You are evaluating a patient for a plantar diabetic foot ulcer, under the first metatarsal head. He has already seen a vascular surgeon who states that the patient has adequate blood flow for wound healing.  You test the patient’s sensation and he is unable to feel the 5.07 filament.  The wound has minimal drainage, no odor, and has 30% slough and 70% pink granular tissue.  His blood sugar this morning was normal.  What must be included in your plan for this patient in order to treat the underlying cause and allow the wound to close?

Negative pressure wound therapy: 

Your patient resides in a transitional care unit (TCU) with a stage 4 pressure injuries to his bilateral ischial tuberosities with a history of 3 admissions to the hospital for wound sepsis in the past 6 months.  The nursing team has been changing his dressing as prescribed.  The patient presents to the outpatient wound clinic with 80% necrotic tissue to his wounds. He has limited financial resources and no available family to participate in his care.  Which of the following is the most appropriate treatment plan given this information?

Charcot arthropathy is a devasting complication of neuropathy resulting in an irreversible deformity of the foot. 

Your patient is a 62 year-old male with a history of diabetes and a wound on his left first toe. You perform an ankle brachial index (ABI) to screen his limb for arterial insufficiency.  Your results are as follows:  Right arm – 145, Right femoral level (upper thigh) – 200, Right popliteal level (lower thigh) – 190, Right posterior tibialis (ankle) – 180, and Right great toe – 80.  Readings are similar on the left lower extremity.  Your conclusion based on the ABI result is:

You are assessing your patient’s abdominal wound  3 days after abdominal surgery for a cholycystectomy. You note: erythema about 1 cm circumferentially around the wound, tenderness to palpation, moderate serosanguineous drainage, no odor, no fever. The patient has diabetes and their blood glucose this morning prior to breakfast was 80. Which of the following is most accurate?

For the patient above, the wound is now 80% granular with minimal drainage and patient denies pain or elevated blood sugars.  At this juncture in treatment, what intervention will allow the patient to heal the fastest? 

A patient is referred to you for “bilateral leg edema and weeping.  Please provide patient with compression socks”.  You noticed when they transferred to a treatment table from their wheelchair they sound very short of breath.  You also noticed that your patient has what appears like edema in their arms/hands as well.  What is your main concern about applying compression? 

You are asked to evaluate a 56 year old woman for her dehisced hysterectomy site. The wound measures 1.5 x 5.2 x 4.0 cms.  At 3:00 she tunnels 15 cm.  At 9:00 she tunnels 6 cm.  There is a foul odor upon entry to the room, copious amount of yellowish-green drainage such she reports having to change her dressing three times per day.  The base of the wound is 70% yellow slough.  She has a moderate amount of edema and erythema extending away from the borders of the wound.   Are you concerned about infection for this patient?

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