Marcie notices several red areas as she removes Mr. Dimitri’s sock, but it’s the open wound that concerns her. Located on the plantar hallux, it measures 0.5 cm x 1 cm and 0.4 cm deep. Examining it more closely, she notes the base is about 40% yellow slough and 60% red granulation. The edges are well defined without any apparent undermining. The wound has no odour and she doesn’t see any signs of infection. She continues her assessment, noting calluses, dry skin, heel fissures and redness and inflammation at pressure points on both Mr. Dimitri’s feet. He denies any pain, numbness or tingling. His skin is warm to touch, pulses palpable and ankle brachial index, 1.2.
Based on her assessment of the wound and lower legs, Marcie diagnoses Mr. Dimitri’s wound as a (healable) diabetic ulcer. She confirms her diagnosis using the BC Provincial Nursing Skin and Wound Committee Guideline for diabetic ulcers.
Marcie knows it’s likely that, with appropriate nursing treatment, Mr. Dimitri’s ulcer will heal. She uses the guideline to determine the appropriate dressing for the wound. She’ll dress the wound today and talk with Mr. Dimitri about minimizing weight bearing until he can see the orthotist for an offloading device. She’ll also refer him to the dietitian and talk with him about the signs and symptoms of infection and preventing further ulcers. She discusses her diagnosis and treatment plan with Mr. Dimitri, answers his questions, and obtains his consent. She’ll evaluate his progress at the next dressing change.
In deciding to treat, Marcie considers the risks, benefits and possible outcomes. In her judgment, the outcome is fairly predictable and she can manage any intended or unintended outcomes. She has the competence to make the diagnosis and carry out the treatment. Her assessment, diagnosis and treatment plan are supported by current evidence. She can meet the CRNBC limits and conditions on diagnosing conditions related to wounds: She has completed her organization’s additional education on wound care and is using a decision support tool.
Marcie dresses the wound and completes her patient teaching. After arranging Mr. Dimitri’s referrals, Marcie documents her diagnosis, plan, and treatment on the wound care flow sheet in Mr. Dimitri’s chart. Marcie shares her plan of care with the health care team at the next team huddle and informs Mr. Dimitri’s physician about the plan of care when his physician next makes her rounds.
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