Patient
The patient, Sarah, is a 28-year-old African American woman with a past medical history of asthma and type 2 diabetes. She admits that she does not check her blood sugar level regularly and takes her medications when she remembers. Her chief complaint is a wound on her left foot got several days ago. No treatment or medical attention was made at once, and the patient used hydrogen peroxide to clean the damaged area. At this moment, a 4-cm lesion is observed, with 7-cm surrounding erythema extended.
Differentials
Sarah has several serious health conditions, including diabetes complications, foot wounds, fever, and breathing problems. The impact of diabetes on wound growth is not always easy to predict, and such differentials as abscess, osteomyelitis, and atherosclerosis. An abscess is possible because of the impossibility of the diabetic organism to deal with infections, characterized by fever, local pain, and drainage (Chang et al., 2018). The patient has some of the symptoms that cause discomfort. Osteomyelitis is a bone infection, the main symptoms of which are fever, redness, and pain, and the patient meets certain criteria in this case (Giurato et al., 2017). Atherosclerosis is common in diabetic patients as it is characterized by blood vessel damage and the inability to carry oxygen in the body (Poznyak et al., 2020). If it is observed in the lower extremities (LE), numbness and weakness are the symptoms. Sarah admits numbness in her right LE. Shortness of breath, cough and wheezing may be supplementary signs, and the patient reports on her breathing problems as well.
Breathing problems and high blood glucose levels could have such differentials as pulmonary edema, sepsis, and diabetic ketoacidosis. Fever and cough are the signs, the nature of which should be checked. She is a former smoker with uncontrolled diabetes and extremely high sugar in the blood, which may provoke excess fluid in the lungs and the inability to breathe freely. Besides, her asthma history plays a role in the impossibility to detect other symptoms at an early stage. Sepsis is the condition when the body is not able to respond to inflection. Diabetes weakens Sarah’s immune system, which causes changes in mental status (her poor attention to medications), fever, and high blood pressure. Finally, diabetic ketoacidosis occurs when the body lacks insulin, and ketones are produced and influence the bloodstream. Confusion and hyperglycemia are the reasons to consider this differential in the analysis.
Current Medical Diagnosis
At this moment, the medical diagnosis can be given a fast growth of diabetic foot infection that leads to a foot ulcer. This condition is common among diabetic patients when poor or no blood sugar control occurs and causes hyperglycemia. Another critical risk factor is the neglect of taking medications regularly. Finally, no medical wound care and the absence of antibiotics to predict infections after skin damage contributes to the infection progress (Aliakbar et al., 2019). The diagnosis of diabetic foot infection cannot be ignored because delayed treatment may result in lower limb amputation.
Diagnostic Images
To check the condition of the patient and develop a further treatment plan, several diagnostic images are necessary. It is better to start with X-rays (anteroposterior and lateral views) to detect if there is any soft tissue gas or a foreign body that causes smelly drainage and pain (Aliakbar et al., 2019). Magnetic resonance imagining (MRI) helps to identify soft tissue and bone conditions based on gadolinium uptake (Giurato et al., 2017). In the majority of cases, X-rays are enough to detect the area and the quality of damage and identify the next treatment step.
Laboratory Work
Several laboratory tests are necessary to understand the reaction of the body to damage. The first step is to evaluate the wound and send its microbial culture (surface swab) for analysis to check the present infections (Chang et al., 2018). Blood tests should be done to count the number of leukocytes (a complete blood test) and detect the signs of anemia, and blood serum secretion show current glycemic control (Giurato et al., 2017). The fact that the patient has not eaten today contributes to obtaining accurate results.
Plan of Care
Healthcare workers choose different ways to help their patients and manage diabetic foot ulcers. To avoid amputation, it is required to follow pharmacological treatment, surgical debridement, and regular dressing changes (Aliakbar et al., 2019). Local wound care includes drainage of an abscess, surgical resection (if necessary), and dressing with saline or 2% iodine solution during the next three months (every five and then every ten days) (Aliakbar et al., 2019). Antibiotic treatment should help to reduce the spread of infection, but as the patient is allergic to penicillin, amoxicillin is better to replace with tetracycline or aminoglycoside. Regarding the fact of diabetes, close monitoring of blood levels is recommended.
Conclusion
In general, the treatment of foot ulcers in diabetic patients is characterized by several restrictions and precautionary measures. In addition to type 2 diabetes, Sarah is obese and has hypertension. She has to be educated about the importance of monitoring her blood sugar levels and taking metformin regularly to predict the development of infection and heart-related problems. If treatment does not lead to positive results within the next five days, X-rays are used to check the spread of infection, and amputation remains the only option to save the patient’s life.
References
Aliakbar, A. H., Alsaadi, M. A., & Barrak, A. A. Z. (2019). Evaluation of the surgical and pharmacological treatment of diabetic foot infection: A retrospective study. Open Access Macedonian Journal of Medical Sciences, 7(9), 1499-1504. Web.
Chang, J. W., Heo, W., Choi, M. S. S., & Lee, J. H. (2018). The appropriate management algorithm for diabetic foot: A single-center retrospective study over 12 years. Medicine, 97(27). Web.
Giurato, L., Meloni, M., Izzo, V., & Uccioli, L. (2017). Osteomyelitis in diabetic foot: A comprehensive overview. World journal of diabetes, 8(4), 135-142. Web.
Poznyak, A., Grechko, A. V., Poggio, P., Myasoedova, V. A., Alfieri, V., & Orekhov, A. N. (2020). The diabetes mellitus – Atherosclerosis connection: The role of lipid and glucose metabolism and chronic inflammation. International Journal of Molecular Sciences, 21(5). Web.