Hi, everyone. We’re going to go through a case study for a diabetic foot ulcer together. Let’s get started. In this scenario, Michael is a 15-year-old male diagnosed last year with diabetes type one. He presents to the acute care unit with a sore that will not heal on the bottom of his right foot. He states that he sees an endocrinologist for his diabetes type one, but has no other health issues to report at this time. He also says that he exercises frequently under the guidance of a dietician and personal trainer consulted through his endocrinologist and still he wrestles for his high school team. His mother is with him and gives consent for treatment. She says, “The pad of his foot has not even been hurting him but when he was pushing off the wrestling mat in practice, he noticed something there.” Now that we have this information, let’s take a look at critical thinking checks number one and number two below.

Great job. The nurse notices that she cannot feel pedal pulses and the feet seem cool, but not cold. However, the area around the wound is warmer and red. Both feet are within normal limits in regards to color. Michael denies any cramping or pain in his legs. Now that we have these results, let’s take a look at critical thinking check number three below.

Excellent work. The wound has a slightly foul odor and has a circular punched out shape. Almost like a red based crater. Michael’s mother asks how this could happen. Let’s take a look at critical thinking check number four below.

Great job. The provider assesses the patient and advises the staff that he has put in orders. He also asks for a set of vital signs, which weren’t taken before. With all of this in mind, let’s take a look at critical thinking check number five below.

Great job. Let’s take a look at those vitals. His blood pressure came back at 110/68 mmHg, on room air he’s saturating at 98%, looks good. His heart rate is 92 beats per minute with a regular rhythm and a respiratory rate of 16 breaths per minute at rest. Temperature running at 37.9 degree Celsius and he isn’t complaining of any pain. 0 to 10 on the 1 to 10 scale with 10 being a medical emergency. With all of this information, Michael’s mother asks why the acute care clinic cannot just take care of her son’s foot. She says, “can’t we just get some antibiotics and go?” With these results in mind, let’s take a look at critical thinking check number six below.

Excellent work, both the patient and the mother agree to the prescribed treatments. Before they leave, the provider indicates he wants to talk to them about when to seek a higher level of care. With this in mind, let’s take a look at critical thinking checks number seven and number eight below.

Well done. Michael says he will follow the prescriptions and follow up as instructed. He also wants to know how to keep this from happening again. With this in mind, let’s take a look at our last critical thinking check number nine below.

Great work, everyone. This wraps up our case study on the diabetic foot foot ulcer. Please take a look at the attached study tools and test your knowledge with a practice quiz. And as always, we love you guys, now go out and be your best self today and happy nursing!

References:

Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities
Authors:Amy C Weintrob, MDDaniel J Sexton, MD, updated Jan, 2021; Evaluation of the diabetic foot
Author:Deborah J Wexler, MD, MSc updated Sept 2021; Patient education: Foot care for people with diabetes (Beyond the Basics)
Author:Deborah J Wexler, MD, MSc, updated Feb, 2021