Healing a Diabetic Foot Wound: A Nursing Story

A uninsured 56-year-old  165 lb. patient was discharged from the hospital with a non-healing diabetic foot wound. Stopping his insulin, he attempted to heal himself resulting in gangrene.

 His hospital course included amputation of the second and third toes and in-house wound vac therapy x 2 weeks, follow up Home Care Nursing and a  visit to the Wound Care Center in 1 week .

The Home Care RN noted edema, yellow slough and characteristic blue green drainage with distinctive Pseudomonas odor . She requested permission to irrigate the wound with .25 % acetic acid, but the MD sent the patient to the ER where the wound was not examined but sent him home with a prescription for Cephalexin 500 mg.

The Home Care RN decided to break a boundary and use the acetic acid solution on the blue-green drainage, looking up the recipe for .25 percent on the Internet. She and the patient made the solution together in his kitchen. They sprayed the wound and rinsed it with saline. Within 2 days both the blue green drainage and odor were resolved. 

The WOCN recommended a silver foam applied q 3-4 days. The nurse taught the patient wound care and visited weekly.

Conclusion:

The plan of care was successful because it was realistic. From the onset, the patient made it clear that he needed to continue to “live his life”: go back to work, drive, ride the subway, etc. The healing course was one of constant compromise and innovation within a realistic setting.

Successful wound healing at home must be reexamined under the lens of reality. When adaptations are addressed at the onset, the health care practitioner will not be surprised to find that although the patient lives a very different lifestyle than witnessed,  goals will be achieved.