Gangrene is a condition that involves the destruction of body tissue caused by a major bacterial infection or a lack of blood supply. The toes and fingers, as well as the arms and legs, are frequently impacted by gangrene.
It can also happen in the muscles and internal organs like the gallbladder. The damaged skin of gangrene frequently turns a greenish-black appearance. There are multiple types of gangrene but there are three main types: dry, wet, and gas.
When the blood supply to the tissue is severed, dry gangrene develops. The region darkens, shrinks, and gets dry. Invasion of this tissue by bacteria results in wet gangrene. As a result, the region swells, leaks fluid, and begins to smell.
Lastly, gas gangrene occurs when bacteria that multiplied in the tissue start to form toxins and release gas. Gas gangrene spreads fast and can cause death within 48 hours if left untreated.
Signs and Symptoms of Gangrene
Gangrene presents various symptoms depending on its etiology. Although general symptoms of the disease may include the following:
- Red and swollen skin
- Severe pain or numbness
- Pale skin and feels cold to touch
- Change in skin color
- The presence of pus accompanied by an unpleasant smell
Causes of Gangrene
Gangrene develops when a region of the body does not receive enough blood flow. The body’s tissues receive oxygen, nutrition, and antibodies from the blood. The tissue cells start to die when they do not get enough blood. The tissues may begin to deteriorate and infections may spread.
- Infections in the tissue. Gangrene can develop as a result of an untreated bacterial infection
- An injury such as severe and deep wounds. Open wounds that allow bacteria to enter the body might arise from gunshot wounds or crushing injuries suffered in automobile accidents. Gangrene may develop if the bacteria infect tissues and are left untreated.
- Surgical complications. Although rare, other necrotizing soft tissue infections often have a distinct entry point due to trauma or problems at the surgical site after surgery
- Medical conditions that affect blood circulation. Atherosclerosis or peripheral artery disease can lead to reduced blood flow
Risk Factors to Gangrene
People who have particular underlying medical disorders that affect their blood vessels are more vulnerable to gangrene. These conditions include:
- Blood vessel disease. Narrowed arteries like atherosclerosis cause plaque buildup that interrupts the body’s blood flow.
- Diabetes. Blood arteries may eventually get damaged by high blood sugar levels. Damage to blood vessels can cause a part of the body’s blood flow to slow down or stop.
- Severe injury or surgery. Gangrene risk is increased by any condition that damages the skin and underlying tissue, including frostbite.
- Obesity. The pressure of extra weight on the arteries can decrease blood flow, increase the risk of infection, and hinder the healing of wounds.
- Immunosuppression. The body’s capacity to fight off infections can be affected by chemotherapy, radiation, and several illnesses, including the human immunodeficiency virus (HIV).
- Complications of COVID-19. Several cases of people developing dry gangrene in their fingers and toes as a result of COVID-19-related blood coagulation issues have been reported (coagulopathy)
- Reynaud’s syndrome. The blood arteries in the fingers and toes are affected by cold temperatures. Blood flow is restricted when the blood vessels contract.
- Popliteal artery entrapment syndrome. The popliteal artery is compressed by the body’s calf muscle. During exercise, this restricts blood flow to the lower leg.
- Vasculitis. Blood flow is impeded by blood vessel inflammation.
- Peripheral artery disease. Enough blood cannot flow to the legs, feet, arms, or hands because of plaque buildup in the limbs.
Complications of Gangrene
The amount of dead tissue from gangrene can be significant, and it can spread quickly over a large portion of the body. Treatment of these areas could lead to:
- Amputation
- Large scarring areas
- Reconstructive surgery
- Organ failure
- Death
Diagnosis of Gangrene
The test diagnosis for gangrene includes:
- Comprehensive history taking. Leg discomfort in patients with critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI) that has progressed from intermittent claudication with exertion to chronic rest pain will be present.
- Physical examination. A thorough examination of the affected extremity should involve detecting any neuropathy and performing a probe-to-bone test in cases of ulceration or tissue loss to determine the extent of tissue damage and the likelihood of developing osteomyelitis.
- Blood tests. The goal of the laboratory assessment of ischemic gangrene is to detect clinical risk factors such as renal failure, hyperlipidemia, and diabetes. Evaluations for concurrent infection are also appropriate, but without other infection symptoms such as localized erythema and edema, wound cultures are less helpful. Infection is frequently indicated by a high white blood cell count. To check for the presence of particular bacteria and other microbes, further blood tests might be performed
- Fluid or tissue culture. A sample from the affected skin can be tested for bacteria. For indications of cell death, a tissue sample can be examined under a microscope.
- Imaging tests. Organs, blood vessels, and bones can all be seen by X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans. These tests can assist in determining the extent of gangrene’s spread within the body.
- Ankle-brachial index (ABI). Ankle-brachial index (ABI) testing, which is non-invasive and termed abnormal if it is less than 1.0, is crucial for the early detection of PAD in a patient with tissue loss. Serious ischemia is also associated with ankle pressure below 40-60 mmHg, and 70 mmHg is regarded as abnormal in cases of tissue loss.
Treatment for Gangrene
There are numerous gangrene treatment methods. Depending on the underlying reason and the stage of the ailment, the doctor will decide which treatment or combination of methods to utilize. Some common treatments are:
- Surgery. It may be performed to understand how much tissue is infected and to gain a closer look inside the body. Different types of surgeries are available, depending on the nature and severity of the gangrene. Gangrene surgery entails Debridement, vascular surgery, amputation, and reconstructive surgery.
- Debridement. This kind of surgery is performed to remove the diseased tissue and stop the illness from progressing.
- Vascular surgery. Surgery may be performed to repair any broken or diseased blood vessels to restore blood flow to the affected area.
- Amputation. A toe, finger, arm, or leg that has developed gangrene may require surgical removal in severe situations (amputated). Amputated patients may be fitted with artificial limbs
- Reconstructive surgery. Surgery may occasionally be required to restore damaged skin or to lessen the visibility of scars from gangrene. A skin graft may be used during an operation. The surgeon uses healthy skin from another location of the body to cover the damaged area during a skin graft. A skin graft can only be performed if the location has sufficient blood flow.
- Medications. Antibiotics are required when gangrene is caused by a bacterial infection. The right dosage will be recommended by the doctor for the patient. A bacterial infection is treated with oral or intravenous medication. Painkillers may be administered to ease discomfort.
- Blood flow restoration. The damaged blood arteries may undergo surgery to improve blood flow. Options consist of bypass surgery and angioplasty
- Bypass surgery. The blood is given a new route to travel through by a surgeon to get around the obstruction.
- Angioplasty. A tiny balloon is inflated by a surgeon inside the artery to widen it and allow blood to flow through. A stent might also be inserted.
- Hyperbaric oxygen therapy. Increased oxygen transport by hyperbaric oxygen therapy. Bacteria that reside in oxygen-deficient tissue develop more slowly in the oxygen-rich blood. Additionally, it speeds up the healing of infected wounds.
- Skin graft surgery. Scars or damaged skin are covered with healthy skin from another area of the body after therapy.
Prevention of Gangrene
There are several things the patient may do to increase the body’s blood flow and stop gangrene. In particular, if the patient has risk factors such as diabetes or peripheral artery disease it is advisable to:
- Have a healthy diet. Eat food that is low in saturated fat and cholesterol.
- Regularly assess the body. This is to monitor whether there is an untreated wound in the body that may cause gangrene. Regularly wash and moisturize any dry spots. Maintain proper hygiene. Use gentle soap and water to clean any exposed wounds. Till they are healed, keep the hands dry and clean.
- Check for frostbite. Blood flow in the affected area is decreased by frostbite. Call a healthcare practitioner if the patient complains of pale, hard, cold, or numb skin after being in frigid weather.
- Diet. Eat food that is low in saturated fat and cholesterol
- Exercise. Having to exercise regularly improves the body’s blood circulation. Diabetes risk increases with weight gain. Additionally, the weight strains the arteries, reducing blood flow. Reduced blood flow slows wound healing and raises the risk of infection.
- Monitoring of blood glucose levels. Keeping the blood glucose levels in check is important since diabetes is one of the risk factors for gangrene. Make sure to regularly check the hands and feet of the patient for wounds, sores, and indications of infection, such as swelling, redness, or drainage.
- Quit smoking. Avoid all kinds of tobacco products. Smoking over an extended period damages the blood vessels.
Nursing Diagnosis for Gangrene
Gangrene Nursing Care Plan 1
Nursing Diagnosis: Ineffective Tissue Perfusion related to gangrene secondary to chronic diabetic foot as evidenced by blisters and lesions on the patient’s toes
Desired Outcomes:
- The patient identifies necessary lifestyle changes.
- The patient engages in behavior or actions to improve tissue perfusion.
- The patient verbalizes or demonstrates normal sensations and movement as appropriate.
Gangrene Nursing Interventions
Assess for indications of diminished tissue perfusion. Keep an eye out for skin texture, hair, sores, or gangrenous regions on the legs, feet, hands, and arms. Skin perfusion may be affected, and pulses may stop, as a result of systemic vasoconstriction brought on by decreased cardiac output. Assessment is therefore necessary for ongoing comparisons.
Ensure that the fluid balance is ideal. Give IV fluids as directed. Adequate filling pressures are maintained with sufficient fluid intake, which also maximizes the cardiac output required for tissue perfusion.
Maintain the cardiac output at optimal levels. This ensures that essential organs receive enough circulation.
Assist in shifting positions and encourage ROM activities. Repositioning a patient gently from a supine to a sitting or standing position helps lessen circulatory impairment. Venous stasis and subsequent circulatory impairment are minimized by exercise.
Whenever necessary, administer oxygen therapy. This increases the amount of hemoglobin in the blood and increases the rate at which blood reaches the ischemic tissues.
Encourage smoking cessation. Smoking tobacco is also linked to the release of catecholamines, which cause vasoconstriction and inefficient tissue perfusion.
Teach the patient to identify the symptoms and signs that the nurse should be notified of. Early detection enables prompt treatment.
All procedures and treatments should be described. The anxiety brought on by the unknown can be reduced by having a clear understanding of anticipated events and experiences.
Gangrene Nursing Care Plan 2
Nursing Diagnosis: Impaired Tissue Integrity related to gangrene secondary to peripheral vascular disease as evidenced by blisters and lesions on the patient’s fingers and toes
Desired Outcomes:
- The patient reports any pain at the site of tissue impairment.
- The patient describes measures to protect and heal the tissue, including proper wound care.
- The patient’s wound decreases in size and forms granulation tissue.
Gangrene Nursing Interventions
Check for color changes, redness, swelling, warmth, discomfort, or other indicators of infection at the site at least once a day. Early detection of possible issues is possible with a systematic inspection.
When caring for wounds, maintain a sterile dressing approach. In cases of impaired tissue integrity, a sterile method lowers the risk of infection. This calls for the use of sterile equipment, gloves, supplies, and dressings, as well as sterile tools.
Inform the patient to refrain from scratching and rubbing. If necessary, provide gloves or trim nails. Scratching and rubbing can aggravate an injury and slow healing.
Encourage the use of pressure-relieving tools such as cushions and foam wedges. These steps aid in pressure redistribution, pressure relief, and pressure injury prevention.
Inform the patient about appropriate hydration, nutrition, and tissue preservation techniques. To avoid impaired tissue integrity, the patient must be properly informed about their situation.
Teach the patient, their partners, and their families how to properly treat the wound, including handwashing, wound cleaning, changing the dressing, and applying topical treatments. Accurate information lowers the risk of infection and improves the patient’s capacity to manage therapy independently.
Teach the patient, their partners, and their families how to properly treat the wound, including handwashing, wound cleaning, changing the dressing, and applying topical treatments. Accurate information lowers the risk of infection and improves the patient’s capacity to manage therapy independently.
Gangrene Nursing Care Plan 3
Nursing Diagnosis: Risk for Infection related to possible sepsis secondary to gangrene
Desired Outcome: The patient will achieve timely healing; be free of purulent secretions, drainage, or erythema; and be febrile.
Gangrene Nursing Interventions
Teach the patient and family to wash their hands properly with antibacterial soap both before and after each care activity. Cross-contamination is made less likely by hand washing and good hand hygiene. Infections are most frequently spread by close contact with healthcare professionals who are unable to wash their hands in between client interactions.
When changing dressings, suctioning, and caring for the site with an invasive line or a urinary catheter, maintain a sterile technique. Medical asepsis limits the spread of microorganisms and lowers the possibility of nosocomial infection. The transmission of infection is prevented through personal protective equipment or PPEs, and isolation.
Keep an eye out for shivering, chills, and severe diaphoresis while noting temperature patterns. In the presence of a widespread infection, chills frequently precede temperature increases.
Dressings and other items should be disposed of in a double bag and labeled properly. Proper disposal of contaminated materials reduces contamination and bacterial spread.
Separate visitors and monitor them as needed. For any client who is infectious, body substance isolation should be used. Draining wounds may just require hand cleaning, wound isolation, and linen isolation.
When treating open wounds or anticipating direct contact with secretions or excretions, wear gloves and gowns. This prevents contamination and infection transmission.
Monitor lab tests, including WBC counts with neutrophils and band counts. An initial increase in band cells and WBC represents the body’s effort to fight the infection, whereas a decline shows decompensation.
Prepare for hyperbaric treatment as necessary. To treat anaerobic infections, wounds may be exposed to high ambient oxygen tension therapy.
Gangrene Nursing Care Plan 4
Nursing Diagnosis: Impaired Physical Mobility related to foot gangrene secondary to diabetes mellitus as evidenced by an inability to move purposefully within the physical environment.
Desired Outcomes:
● The patient performs physical activity independently or within the limits of the disease.
● The patient demonstrates the use of adaptive devices to increase mobility.
● The patient uses safety measures to minimize the potential for injury.
● The patient evaluates pain and the quality of management.
Gangrene Nursing Interventions
Evaluate the environment’s safety. Throw rugs, kids’ toys, and pets can all act as obstructions that further restrict one’s ability to move around safely.
Look for redness and tissue ischemia in the skin’s integrity (especially over the ears, shoulders, elbows, sacrum, hips, heels, ankles, and toes). Pressure ulcers can be prevented, detected, and treated early by routine skin inspection, especially over bony prominences.
When allowed to leave the bed, assist the patient with muscular workouts by performing knee bends, jumping on one foot, and toe touching. The patient increases their sense of balance and strengthens body components used for compensation.
Encourage and assist with early ambulation when it is feasible. Assistance with each initial change: ambulation, sitting in a chair, and dangling legs. The patient is kept as functionally active as possible thanks to these movements. Early mobility boosts confidence in regaining independence and lowers the likelihood of debilitation.
Display the use of any necessary mobility aids, such as a trapeze, crutches, or walkers. These gadgets can boost activity levels and make up for diminished function. Utilizing such tools aims to increase safety, improve mobility, prevent falls, and save energy.
Ensure that the patient has time to rest in between activities. Take energy-saving measures into account. Rest times are crucial for energy conservation. The patient must become aware of and accept their limitations.
Gangrene Nursing Care Plan 5
Nursing Diagnosis: Situational Low Self-esteem related to loss of toes secondary to gangrene
Desired Outcome: The patient will verbalize and show signs of acceptance of self and healthy adaptation to the current situation.
Gangrene Nursing Interventions
Assess the patient’s personal strengths and remember any effective coping skills they’ve used in the past. Building on the patient’s existing abilities can be beneficial for helping them deal with their current circumstances.
Assess the patient’s level of support. The rehabilitation process can be facilitated by the significant others’ and friends’ sufficient support.
Encourage the expression of worries, unfavorable emotions, and mourning about lost body parts. The patient can start to deal with the facts and reality of life without a limb by expressing their emotions.
Encourage ADL participation. Create opportunities for the patient to see and take care of the stump while highlighting any healing progress. Promotes a sense of self-worth and independence. Looking at the stump and hearing supportive comments (given in a normal, matter-of-fact manner) might aid the patient with this acceptance, even if integrating the stump into body image can take months or even years.
Encourage and make arrangements for another amputee, preferably one who is successfully recovering, to come and visit. A peer with similar experience can act as a role model, give comment validity, and inspire hope for rehabilitation and a normal future.
Give the patient a safe space to express sexuality-related issues. This encourages discussion of values and beliefs related to the delicate subject and exposes myths and misconceptions that could impede situational adjustment.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
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