Diabetic Foot Ulcer and Its Management

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The patient has type 2 diabetes, and the problem of wound infection on her foot can be diagnosed as a diabetic foot ulcer. The causes of pain must be properly identified to exclude unnecessary neuropathic aspects (Khan, 2020). Different diagnoses for this problem are as follows:

Osteomyelitis is ruled out because the patient has crusting and purulent drainage with surrounding erythema (about 7 cm) with no bone fracture and inflammation (Gandhi, 2022);
Cellulitis is a bacterial infection with such symptoms as redness, pain, swelling, and fever, and although the patient reports pain and swelling (for ruling in), she denies fever and redness (Sullivan & de Barra, 2018).
Chronic venous insufficiency is ruled out because swelling, tenderness, and pain do not get worse due to deep venous thrombosis but due to particular physical trauma (Patel & Surowiec, 2022).
Pyoderma gangrenosum is characterized by unclear etiology and is diagnosed when other causes, like diabetes or infection, are excluded, and in this case, the patient has diabetes (Jackson, 2020).

At this moment, a foot infection is a medical diagnosis that provokes certain concerns. When people have diabetes, nerve damage, poor blood flow, and wounds, they are at risk for developing foot ulcers (Centers for Disease Control and Prevention, 2022). It is recommended to check your feet every day even if there are no traumas, maintain glucose control, and follow medical prescriptions (Centers for Disease Control and Prevention, 2022). The patient says she does not take her diabetes medications regularly and fails to control her blood sugar, which has to be discussed to explain the risks.

Such medical diagnoses as foot infections affect other diagnoses in multiple ways. The patient has diabetes and asthma, and both conditions can be worsened due to infection. Foot complications are common among such patients and lead to disastrous progression to tissues (Armstrong & Lipsky, 2004). If the infection is neglected or poorly treated, the risk of amputation grows as the only chance to manage infection spreading and save human life (Centers for Disease Control and Prevention, 2022). Increased coughing may also be observed, and the patient’s evaluation reveals expiratory wheezing throughout.

Several diagnostic images should be ordered to rule in or out some conditions. For example, a probe-to-bone test and X-rays are necessary to exclude osteomyelitis and check the condition of the patient’s bones (Tickner et al., 2022). B-mode imaging is an ultrasound to see if venous thrombosis is the reason for swelling and numbness (Patel & Surowiec, 2022). These images will help identify if the infection is the only reason for the patient’s pain.

Laboratory work must be ordered in this patient’s case to analyze wound cultures and blood changes. The blood glucose level has already been proven to increase (230). However, a complete blood count is required to see the level of leukocytes (infection-caused) and anemia signs. Superficial swab specimens are not always reliable compared to deep tissue specimens (Oliver & Mutluoglu, 2022). Such abnormalities as decreased red blood cells increased white blood cells, and additional pathogens would be commonly anticipated in this case.

A comprehensive plan of care should include a list of pharmacological and non-pharmacological interventions for the patient, paying attention to her allergy to penicillin. Oral regimens may include doxycycline or clindamycin, which are usually safe and unrelated to penicillin and are effective in managing infection (Oliver & Mutluoglu, 2022). Metformin, Albuterol, and Singulair should be regularly taken to predict diabetes- and asthma-related complications. Patient education must include the importance of diet modifications and physical activity to predict obesity (her current weight is 250 lb). Tetanus shots need to be taken every ten years, and the patient took the last vaccine about 15 years ago (Tetanus shot, 2022). Finally, common diabetic recommendations include smoking cessation, obligatory blood glucose monitoring, and counseling with an endocrinologist to check her hormone levels, affecting her metabolism, appetite, and blood pressure.

References

Armstrong, D. G., & Lipsky, B. A. (2004). Diabetic foot infections: Stepwise medical and surgical management. International Wound Journal, 1(2), 123-132. Web.

Centers for Disease Control and Prevention. (2022). Diabetes and your feet. CDC. Web.

Gandhi, J. (2022). Osteomyelitis. Medscape. Web.

Jackson, J. M. (2020). Pyoderma gangrenosum. Medscape. Web.

Khan, T. (2020). Diabetic foot ulcers differential diagnoses. Medscape. Web.

Oliver, T. I., & Mutluoglu, M. (2022). Diabetes foot ulcer. StatPearls. Web.

Patel, S. K., & Surowiec, S. M. (2022). Venous insufficiency. StatPearls. Web.

Sullivan, T., & de Barra, E. (2018). Diagnosis and management of cellulitis. Clinical Medicine, 18(2), 160-163. Web.

Tetanus shot. (2022). Cleveland Clinic. Web.

Tickner, A., Bolling J., & Ghannoum, D. (2022). A guide to diagnostic techniques for DFU soft tissue infection and osteomyelitis. Podiatry Today. Web.

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Diabetic Foot Ulcer and Its Management

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