A client with diabetes mellitus develops an ulcer on the bottom of the foot. Which pathology is the primary contributing factor to the ability of the ulcer to heal?

Sensory neuropathy.

Hyperlipidemia.

Ketoacidosis.

Microvascular changes.

Answer and Explanation

The Correct Answer is D

A) Sensory neuropathy:

Sensory neuropathy, while common in diabetes mellitus, primarily affects sensation in the extremities and can lead to reduced pain perception and protective sensation. While sensory neuropathy can contribute to the development of foot ulcers by reducing the ability to detect trauma or pressure, it is not the primary factor influencing the ability of the ulcer to heal.

B) Hyperlipidemia:

Hyperlipidemia, characterized by elevated levels of lipids (cholesterol and triglycerides) in the blood, is a common comorbidity in diabetes mellitus. It can contribute to the development of atherosclerosis and macrovascular complications such as coronary artery disease and peripheral arterial disease. While macrovascular disease can impair wound healing by reducing blood flow to the affected area, it is not the primary contributing factor to the ability of the ulcer to heal.

C) Ketoacidosis:

Ketoacidosis, a serious complication of uncontrolled diabetes mellitus, results from the accumulation of ketones in the blood, leading to metabolic acidosis. While ketoacidosis can have systemic effects and impair overall health, it is not directly related to the ability of a foot ulcer to heal.

D) Microvascular changes:

Correct. Microvascular changes, such as thickening of the capillary basement membrane and endothelial dysfunction, are hallmark features of diabetes mellitus. These changes lead to impaired microcirculation, reduced oxygen delivery, and compromised nutrient supply to tissues, including the skin and soft tissues of the foot. Poor microvascular perfusion contributes to delayed wound healing and an increased risk of infection in individuals with diabetes mellitus. Addressing microvascular changes is essential for promoting wound healing in diabetic foot ulcers, making it the primary contributing factor to the ability of the ulcer to heal.

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Correct Answer is C

Explanation

A. Myocardial infarction:

Myocardial infarction (MI) typically presents with severe and prolonged chest pain or discomfort that is not relieved by rest or nitroglycerin. MI is characterized by myocardial necrosis due to prolonged ischemia, often resulting from the occlusion of a coronary artery by a thrombus or plaque rupture. While chest pressure and breathlessness are symptoms commonly associated with MI, the transient nature of the symptoms described by the client, as well as their relief after rest, is more indicative of stable angina rather than MI.

B. Unstable angina:

Unstable angina is characterized by new-onset angina, increasing frequency, or worsening intensity of angina symptoms. It is considered a medical emergency as it may precede a myocardial infarction. However, unstable angina typically presents with symptoms at rest or with minimal exertion and is not usually relieved by rest or nitroglycerin. The client's symptoms, which are relieved by rest, are more consistent with stable angina.

C. Stable angina:

Stable angina is characterized by predictable chest pain or discomfort that occurs with exertion or stress and is relieved by rest or nitroglycerin. The symptoms described by the client, including chest pressure and breathlessness that improve with rest, are consistent with stable angina. Stable angina occurs due to transient myocardial ischemia caused by an imbalance between myocardial oxygen supply and demand, often related to coronary artery disease.

D. Prinzmetal angina:

Prinzmetal angina, also known as variant angina, is characterized by chest pain or discomfort that occurs at rest, often in the early morning hours, and is typically caused by coronary artery spasm rather than fixed atherosclerotic lesions. While Prinzmetal angina can present with transient symptoms similar to those described by the client, it is less common than stable angina and is often associated with transient ST-segment elevation on electrocardiogram (ECG), which is not mentioned in the scenario.

A. Increased preload that results in generalized peripheral edema. B. The lowered blood pressure results in a reduction of the heart rate. C. Decreased preload that can lead to decreased cardiac output. D. Increased peripheral resistance resulting from poor renal perfusion.

Correct Answer is C

Explanation

A) Increased preload that results in generalized peripheral edema:

This statement is incorrect. Decreased blood volume due to hemorrhage leads to decreased preload, not increased preload. Generalized peripheral edema is more commonly associated with conditions such as heart failure or kidney disease, where fluid retention leads to increased preload.

B) The lowered blood pressure results in a reduction of the heart rate:

While it's true that a decrease in blood pressure can trigger compensatory mechanisms such as an increase in heart rate (tachycardia), the specific response mentioned in this option is not entirely accurate. The primary compensatory response to hemorrhage-induced hypotension is typically an increase in heart rate, not a reduction.

C) Decreased preload that can lead to decreased cardiac output:

Correct. With decreased blood volume (preload), there is less blood returning to the heart during diastole. This leads to decreased ventricular filling and subsequently decreased stroke volume and cardiac output. Decreased cardiac output can contribute to hypotension and inadequate tissue perfusion.

D) Increased peripheral resistance resulting from poor renal perfusion:

While poor renal perfusion can trigger mechanisms to increase peripheral resistance (such as activation of the renin-angiotensin-aldosterone system), this option does not directly address the primary effect of decreased preload on cardiac output. Increased peripheral resistance alone does not adequately compensate for decreased preload to maintain cardiac output.

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A client with diabetes mellitus develops an ulcer on the bottom of the foot. Which pathology is the primary contributing factor to the ability of the ulcer to heal?

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