Diabetes Mellitus and Osteomyelitis

Question: Discuss about the Diabetes Mellitus and Osteomyelitis. Answer: Introduction: The case study under examination is about a 60-year-old woman. She is a known diabetic patient who presents to the hospital with complaints of painful and cold feet. Additionally, her toe of the left foot is swollen with blackened callus. This paper explains the management of the patient focusing on history taking, neurovascular assessments, diagnostic tests, treatment options, recognition of osteomyelitis and possible referral. History taking for this patient can consider the chief complaint, the history of presenting illness and the past medical and surgical history. Fawcett and Rhynas( 2012) ascertain that a comprehensive history can elicit crucial information that can help the nurse identify possible causative factors of the disease. For instance, in the case, the nurse identifies the cold red feet and attributes them to osteomyelitis. Without a proper history, the nurse could have diagnosed diabetic foot. Consequently, the three aspects of health history can elicit crucial information. This assessment can help the nurse to recognize the extent of neurovascular deterioration and determine its cause. For instance, on examination, the nurse notes a blackened callus on the toe. Additionally, the nurse identifies swelling and ulcers. Consequently, the nurse suspects osteomyelitis. According to Malhotra, Chan, and Nather (2014), one of the complications of diabetic foot ulcers is osteomyelitis. Malhotra et al. (2014) reiterate that swelling and pain are inevitable in osteomyelitis. Therefore, neurovascular assessment by looking at the feet and considering the available research evidence is crucial to determine the diagnosis. Diagnostic Tests Diagnostic tests are necessary in this case to determine if osteomyelitis is present. Chiappini, Mastrangelo, and Lazzeri (2016) argue that a blood test to can identify elevated leukocytes, which can indicate infection. Additionally, an ultrasound scan and X-ray are necessary for examining the bone image to determine deviations from normal. These are the most convenient tests that can allow the nurse to diagnose osteomyelitis. Treatment of this patient can involve antibiotics and surgery. Gomes, Pereira, and Bettencourt (2013) argue that antibiotics are effective in managing osteomyelitis in an acute stage. However, from the assessment, the patient has a necrotic tissue. X-ray and CT scan results can show necrosis of the bone. In a case where the bone is necrotized, the nurse can refer the patient for further management. Referral to the Podiatric Surgeon A podiatric surgeon is the most appropriate resource for the referral. According to Malhotra et al. (2014), the surgeon can combine antibiotics with surgical resection of the necrotic tissue. Since Staphylococcus aureus causes the conditions, administering penicillin drugs would be appropriate (Gomes et al., 2013). Eventually, these therapeutic measures can prevent residual disease of the foot. Osteomyelitis occurs when the bone becomes inflamed after an infection. Gomes et al. (2013) argue that it can lead to the destruction and necrosis of the bone. Moreover, Malhotra et al. (2014) explain that it can result from a diabetic ulcer. Some of the signs and symptoms include localized pain and swelling, fever, tenderness and limited range of motion in the affected body organ. The condition is classified into four stages. In early stages, stage one is restricted to the bone while stage two involves the cortical bone. Later, stage three progresses to the medullary bone while stage four involves the entire bone. The condition spreads fast if not managed quickly. Conclusion History taking and proper physical assessment of diabetic patients are crucial to identifying if they have complications. Osteomyelitis is one of the most common complications of diabetes mellitus. It often occurs in the foot. The patient can present with a necrotized foot that is painful and swollen. Nevertheless, with proper medical and surgical therapy with a podiatric surgeon, the patient can recover quickly. List of References Chiappini, E., Mastrangelo, G. Lazzeri, S., 2016. A case of acute osteomyelitis: An update on diagnosis and treatment. International Journal of Environmental Research and Public Health, 13(6), p.539. Available at: https://www.mdpi.com/1660-4601/13/6/539/htm [Accessed 21 January 2016]. Fawcett, T. Rhynas, S., 2012. Taking a patient history: the role of the nurse. Nursing Standard,26(4),pp.41-46.Available at:https://journals.rcni.com/doi/abs/10.7748/ns2012.02.26.24.41.c8946 [Accessed 21 January 2017]. Gomes, D., Pereira, M. Bettencourt, A.F., 2013. Osteomyelitis: an overview of antimicrobial therapy. Brazilian Journal of Pharmaceutical Sciences, 49(1), pp.13-27. Available at: https://www.scielo.br/pdf/bjps/v49n1/a03v49n1.pdf [Accessed 21 January 2017]. Malhotra, R., Chan, C.S.-Y. Nather, A., 2014. Osteomyelitis in the diabetic foot. Diabetic Foot Ankle, 5, Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119293/ [Accessed 21 January 2017]. WHO, 2016. Media Center: Diabetes Factsheet. [Online] Available at: https://www.who.int/mediacentre/factsheets/fs312/en/ [Accessed 21 January 2017].