Patient Situation

This essay will focus on the Kath Jones, 62 years old who has right below knee amputation using the clinical reasoning cycle. The essay will consider the situation of the patient, discuss the collection, processing and presentation of related health information, identify and prioritise a minimum of 3 nursing problems. The essay will also establish goals for priority nursing care for the patient. The essay will also discuss and evaluate the nursing care of the client.

Patient Situation

Kath, a 62-year-old indigenous Australian female has a history of Peripheral Vascular Disease (PVD) which developed as a complication of Type II Diabetes which is managed through dietary modifications and oral hypoglycemic medication. She is divorced with 2 sons who work in a nearby mining area. She is independent in her house which is located in a rural setting. She has a part-time job at a local newsagent.

Collection, processing and presentation of related health information

Kath had a fall which led to the development of a large vascular ulcer on her right calf (medial aspect). The client sustained a large bruising and graze which subsequently became infected and turned out to be gangrenous for more than six months. The bruising became unresponsive to medical treatment leading to amputation (below knee) on her right leg. The amputation was conducted electively under spinal anaesthesia in a regional hospital (Sillesen,2017).

Her post-operative period was uneventful. The amputated stump is healing properly. Now, she is on her 5^th-day post-operation and she is to be discharged to a rehabilitation health facility for training on safe mobilization using a prosthesis. In the rehabilitation centre, she needs to be educated on effective management of the Type II Diabetes before she gets back to her independent lifestyle. Currently, she is on Metformin 1g TDS.

PVD is a circulatory disorder that is associated with narrowing, blockage and spasms of blood vessels outside the brain and heart especially veins and arteries. There are 2 major types of PVD namely; functional and organic (Shah et al, 2015).   Functional PVD involves narrowing and widening of blood vessels in response to temperature variations and brain signals while organic PVD involve physical damage through changes in the structure of blood vessels following formation of the plaques secondary to arteriosclerosis, inflammation and tissue damage (Schaper et al, 2012).

PVD also affects blood vessels supplying oxygen and blood to the arms, kidneys, intestines and stomach. Narrowing of blood vessels leads to a decreased flow of blood to the respective body organs and tissues. Narrowing of blood vessels is caused by arteriosclerosis which involves build-up of plaques in a vessel hence limiting the flow of oxygen and blood to the limbs and body organs (Jain, Kulkarni& Bhosale,2017).

Progressive growth of the plaque leads to formation of clots which develop and block the vessel completely. Complete blockage of a vessel results in organ and tissue damage leading to possible loss of limbs, toes or fingers (Sylvain,2013). PVD is caused by smoking, diabetes, extreme injuries, high cholesterol levels, elevated blood pressure, emotional stress, infection and drugs (American Diabetes Association, 2015).

Collection, Processing and Presentation of Related Health Information

The signs and symptoms of PVD are painful extremities, calves, buttocks and thighs.  A patient with PVD may experience numbness of feet or legs, heaviness of limbs, redness of the skin, painful foot, non-resolving wounds on the toes and feet, frequent infections, cramping of legs which is precipitated by physical activities (Sillesen,2017). The potential complications of untreated PVD include impotence, tissue necrosis leading to amputation of a limb, paleness of skin, pain when moving and resting, restricted mobility due to severe pain, non-resolving wounds and life-threatening bloodstream and bone infections. Clogged arteries supplying blood to the brain and heart may lead to serious complications such as stroke, cardiac failure and death (Jain, Kulkarni & Bhosale,2017).

There are various risk factors for PVD which include; overweight, abnormal levels of cholesterol, an age of more than 50 years, cardiovascular disease, diabetes, previous history of stroke or cerebrovascular disorder, hypertension and a family history of PVD, hypertension or high cholesterol. Other lifestyle practices that increase the risk of development of PVD are smoking, physical inactivity, poor nutritional habits and use of drugs (Freeman et al, 2013)

Nursing problems/issues identified

• Impaired Physical mobility. This is related to loss of her right lower limbafter amputation.
• Risk for infection. The client went an invasive imputative procedure. Environmental exposure may also lead to infection.
• Situational Low self-esteem related to loss of her right lower limb and change in her ability to function in her life. The client might have feelings of powerlessness, helplessness, negative perception of her physical functioning and appearance. She might also have a preoccupation with her missing limb and negative perception regarding her capacity to resume her daily duties and responsibilities in her home (Peach et al, 2012).

Goals for priority of nursing care

• The client should verbalizeproper understanding and acceptance of her situation, treatment approach and safety andprecautionary measures.
• The client should demonstratebehaviours, techniques and willingness to resume and participate in various activities.
• The patient should have timely healing of the wound free of erythema, purulent drainage and a be afebrile.
• She should establish a realistic plan for adaptation of new responsibilities and modification of her roles.

Nursing care of the Kath Jones

The patient should be encouraged and enlightened on adherence to the prescribed hypoglycemic drug (metformin) and dietary modification for management of type II diabetes. The stump area should be regularly inspected, cleaned, dried thoroughly and rewrapped using air splint or elastic bandage. All this should be done using aseptic technique to prevent infections. This gives the nurse an opportunity to evaluate stump healing and note any possible complications. Wrapping prevents the formation of edemaand development of a conical shape for proper fitting of the prosthesis (Schaper et al, 2012).

The patient should be encouraged on isometric and active exercises for the unaffected limbs and upper torso to increase the strength of muscles to facilitate ambulation and transfers hence promoting mobility. The patient should be encouraged to participate in Activities of Daily Living. She should also be given an opportunity to care and view the stump. This would enhance patient’s feelings self-worthiness and promote independence (Peach et al, 2012).

Evaluation of Nursing Care

• The patient verbalizes properunderstanding and acceptance of her situation, treatment approach and safety andprecautionary measures.
• The patient demonstrates behaviors, techniques and willingness to resume and participate in various activities.
• Patient’s stump healed faster with no erythema, purulent drainage and a be afebrile.
• The patient has a establish a realistic plan for adaptation of new responsibilities and modification of her roles.

Reflection of Patient’s Outcome

Type II Diabetes is correlated with PVD. I realized that its very true that proper management of type II diabetes would be very useful in the prevention of PVD in a patient. Upon doing a lot of research, it has come to my understanding that type II diabetes has life-threatening complications if it goes unmanaged. To prevent such complications like PVD, I would always recommend timely diagnosis and management of type II diabetes through lifestyle and dietary modifications. I also think that proper compliance to prescribed treatment would also be important in control of diabetes hence preventing its serious side effects and complications.

References

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 33(2), 97.

Freeman, J. E., Panasyuk, S. V., Hopmeier, M. J., Schomacker, K., & Brand, D. (2013). U.S. Patent No. 8,374,682. Washington, DC: U.S. Patent and Trademark Office.

Jain, P., Kulkarni, A., & Bhosale, S. (2017). Peripheral vascular disease. Objective Anaesthesia Review: A Comprehensive Textbook for the Examinees, 62.

Peach, G., Griffin, M., Jones, K. G., Thompson, M. M., & Hinchliffe, R. J. (2012). Diagnosis and management of peripheral arterial disease. Bmj, 345(aug14 1), e5208.

Schaper, N. C., Andros, G., Apelqvist, J., Bakker, K., Lammer, J., Lepantalo, M., … & Hinchliffe, R. J. (2012). Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot. Diabetes/metabolism research and reviews, 28, 218-224.

Shah, A. D., Langenberg, C., Rapsomaniki, E., Denaxas, S., Pujades-Rodriguez, M., Gale, C. P., … & Hemingway, H. (2015). Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1· 9 million people. The lancet Diabetes & endocrinology, 3(2), 105-113.

Sillesen, H. H. (2017). Peripheral vascular disease. Textbook of Diabetes, 683-697.

Sylvain, H. (2013). Peripheral Vascular Disease. Journal of the Dermatology Nurses’ Association, 5(2), 102-104.