An Alternative Method of Offloading a Neuropathic Foot Ulcer

AN ALTERNATIVE METHOD OF OFFLOADING THE NEUROPATHIC FOOT ULCER
Patient participation is at the apex of success. Interventions must be achievable for positive outcomes. Ultimately, the patient chooses interventions. Interventions offered are based on the conscientious, explicit, and judicious use of current best evidence in decision making. It customizes experience with the various forms of evidence applied to the specific problem/situation under investigation. (Sackett,et al, 1997).  The case study involves an individual with an infected diabetic foot ulcer. 

History:59yr old single male, caring for two children, one is handicapped. Comorbidities include obesity, heart disease, venous insufficiency, diabetic retinopathy, chronic renal failure, degenerative disc disease and nicotine use.

Ideal situation:Debridement, absence of infection, glycemic control, smoking cessation and total pressure relief.

Reality:Debridement; home IV antibiotics, elevated glycemic levels; continued smoking.  Nonweight bearing and total contact casting were not options due to clinical restrictions.  Back pain due to unequeal leg lenght rendered a removable cast walker unacceptable.

Interventions based on evidence based practice:Outpatient  interventions: conservative sharp debridment, bacterial control, optimal vascular flow and edema control, encouragement re: smoking cessation and diabetic control.  Wound care was based on principles of wound healing.  Pressure relief with the least mobility restriction was addressed by fabricating a 'soft cast' building in pressure relief with felt and cotton to allow for maximum pressure relief with weight bearing.

Outcome:Falling outside the expected healing time, the patients wound healed.  With custom molded shoes and preventative care, there was no recurrence after two years.

Conclusion:Newman's theory defines health as "expanding consciousness," or increasing complexity.  The nurses' role is to recognize the person's unique pattern of life and to work within that pattern with the person to achieve the person's goals. This individuals’ diabetic ulcer healed in less than ideal circumstances through application of Newman based nursing theory and interventions the patient chose from evidence based practice interventions.