Prevention of Ulceration and Amputation, by Neurolysis of Peripheral Nerves in Diabetics with Neuropathy and Nerve Compression: Decisiontree Utility Analysis.