Diabetic foot ulcers represent a significant complication in patients with diabetes mellitus, affecting their quality of life and requiring comprehensive nursing care. This guide provides essential information about nursing diagnoses, interventions, and care plans for managing diabetic foot ulcers effectively.
Understanding Diabetic Foot Ulcers
Diabetic foot ulcers develop as a result of poor glycemic control combined with peripheral neuropathy and vascular complications. These ulcers typically begin with callus formation due to pressure points and reduced foot sensation. The condition affects approximately 15% of diabetic patients during their lifetime, with 60% developing underlying neuropathy.
Risk Factors:
- Uncontrolled blood glucose levels
- Peripheral neuropathy
- Poor circulation
- Previous foot ulcers
- Improper footwear
- Poor foot care practices
Clinical Assessment
Healthcare providers should conduct thorough assessments including:
- Blood glucose monitoring
- Vascular assessment
- Neurological examination
- Wound characteristics evaluation
- Infection screening
- Nutritional status assessment
Comprehensive Nursing Care Plans
1. Impaired Skin Integrity
Nursing Diagnosis Statement:
Impaired skin integrity related to diabetic neuropathy and decreased circulation as evidenced by ulcer formation and tissue breakdown.
Related Factors:
- Peripheral neuropathy
- Poor circulation
- Impaired glucose regulation
- Pressure points
- Poor foot care practices
Nursing Interventions and Rationales:
- Perform comprehensive wound assessment daily to monitor healing progress
- Implement proper wound care techniques using sterile dressing changes
- Document wound characteristics, including size, depth, and appearance
- Teach proper foot care and inspection techniques
- Monitor blood glucose levels to promote optimal healing
- Implement pressure relief measures
Desired Outcomes:
- The wound will show progressive healing
- The patient will demonstrate proper wound care techniques
- The patient will maintain optimal blood glucose levels
2. Risk for Infection
Nursing Diagnosis Statement:
Risk for infection related to open wound and compromised circulation.
Related Factors:
- Break in skin integrity
- Decreased peripheral circulation
- Elevated blood glucose levels
- Compromised immune function
- Poor wound healing
Nursing Interventions and Rationales:
- Monitor wound for signs of infection
- Maintain sterile technique during dressing changes
- Administer prescribed antibiotics as ordered
- Monitor temperature and other vital signs
- Educate patient about infection prevention
- Maintain optimal blood glucose levels
Desired Outcomes:
- The wound will remain free from infection
- The patient will demonstrate an understanding of infection prevention measures
- The patient will maintain blood glucose within the target range
3. Ineffective Peripheral Tissue Perfusion
Nursing Diagnosis Statement:
Ineffective peripheral tissue perfusion related to diabetic vascular disease as evidenced by delayed wound healing.
Related Factors:
- Diabetes mellitus
- Peripheral vascular disease
- Atherosclerosis
- Smoking history
- Sedentary lifestyle
Nursing Interventions and Rationales:
- Assess peripheral pulses and capillary refill
- Monitor extremity temperature and color
- Encourage smoking cessation if applicable
- Promote regular exercise as appropriate
- Elevate affected extremities appropriately
- Monitor wound healing progress
Desired Outcomes:
- Improved peripheral circulation
- Enhanced wound healing
- The patient will demonstrate an understanding of circulation promotion techniques
4. Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced nutrition: less than body requirements related to impaired metabolism and healing needs.
Related Factors:
- Increased metabolic demands
- Poor dietary habits
- Limited understanding of nutritional needs
- Financial constraints
- Medication effects
Nursing Interventions and Rationales:
- Assess nutritional status and dietary intake
- Consult with a dietitian for meal planning
- Monitor protein and albumin levels
- Encourage adequate fluid intake
- Provide education about proper nutrition
- Monitor weight trends
Desired Outcomes:
- Improved nutritional status
- Enhanced wound healing
- Maintenance of appropriate weight
5. Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge deficit related to lack of information about diabetic foot care and prevention of complications.
Related Factors:
- Limited exposure to information
- Misinterpretation of information
- Lack of interest in learning
- Cognitive limitations
- Language barriers
Nursing Interventions and Rationales:
- Assess current knowledge level
- Provide education about diabetic foot care
- Demonstrate proper foot inspection techniques
- Teach proper footwear selection
- Review medication management
- Provide written materials in appropriate language
Desired Outcomes:
- The patient will demonstrate an understanding of foot care principles
- The patient will perform daily foot inspections
- The patient will seek appropriate medical care when needed
Conclusion
Effective management of diabetic foot ulcers requires a comprehensive nursing approach focusing on wound care, infection prevention, circulation improvement, nutrition, and patient education. Regular assessment and modification of care plans ensure optimal outcomes and prevent complications.
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023 Jan 1;46(Suppl 1):S19-S40. doi: 10.2337/dc23-S002. Erratum in: Diabetes Care. 2023 May 1;46(5):1106. doi: 10.2337/dc23-er05. Erratum in: Diabetes Care. 2023 Sep 01;46(9):1715. doi: 10.2337/dc23-ad08. PMID: 36507649; PMCID: PMC9810477.
- Frykberg RG, Banks J. Management of Diabetic Foot Ulcers: A Review. Fed Pract. 2016 Feb;33(2):16-23. PMID: 30766158; PMCID: PMC6368931.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Fitridge R, Game F, Monteiro-Soares M, Senneville E; IWGDF Editorial Board. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2024 Mar;40(3):e3657. doi: 10.1002/dmrr.3657. Epub 2023 May 27. PMID: 37243927.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
