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Personal Experiences in Treatment of Diabetic Foot Syndrome

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Lewandowski A., Paszta W., Nowatorski W.

Polish Journal of Surgery

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2008

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vol. 80

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issue 11

609-614

EN

Changes like deformities, ulcerations, infection and destruction of deep tissues of foot caused by diabetes mellitus are called diabetic foot syndrome. About 2.5 million people (6% of population) suffer from diabetes mellitus in Poland. About 100 000 of them suffer from diabetic foot syndrome.The aim of the study was to retrospectively analyze patients with diabetic foot syndrome and present results of the surgical treatment of these patients.Material and methods. The study group comprised 112 patients of both sexes aged between 34 and 90 years treated in our Department of Surgery from January 2003 to December 2007. The mean age for men was 61 years and for women - 72 years. Most patients in the study group were diagnosed with type 2 diabetes mellitus (89.2% in men and 95.7% in women). Symptomatic atherosclerosis occurred in 25% of treated patients.Results. 112 patients with diabetic foot syndrome needed 144 hospitalizations (65 male patients needed 86 hospitalizations and 47 female patients needed 58 hospitalizations). The average hospitalization duration for male patients was 24 days and for female patients was 22 days. 8 patients (7,1%) died - 3 men and 5 women. 82 (73%) patients were operated. Operative methods consisted of phlegmon incision, amputation of toes, metacarpal amputation and amputation of limb under and above the knee. 38 different bacterial species were cultured as the results of microbiological evaluations in 71 patients.Conclusions. Patients with diabetic foot syndrome are hospitalized in department of surgery many times, they need multidisciplinary treatment and can be a source of nosocomial infections.

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ROLA PIELĘGNIARKI W OPIECE NAD PACJENTEM PRZYGOTOWYWANYM DO AMPUTACJI KOŃCZYNY DOLNEJ SPOWODOWANEJ ZESPOŁEM STOPY CUKRZYCOWEJ studium przypadku w oparciu o ICNP®

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Kuklińska A.

Long-Term Care Nursing

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2019

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vol. 4

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issue 2

58-73

EN

Introduction Diabetes is undoubtedly one of the biggest problems of modern medicine. The percentage of patients incre¬ases every year. Modern lifestyle – reduced physical activity, consumption of high-calorie products are the main causes of a given state of affairs. In diabetes, the problem is not so much increased blood glucose, but the threat of numerous metabolic disorders that lead to serious complications such as limb amputation due to diabetic foot syndrome [Szewczyk, 2013]. Aim of the study The aim of the presented work is to determine the patient’s care problems and to develop the tasks of a nurse in patient care prepared for amputation of the lower limb caused by diabetic foot syndrome based on a case--by-case study. While creating the care plan, reference was made to the dates taken from ICNP®. Case in the presented case, the patient is a woman aged 49 years with insulin-dependent diabetes with peri-pheral circulation complications. The patient complains of severe, stabbing pain in a sick limb. The patient is being prepared for amputation of the right lower limb caused by necrosis of the right toes of the right foot and right forefoot necrosis in the course of the diabetic foot. The procedure went well and without compli¬cations under general anesthesia. Discussion Diabetes is one of the earliest diagnosed diseases of our civilization, but recently it has been learned to treat without destroying the sick organism. However, it is still a serious problem to this day and, despite treat¬ment, leads to numerous complications. Complications affect the whole body of the patient, from vascular changes in the head to the feet. According to the World Health Organization, it is estimated that by 2025 there may already be 300 million diabetics worldwide [Dębosz i Humańska, 2017]. It is estimated that 7-9% of patients with diabetes in Poland. At present, 3 million people suffer from diabe¬tes in Poland, but only 2.2 million are diagnosed with the disease. Every fourth person over 60 years of age suffers from diabetes, and among people over 80 years of age every second. People with pre-diabetes, i.e. when the blood glucose level is higher than it should, but is too low to make a diagnosis of type II diabetes, is 4 times more than those with diabetes [Czupryniak i Strojek, 2016]. The goal of diabetes treatment is to maintain normal blood glucose, cholesterol and blood pressure levels, but also to prevent complications through a diabetic diet, maintain adequate weight, exercise, and quit smo¬king, e.g. The lifestyle of people with diabetes can have a huge impact on the occurrence of complications, and the most common complication is diabetic foot syndrome [Sutkowska, 2012]. Diabetic foot syndrome is a serious health problem for diabetics, it worsens the quality of life and is the most common cause of disability, as well as shortening life. Late diagnosed, poorly controlled and too long dura¬tion of the disease leads to chronic complications that affect the foot ulcer in a diabetic [Szewczyk, 2013]. Self-monitoring is very important in treating the diabetic foot. If a diabetic notices any disturbing changes on the foot, he should immediately visit a diabetologist [Szewczyk, 2013]. Preventive measures should be implemented as early as possible, as proper control and proper foot care can completely prevent the formation of diabetic foot, or at least delay its formation [Szewczyk, 2013]. Amputation is cutting off the limb used to improve health and is always the last surgery most often after an unsuccessful attempt to heal. In patients with diabetes, damage to the blood vessels and nerves leads to serious infections that are very difficult to treat. Minor damage is the cause of infection, which consequently results in amputation. Amputation is done when the efforts to save the foot are ineffective and the infection is a serious threat to life [Wannot, Nierobisz i Biskupek-Wannot, 2017]. The most common risk factors for lower limb loss: peripheral atherosclerosis and neuropathy, deformity of the feet especially in limited joints, past ulceration or amputation due to diabetes, poor glycemic self-con¬trol, vision impairment, obesity, foot injuries due to incorrect footwear, hypertension, dyslipidemia, smo¬king tobacco and alcohol abuse, inability to care for feet due to mobility restrictions or visual impairment as well as old age [Fabian, Koziarska–Rościszewska i Szymczyk, 2008]. Proper preparation of patients for diabetes and intensive perioperative care have a great impact on the outcome of surgical treatment. A patient with diabetes requires special therapeutic treatment in the perio¬perative period. To ensure the best care for a patient with diabetes during surgery, the cooperation of the surgical, anaesthesiological and diabetic team is important [Szewczyk, 2013]. Conclusions A person who has undergone lower leg amputation is not capable of self-care and self-care. Proper prepara¬tion of patients for diabetes and intensive perioperative care have a great impact on the outcome of surgical treatment. A patient with diabetes requires special therapeutic treatment in the perioperative period. To ensure the best care for a patient with diabetes during surgery, the cooperation of the surgical, anaesthe¬siological and diabetic team is important [Szewczyk, 2013]. By using the terms from the ICNP catalog, the nursing process is understandable for people of different nationalities.

PL

Wstęp Cukrzyca jest niewątpliwie jednym z największych problemów współczesnej medycyny. Odsetek chorych wzra¬sta z roku na rok. Współczesny tryb życia – zmniejszona aktywność fizyczna, spożywanie wysokokalorycznych produktów, to główne przyczyny takiego stanu rzeczy. W cukrzycy problem stanowi nie tylko podwyższony poziom glukozy we krwi, ale także zagrożenie licznymi zaburzeniami metabolicznymi, które prowadzą do poważnych powikłań, jak np. amputacja kończyny na skutek zespołu stopy cukrzycowej [Szewczyk, 2013]. Cel pracy Celem prezentowanej pracy jest określenie, na podstawie studium indywidualnego przypadku, problemów pielęgnacyjnych pacjenta oraz zdefiniowanie zadań pielęgniarki w opiece nad pacjentem przygotowywanym do amputacji kończyny dolnej spowodowanej zespołem stopy cukrzycowej. Podczas tworzenia planu opieki odwoływano się do terminów zaczerpniętych z ICNP®. Prezentacja przypadku W prezentowanym przypadku pacjentem jest kobieta w wieku 49 lat z cukrzycą insulino zależną z po¬wikłaniami w zakresie krążenia obwodowego. Pacjentka uskarża się na silny, przeszywający ból chorej kończyny. Chora przygotowywana do zabiegu amputacji kończyny dolnej prawej spowodowanej martwicą palców stopy prawej oraz martwicą przodostopia prawego w przebiegu stopy cukrzycowej. Zabieg prze¬biegł prawidłowo i bez powikłań przy ogólnym znieczuleniu chorej. Wnioski Osoba po zabiegu chirurgicznym amputacji kończyny dolnej nie jest zdolna do samoopieki i samopielę¬gnacji. zastosowaniu terminów z katalogu ICNP® proces pielęgnowania jest zrozumiały dla osób o różnych narodowościach.

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OCENA FUNKCJONOWANIA PACJENTÓW Z ZESPOŁEM STOPY CUKRZYCOWEJ

72%

Ponczek D., Bąk A.

Long-Term Care Nursing

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2019

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vol. 4

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issue 1

5-16

EN

Abstract Diabetes is a chronic disease leading to many complications. One of them is the diabetic foot syndrome (DFS) that disturbs the patient’s functioning in every sphere of life. Aim of the study The evaluation of the functioning of patients with the diabetic foot syndrome. Material and methods The study was conducted among 68 patients with DFS treated in the Outpatient Department of Chronic Wounds and in the Department of Vascular Surgery and Angiology at Antoni Juras z University Hospital No. 1 in Bydgoszcz. Interview, palpation, observation and author’s questionnaire, PEDIS classification and Barthel scale were used in order to achieve the goals of the study. Results The study evaluated physical condition of the patients with DFS by using the Barthel scale. Their condition turned out to be “light”. Better dexterity was observed among patients without the need of hospitalization during the year before the interview and among those people who were in a relationship. Patients func¬tioned on the average level in the mental and social sphere. The worse mood was more frequently observed among women. People that suffered from diabetes for a shorter time and men in general were more active in the social sphere. Conclusions DFS causes disorders in allthree spheres of the patient’s life. It is advisable to provide patients with the spe¬cialist care by an interdisciplinary team that will increase the overall quality of life for patients with DFS.

PL

Wstęp Cukrzyca jest chorobą przewlekłą prowadzącą do wielu powikłań. Jednym z nich jest zespół stopy cukrzy¬cowej (ZSC), który zaburza funkcjonowanie pacjenta w każdej sferze życia. Cel pracy Ocena funkcjonowania pacjentów z ZSC. Materiał i metody Badania przeprowadzono wśród 68 pacjentów z ZSC leczonych w Poradni Leczenia Ran Przewlekłych i w Klinice Chirurgii Naczyniowej i Angiologii w Szpitalu Uniwersyteckim nr 1 im. Antoniego Jurasza w Bydgoszczy. Dla realizacji celów badania zastosowano wywiad, badanie palpacyjne, obserwację oraz wykorzystano au¬torski kwestionariusz ankiety, klasyfikację PEDIS i skalę Barthel. Wyniki Stan fizyczny badanych osób z ZSC oceniony za pomocą skali Barthel okazał się „lekki”. Lepszą sprawność zaobserwowano u pacjentów bez konieczności hospitalizacji w ciągu roku przed wywiadem oraz u osób pozostających w związku. W sferze psychicznej i społecznej pacjenci funkcjonowali na poziomie średnim. Obniżony nastrój częściej obserwowano u kobiet. Bardziej aktywni społecznie byli mężczyźni oraz osoby chorujące na cukrzycę krócej. Wnioski ZSC wpływa na występowanie zaburzeń w każdej z trzech sfer życia pacjenta. Wskazane jest objęcie pa-cjentów specjalistyczną opieką interdyscyplinarnego zespołu, dzięki czemu zwiększy się ogólna jakość życia pacjentów z ZSC.

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2 Long-Term Care Nursing

1 Polish Journal of Surgery

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1 Bąk A.

1 Kuklińska A.

1 Lewandowski A.

1 Nowatorski W.

1 Paszta W.

1 Ponczek D.

Personal Experiences in Treatment of Diabetic Foot Syndrome

ROLA PIELĘGNIARKI W OPIECE NAD PACJENTEM PRZYGOTOWYWANYM DO AMPUTACJI KOŃCZYNY DOLNEJ SPOWODOWANEJ ZESPOŁEM STOPY CUKRZYCOWEJ studium przypadku w oparciu o ICNP®

OCENA FUNKCJONOWANIA PACJENTÓW Z ZESPOŁEM STOPY CUKRZYCOWEJ