Treatments of Diabetic Foot Ulcers: Debridement - Essay Example

Reflective Clinical Assignment: Treatments of diabetic foot ulcers (Debridement) Section 1: Description of a practice My current involvement is with a diabetic unit in a Saudi Arabia hospital. In this unit, the following are being applied: optimal diabetic control, appropriate wound management, management of ischemia, management of infection, debridement, and pressure relief. The topic on the treatment or debridement of diabetic foot ulcers was chosen because it is one of the most persistent issues for diabetic patients (Robbins, et.al., 2008). I chose Saudi Arabia because diabetic foot ulcers are a major issue for them. Knowing how to manage it can help improve the quality of life of patients. A recent study by Tashkandi, et.al., (2011) indicates that diabetes has become a common issue in Saudi Arabia and about 50% people with this disease are likely to develop diabetic foot ulcer within a year of their diagnosis. This topic seeks to evaluate an aspect of the practice which is not adequately addressed in the practice. Anecdotally, the clinical environment is one where the patient is first assessed by the nurses, and as student nurses, we often assist the staff nurses in this process. A specific assessment of the foot ulcer is then carried out and the assessment is entered into the chart to be reviewed later by the physician. The recommended nursing care is then planned by the nursing staff, and we are often asked to assist in the cleaning and debridement of the patient foot ulcer. Daily routines include regular morning rounds by the nurses, and once again, we assist them in the rounds nurses. Section 2: Review of related literature The study by Haycocks and Chadwick (2012) discusses that debridement is a crucial element in wound bed preparation in order to ensure healing. It should however be used with other elements of wound management in foot ulcers, including pressure relief, holistic assessment, and infection control. Robbins, et.al., (2008) also declare that debridement is only part of a larger picture in diabetic foot ulcer management. Nevertheless, with surgical and sharp debridement, rapid and specific methods are made possible. The Haycocks and Chadwick (2012) study is very much helpful because it establishes that specific methods of debridement are needed for patients, and that some methods of debridement may not apply to some patients. The results of this study are very much in agreement with previous knowledge on the subject matter (Jeffcoate, et.al., 2006). The results are also adequately supported and are very much current with sufficient support from theories and other studies, especially those relating to wound healing (Resnick, et.al., 2004). The information indicated is however based on secondary information, citing results and work of other authors. In a similar study, Lebrun, et.al., (2010) discuss that debridement has long been considered the accepted form of treatment for diabetic foot ulcers. As also discussed under the Rayman, et.al., (2004) study, debridement has been known to change the environment of the wound, allowing for the removal of the necrotic tissue which often prevents healing. The Lebrun, et.al., (2010) paper was carried out as a systematic review of five clinical trials, and most were not randomized clinical trials testing the relationship between debridement and wound healing. The study provided a tentative discussion on the relationship of wound healing and debridement and the results from the studies were not definitive enough for adoption into the clinical practice. Although there are some issues on the correlations within the study, this study was able to provide collaborative data on debridement and diabetic foot ulcers. Its results are similar to previous studies which indicate the importance of multidisciplinary management of diabetic foot ulcers (Rose, et.al., 2008). However, there is still an apparent need to carry out other more specific studies on the topic, mostly in relation to establishing the impact of debridement on diabetic foot ulcers. In a study by Cabeza de vaca, et.al. (2010), the authors carried out a cohort study on patients recommended for amputation and whether or not, their foot can be saved with conventions methods of treatment, including debridement, pressure alleviation, and antibiotics. The study revealed that 85% of patients with diabetic foot ulcers were able to avoid amputation and only 49% of the patients ended up requiring minor amputations. Major amputations were therefore avoided with the application of debridement combined with other forms of therapy and conventional treatment for patients with diabetic foot ulcers (Cabeza de Vaca, et.al., 2010). This research was able to provide new information essential to the management of diabetic foot ulcers, very much like the data cited by Yusof, et.al., (2007) which recommends combined therapies for diabetic foot ulcers. The value of combined therapies in terms of avoiding foot amputations for patients has been established through this Cabeza de Vaca study. When other conventional types of treatment are included in the management, foot amputations can be avoided (Boulton, et.al., 2005). This cohort study was able to provide reliable and first hand data on patients, providing a strong basis for the results. The results are fully substantiated and it is very much contemporary research which also considers how theories on wound healing apply to diabetic foot ulcers. Maggot debridement is also one of the alternative methods of treatment used in chronic wound healing. In a study by Gottrup and Jorgensen (2011), the authors set out to establish the efficacy of maggot debridement in treating diabetic foot ulcers. This study was carried out by evaluating the mode of action, the application in practice, the clinical results, as well as the discussion of the issues based on their clinical effect. Based on results and literature studies on the subject matter, maggot debridement has proven to be a safe and effective method on diabetic foot ulcer debridement; it also presents with lesser side effects when compared with conventional forms of treatment. There is however a lack of clinical studies supporting the results of their study, nevertheless, the results revealed by this study by Gottrup and Jorgensen (2011) indicates that this technique is safe and effective and can be used primarily for diabetic foot ulcers because of its selective application in the debridement of necrotic tissue. The results of this study provide an innovative consideration for health professionals, especially those caring for patients with diabetic foot ulcers (Matsuda, 2011). Maggots have been used in managing other infected wounds as well and this study provides basis for its specific application on patients with diabetic foot ulcers (Hideya, et.al., 2004). This study is adequately substantiated by other studies and sufficient primary resources. It is also very much current and is supported by theories and by studies as indicated in the literature review. Section 3: Integrating theory and practice Based on the various studies cited above, it is clear to note that debridement offers a favourable form of treatment for diabetic foot ulcers. The literature discusses that the debridement process eliminates the necrotic tissues in the foot, which then facilitates the wound healing process which is the first step towards the treatment of diabetic foot ulcers. As was mentioned previously, many diabetic patients suffer from diabetic foot ulcers and when this disease is unmanaged, they often end up having foot amputations. Foot amputations severely degrade the quality of a patient’s life, and therefore prioritizing debridement over amputations would be the better choice in the management of diabetic foot ulcers (Edwards, 2009). One of the studies above indicates that implementing debridement along with other conventional forms of treatment may eventually lead to wound healing and negate the need for amputations (Haycocks and Chadwick, 2012). Using maggots in the debridement process also shows much promise. The study presented in the literature review is a primary clinical research which was able to establish reliable results (Gottrup and Jorgensen, 2011). Although using maggots is not a conventional method of managing foot ulcers, it has proven to be useful in the management of diabetic foot ulcers, and patients treated with this method were able to avoid foot amputations. Based on the recommendations of the studies cited in the literature review, effective management of diabetic foot ulcers must also be supported by other forms of treatment, including antibiotics, pressure relief, and infection control (Cabeza de vaca, et.al., 2010). These recommendations can be easily implemented in the practice, especially by the nurses who are often left with the care of the patient 24-hours a day. With the assistance of the student nurses, turning the patient position every two hours can prevent pressure ulcer formation at the foot or different bony protrusions of the patient’s body (Edwards, 2009). Infection control for the patient would also involve the application of aseptic techniques in handling and cleaning the wound, as well as in keeping the wound clean and dry. The administration of antibiotics would also assist in the elimination of bacteria in the patient’s body, eventually ensuring that the patient’s wound would heal (Cabeza de Vaca, 2010). Holistic care is also mentioned by the studies in the review, and in the actual practice, this can also be a valuable addition to ensure the treatment of diabetic foot ulcers (Haycocks and Chadwick, 2012). Holistic care implies physical, social, emotional, as well as spiritual well-being. Ensuring that a patient is physically, socially, well as well as emotionally healthy requires the involvement of the patient’s family and friends encouraging the patient to be cooperative in the treatment process and to also have the strong determination to recover. Using debridement in managing diabetic foot ulcers must be considered based on a wider context for diabetic patients, specifically considering their personal qualities and preferences which may indicate different applications of the treatment. Some patients may prefer debridement using maggots, but some others may not prefer it (Hideya, 2005). In such case, other options may be considered in the management of the patient’s foot ulcer. The role of nurses and student nurses in the debridement process includes their involvement in interventions which help prevent, manage, and reduce the impact of diabetic ulcers (Padmore, 2009). Nurses and student nurses are the main individuals involved in the management of diabetic foot ulcers. The literature implies that health professionals need to coordinate with each other in order to implement effective management of diabetic foot ulcers. These studies also imply the need for student nurses and nurses to be vigilant with their patients having diabetic foot ulcers, applying infection control measures, increasing movement, and preventing the development of pressure ulcers. References Boulton, A., Vileikyte, L., Ragnarson-Tennvall, G., and Apelqvist, J. 2005. The global burden of diabetic foot disease. Lancet, 366(9498), 1719-1724. Cabeza de Vaca, F., Macias, A., Ramirez, W., and Munoz, J., et.al., 2010. Salvaging diabetic foot through debridement, pressure alleviation, metabolic control, and antibiotics. Wound Rep Reg, 18, 567–571 Edwards, J., 2009. Debridement of diabetic foot ulcers. Cochrane Database Library, 1(3556). Gottrup, F. and Jorgensen, B., 2011. Maggot debridement: an alternative method for debridement. ePlasty, 11, 290-301. Haycocks, S. and Chadwick, P., 2012. Debridement of diabetic foot wounds. Nursing Standard. 26(24), 51-58. Hideya, M., Takuya, K., and Shinnya, U., 2005. Successful treatment of severe ischaemic foot ulcer with sterile maggots: The first case in this country. The Japanese Journal of Vascular Surgery, 14, 653-657. Jeffcoate, W., Chipchase, S., and Ince, P., 2006. Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care, 29, 1784. Lebrun, E., Tomic-Canic, M., and Kirsner, R., 2010. The role of surgical debridement in healing of diabetic foot ulcers. Wound Rep Reg, 18, 433–438. Matsuda, Y., 2011. Impact of maggot debridement therapy in patients with diabetic ischemic foot ulcer. Journal of US-China Medical Science, 8(4), 199-204. Padmore, J., 2009. The introduction and evaluation of applied wound management in nurse education. Wounds UK, 5(4), 28-31. Rayman, G., Krishnan, S., Baker, N., Wareham, A., and Rayman, A., 2004. Are we underestimating diabetes-related lower extremity amputation rate? Results and benefits of the first prospective study. Diabetes Care, 27(8): 1892-1896. Resnick, H., Carter, E., and Lindsay, R., 2004. Relation of lower-extremity amputation to all-cause and cardiovascular disease mortality in American Indians: the strong heart study. Diabetes Care, 27, 1286. Robbins, J., Strauss, G., Aron, D., Long, J., et.al., 2008. Mortality rates and diabetic foot ulcers: is it time to communicate mortality risk to patients with diabetic foot ulceration? J Am Podiatr Med Assoc, 98(6), 489-493. Rose, G., Duerksen, F., Trepman, E., Cheang, M., et.al., 2008. Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people. Foot Ankle Surg, 14(2), 74-81. Tashkandi, W., Badri, M., and Badawood, M., 2011. Lower limb amputations among diabetics admitted with diabetic foot disorders in three major hospitals in Jeddah, Saudi Arabia. JKAU, Med. Sci., 18(1), 23-35. Yusof, M., Sulaiman, A., and Muslim, D., 2007. Diabetic foot complications: a two-year review of limb amputation in a Kelantanese population. Singapore Med J, 48(8), 729-732. Read More