Question

How would you prioritize these nursing diagnoses? What is the interrelationship between them (i.e. how does one influence the other)? It is for a patient with chronic osteomyelitis, diabetes mellitus type 1, and who is going for a toe amputation.

1. impaired physical mobility R/T loss of a toe.

2. risk for infection R/T diabetes mellitus

3. risk for ineffective tissue perfusion R/T ???

4. situational low self-esteem R/T change in body

Answer 1

Diabetes mellitus is a metabolic disorder caused due to less production of insulin by the pancreas, high level of glucose in the blood, or both.

Also,

Osteomyelitis is the inflammation of the bone and marrow of the bones, osteomyelitis is one of the complications of diabetes, this complication of diabetes is most of the times not diagnose properly or not been taken into the consideration.

Osteomyelitis can occur due to other causes as well such as infection, lack of calcium in the bone, hormonal imbalance, menopause but the intensity of osteomyelitis increases multiple times with the presence of diabetes.

Treatment of osteomyelitis is done with the help of antibiotics but the duration of treatment is increased due to presence of diabetes and the length of stay in the hospital is also increased, risk of amputation is higher in patient with osteomyelitis along with diabetes, it's very important to diagnose early and treat diabetes at primary level to avoid such complications like amputation of knees, foot etc.

Osteomyelitis and diabetes are interrelated to each other as neuropathy is one of the complications of diabetes, neuropathy is the condition in which foot muscles loses it's ability to contract and reduces the sensation in the foot and also increases blood pressure to the foot, increase blood pressure causes a break into the skin and open skin becomes more prone to infection and if it is left undiagnosed and untreated, the bacteria invade deeper into the skin and to the bones that causes osteomyelitis.

Nursing diagnosis according to the priority of the patient.

1. The risk for infection related to diabetes mellitus.

The risk for infection is increased related to diabetes mellitus as evidenced by inflammation to the bones, and delay in wound healing.

Diabetes mellitus causes neuropathy and loses the ability of foot muscles to contract properly and blood pressure to those areas are increased, increased blood pressure causes breaks in the skin and open skin get infected with the bacteria, and if left untreated it invades underlying bones and causes osteomyelitis.

2. The risk for ineffective tissue perfusion.

The risk for ineffective tissue perfusion related to increased blood glucose level as evidenced by the non-healing wound of the foot, and loss of sensation to the foot.

3. Impaired physical mobility related to loss of a toe.

Severe infection to the bones due to osteomyelitis along with the presence of diabetes may lead to amputation of the toe and impairs physical mobility of the patient.

4. Situational low self-esteem related to change in the body.

The self-esteem of the patient gets affected due to the change in the body such as amputation of the toe.