The Diabetes Plus an Infected Diabetic Ulcer - Essay Example

"The Diabetes Plus an Infected Diabetic Ulcer" is a brilliant example of a paper on diabetes mellitus. 
Regarding a patient who presents in a podiatric clinic with a history of diabetes plus an infected diabetic ulcer, one mostly suspects osteomyelitis. Osteomyelitis is an acute or chronic bone infection. It usually results due to the hematogenous spread of bacteria from other sites or via the direct spread of bacteria to the bone via overlying wound or trauma. In diabetics who develop diabetic foot, sometimes develop osteomyelitis due to the direct spread of bacteria from the skin due to favorable conditions.  

In such a patient who presents in a podiatric clinic with a history of diabetes plus an infected diabetic ulcer, proper history taking is essential.  This entails asking when the ulcer on her left leg started, the duration, color changes the wound has undergone, if the joint around it became warm when it started, and history of difficulties in using the affected limb need to be documented. One may also ask any recent infection history elsewhere in the body to rule out any hematogenous spread. Also, enquire about the characteristic of pain at the ulcer area. Ask about its onset, duration, character, frequency, aggravating, and relieving factors plus associated factors (Velves 2006, p. 18). Also, ask her about her diabetic status to find out if the ulcer came about due to poor control of glucose. The document also on the quantity of insulin she is takes and for how long. Also, try to ask for any history of trauma on her left toe. 

On physical examination, ensure to take her vital signs. Fever may be indicative of the infection becoming septic. Also on examination, try to elicit the tender site, check the consistency of the area around the wound i.e. might be raised, note the temperature around the ulcer site, i.e. was cold. Note the presence of any draining sinus and record its characteristics (Waldvogel 2010, p. 83). 

Investigations that can be done include complete blood count. In this form of osteomyelitis, one would look for leucocytosis and a raised ESR to confirm the presence of an inflammatory process. A random blood sugar test can also be done to get her blood sugar levels (Hodler 2009, p.25). An abscess specimen can be collected from that given toe and taken for culture and sensitivity to get the right causative agent. 

Radiological investigations that can be done include an X-ray of the affected side limb to show cortical disruption. Other radiological studies that can be done include a Doppler ultrasound to ascertain the state of her blood vessels of the lower-left limb (Waldvogel 2010, p. 142). 

In management, one can manage the patient generally and also got the definitive management of osteomyelitis secondary to a diabetic foot. General management of the patient could include proper nutrition of the patient by nutritionist guidance so as not to interfere with her glucose levels. The best rest is also important. Physiotherapy of the affected limb after the treatment might be useful in returning the limb to mobility. 

Specific management could entail surgical debridement and ensuring the abscess at that wound is drained well. Ensure you leave a tap to run with antibiotics for some days until you confirm recovery (Zgonis 2009, p. 92). Ensure you accompany surgical treatment with oral antibiotics to minimize risks of post-operative infections in such a patient. The common combination of antibiotics given is a fluoro-quinolone + clindamycin (Waldvogel 2010, p.39). Pain can also be managed by analgesics. Sometimes, results of culture and sensitivity can direct one on which antibiotic to specifically use. 

The patient can be referred to an orthopedist when she develops or shows a sign of developing a gangrenous foot develops. Another possible referral may be to a medical consult when treatment does not work or the patient develops the systemic infection. The patient can also be referred to a physiotherapist after healing to ensure she attains the mobility of her left leg.  

In conclusion, osteomyelitis in diabetes can be properly managed by following the above treatment regimen. It is also of uttermost importance to refer a patient to a relevant doctor in case complications result (Levin 2008, p45).