Whether a patient has Type 1 or Type 2 diabetes makes no difference when it comes to the effects on wound care. Several problems arise with diabetics and the way there body works to heal a wound and what problems they face. Throughout all of the articles I reviewed they each list common issues patients face with wound healing. There are several things that diabetics can do to prevent ulcers from forming and to prevent the possible return once they have healed. The following articles discuss several different problems associated with diabetes and wounds.
Patients who have diabetes are predisposed to greater risk factors in developing pressure ulcers. The healing process for these patients is a much longer duration than a patient who does not have diabetes. Impaired renal systems in a diabetic patient and uncontrolled blood glucose levels impair the healing process drastically. Diabetics develop neuropathy (numbness) in the feet, which is one of the leading causes of pressure ulcers and can lead to amputation of toes or the entire foot.
Most patients suffer some form of injury or trauma to the affected area and have no idea of the injury due to loss of sensation in the area, and then prolonged untreated wounds can develop necrosis which will lead to amputation. Diabetic patients have a prolonged inflammation phase of wound healing that can increase the possibility of infection that prolongs healing. The most important things to prevent in patients is blood loss and infection entering the wound (Sharp & Clark, 2011). Calciphylaxis in a diabetic patient is a large problem when it comes to caring for a pressure ulcer or any type of wound.
Calcium deposits in the blood vessels of the skin surface decrease blood profusion and can lead to dead tissue. Any untreated wound no matter where it is located on the patient can lead to infection and ulcer eruption. Treating patients with hemodialysis reduced the amount of calcium in the blood vessels and increased blood flow. In DIABETES 3 patients with calciphylaxis pain is a major factor when cleaning wounds and a team of specialist must come up with the correct cocktail of medications to help reduce the pain while cleaning any wounds.
Nutrition is a major concern in this case to maintain the proper levels to help the patient improve and not have the infection get worse (Kauric-Klein, 2012). In this study of surgical procedures and the development of pressure ulcers found that if patients are scored for risk factors upon initial assessment the team has an upper hand at preventing a problem before it happens. However it was noted that patients who have diabetes also had a 49% greater chance of developing a pressure ulcer after surgery.
Pressure ulcers have an increased chance of forming the longer a patient is on the table during a surgical procedure. The preferred scoring system in this study is called the Braden score and was more accurate on the risk factors for possible ulceration. Several different techniques are then put into place to help alleviate the potential of a pressure ulcer developing during or after the surgery. (Tschannen, Bates, Talsma, & Guo, 2012). In comparison of all of these articles one main focus was on a thorough skin assessment of each patient upon initial admission to the hospital.
Nutrition plays a major factor in helping patients with diabetes to aide in the healing process. Patients must be educated in maintaining a healthy blood glucose level in order for their bodies to function in a healthy manor. My role as a nurse will be to always make a thorough assessment of my patients on a daily basis and throughout my shift. Turning a patient every two hours if they cannot move themselves is a critical function. In a diabetic patient it is also important to look for moisture of any kind that can lead to skin breakdown.
Careful inspection of a patient by all staff involved in care will help to reduce or eliminate hospital acquired pressure ulcers. References DIABETES 4 Kauric-Klein, Z. (2012). Calciphylaxis: A Case Study. Nephrology Nursing Journal, 39(5), 406- 408. Sharp, A. , & Clark, J. (2011). Diabetes and its effects on wound healing. Nursing Standard, 25(45), 41-47. Tschannen, D. , Bates, O. , Talsma, A. , & Ying, G. (2012). Patient-specific and surgical characteristics in the development of pressure ulcers. American Journal Of Critical Care, 21(2), 116-125. doi:http://dx. doi. org/10. 4037/ajcc2012716.