AGNES SMITH
1. Action point: Identify the factors that could be affecting wound healing for Mrs Smith. For each factor identified, discuss the underlying patho-physiology.
· Micro vascular disease Diabetes frequently leads to blood vessel constriction. Various forms of vasculitis (blood vessel inflammation) frequently cause vessel walls to harden, thicken, and develop scar tissue, decreasing their diameter and impeding blood flow. Vascular damage decrease oxygen supply to the peripheral nerves and quickly lead to serious damage to or death of nerve tissues, much as a sudden lack of oxygen to the brain can cause a stroke Poor circulation also limit the amount of healing nutrients that reach a wound (NINDS). Several micro vascular abnormalities, including a reduced response to tissue injury causing under perfusion, the development of dependent oedema due to a defective venoarteriolar reflex, and increased permeability of capillaries, have also been proposed to delay wound healing (Malik & Rayman, 2007)
· Peripheral Neuropathy slows down the wound healing in a diabetic ulcer as it causes vessel ischemia. The loss of protective sensation due to neuropathy and diminished trophic effect by neuropeptide deficiency have been proposed to lead to trauma and increased pressure on the foot skin and a diminished hyperaemic response to tissue injury, respectively (Malik & Rayman, 2007).
· Hyperglycemia Persistent uncontrolled hyperglycemia interferes with wound healing, results in endothelial dysfunction, and increases the risk of sepsis. The exact effect of uncontrolled hyperglycemia on the process of wound healing and endothelial dysfunction has not been completely determined (Medscape, 2006).
2. Action point: Your student nurse asks you what the difference is between Type 1 and Type 2 diabetes. Explain diabetes type 1 & type 2 to your student.
· Type I Diabetes (T1D) is the autoimmune destruction of the pancreatic beta cells. As pancreatic beta cells are involved in the production of insulin, a hormone that regulates the glucose metabolism, its destruction means an absolute lack of insulin increasing blood glucose levels and causing the breakdown of body fats and proteins. The rate of beta cell destruction depends on the individual and commonly occurs in young people but can happen at any age. T1D is triggered by both genetic and environmental factors (Porth, 2007).
· Type II Diabetes (T2D) is the occurrence of hyperglycemia or high blood sugar levels despite the availability of insulin and accounts for 90-95% people with diabetes, mostly over 40 years of age with some degree of obesity. T2D involves both genetic factors such as family history and acquired factors such as lifestyle, physical activity and diet (Porth, 2007).
3. Action point: Considering the underlying patho-physiology, discuss the reasons why Agnes’s wound may not feel painful and has moderate-heavy amounts of exudate.
· Distal Symmetric Neuropathy is a complication caused by diabetes and uncontrolled hyperglycemia which causes nerve damage to the nerves in the extremities causing its death. It can cause Agnes not to feel the pain due to impaired pain sensation and can make her unaware of the constant trauma that being caused by the ulcer to her feet.
· The heavy amounts of exudates are caused by the inflammatory phase of the healing process. The inflammatory phase uses the exudates as a support medium for enzymes, antibodies and the various cells necessary for wound cleansing. Exudate also contains a number of growth factors produced by the body which are critical in the promotion of healing. If the inflammatory phase is impaired, wound healing may be slowed or halted (Monash University, N.d).
4. Action point: Access the policy/guideline used by the staff in your clinical placement for managing a patient who is experiencing hypoglycaemia. Fully discuss the key aspects of the policy/ guideline within your team, and ensure you have the knowledge necessary to respond safely and effectively in a similar situation.
· Key Points:
Guideline: For the Treatment of Hypoglycaemia
· Used by the Counties Manukau District Health Board Staff for the management of hypoglycaemia. The policy explains what to do in cases of moderate to severe and life treatment hypoglycaemia. The policy also contains information about, signs and symptoms, medication and administration and other important factors that a medical professionals needs to aware of in such situations.
REFERENCES:
Malik, R., & Rayman, G. (2007). Neurovascular Factors in Wound Healing in the Foot Skin of Type 2 Diabetic Subjects. P a t h o p h y s i o l o g y / C o m p l i c a t i o n s , 30.
Medscape. (2006). Diabetic Foot Disease: Etiology of DFD. Retrieved 07 27, 2011, from Medscape: http://www.medscape.com/viewarticle/545974_3
Monash University. (N.d). WOUND CARE MODULE. Melbourne: Monash University.
NINDS. (n.d.). Peripheral Neuropathy Fact Sheet. Retrieved 08 3, 2011, from NINDS: http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm
Porth, C. (2007). Essentials of Pathophysiology. Philadelphia: Lippincott Williams & Wilkins .