please review i have already answered. i will send

Background/Assessment
55 Year old Female – Not working. Is Married with 2 daughters living at home. Her BMI is 28 Kg/m2. Carol presents to you after noting 2 days of a weeping right 3rd toe and newly developed pain and redness on the top right foot. On further questioning, Carol reports that she walked a lot more than she expected a couple of days ago in shoes without any socks because it was a hot day. She has just been applying a band aid daily.
Carol also informs you that 6 months previously she had developed a skin infection at the site of IV administration for her chemotherapy, which she was prescribed dicloxacillin for and it cleared up.
Findings:

Plantar view right foot toes Dorsal view right midfoot/ankle
Medical/Surgical
History
1986 Type 1 Diabetes Mellitus aged 28
1995 Hypertension
1995 Hyperlipidaemia
2006 Depression
2006 Cataract surgery and Intra ocular lens implant bilateral
2006 Right 2nd toe tenotomy of clawed toe secondary to recurrent ulceration
2007 Thyroidectomy
2009 Gastric Banding surgery
2010 Breast Cancer, Mastectomy [Right breast] currently undergoing weekly chemotherapy
Current Pathology:
HbA1c: 7.6
Total Cholesterol: 5.0
eGFR >90
Current Diabetes Foot Status:
Neuropathy. Sensory: Reduced Vibration and loss of protective sensation, no motor involvement, but may have elements of autonomic neuropathy with postural hypotension.
Pedal Pulses: palpable and regular
ABI: 1.16
Past history of digital ulceration and cellulitis requiring hospitalisation but no osteomyelitis
No amputations
Limited joint mobility
Allergies/hypersensitivies
No hypersensitivities reported and no known allergies
Current Medications
Drug Name             Strength Dosage
Avapro® Tablet [Irbesartan]             150mg Half tab mane m.d.u
Crestor® Tablet [Rosuvastatin]              10mg 1 tab daily m.d.u
Efexor-XR® Capsule [Venlafaxine]          150mg 1 tab daily m.d.u
Lantus® injection Cartridge [Insulin Glargine] 100 units/ml 14 units mane/10 units nocte
Novorapid® injection Cartridge [Insulin Aspart] 100 units/ml 10 units mane/10 units nocte
1) What is your diagnosis? Describe the pathophysiological basis and provide your clinical rationale for the condition.
Marking criterial: High Distinction 3%
Correct diagnosis, succinct and clear description of pathophysiological basis and strong and clear clinical rationale for diagnosis.
The patient has developed a neuropathic ulcer under the right 3rd distal phalange. A neuropathic ulcer occurs due to constant friction or compression forces causing extended microtrauma of overlying tissue. This eventually developed unnoticed injury and ulceration due to extensive peripheral neuropathy that is secondary to type-1 Diabetes Mellitus. As mentioned by Jain (2018), a neuropathic ulcer appeared as a vigorously callused, surrounding erythema, deep circular with high exudation of haemoserous fluid, and maceration of surrounding skin. As per the case study, the current appearance of the ulcer rises suspicion of infection.
Wound Swap needs to be sent for bacterial culture and systemic antibiotics are given until infection is further determined. Magnetic resonance imaging is done for early detection of osteomyelitis, within 1 to 2 days after the onset of infection, although, a bone biopsy is a standard test (Llewellyn et al., 2020). Long-term diabetes causes glycosylation of collagen and thickening of periarticular structures such as tendons, and ligaments, leading to structural deformity and limited joint mobility (Jakosz, 2019).
Apart from this, a BMI of 28 and above suggest overweight, which increases pressure on the third toe. This can affect gait and precipitate limb compensation. These mechanisms and risk factors in combination resulted in ulceration. Diabetes, hypertension, hyperlipemia, chemotherapy causes immunosuppression that adversely that affects wound healing.

Cursory assessment can reveal an ulcer on the dorsal aspect of the right 5th interdigital space. An open wound is predisposing factors for a bacterial infection that developed cellulitis on the dorsum of the right foot. Cellulitis is characterized by erythema, swelling, warmth, and pain (Gunderson, Cherry & Fisher, 2018). Recurrent cellulitis occurs due to obesity, diabetes, immunosuppression, chronic vascular insufficiency, and recurrent open ulcer which lead to the penetration of bacteria into the skin (Dall, Peterson, Simmons & Dall, 2005)
2) What is your evidence-based non-pharmacological treatment plan?
High Distinction 5%
An excellent non-pharmacological management plan with all key points made on the available evidence-base.
The neuropathic ulcer is a sign of increased mechanical stress therefore this stress is needed to be removed.
Short Term Care: (Reduce infection, offload)
As mentioned by Russo et al. (2016), antibiotic therapy is given to the patient to control the immediate infection. The Weekly wound assessment and management is done to prevent further progression of infection (Armstrong & Lavery, 2010). It must be noted that facilitate wound healing by offloading and re-distribution of pressure from the forefoot can be helpful in the prevention of progression. Daily dressing of the wound is done using iodosorb to reduce bacteria load and promote wound bed healing. (Tavintharan et al., 2009). Apart from this, offloading is done for rapid healing of pressure foot ulcers (Aguilar Rebolledo, Terán Soto & Jorge Escobedo de la Peña, 2010
Apart from this, the probe-to-bone assessment is done. It has been seen that positive PTB in an infected wound is highly suggestive of osteomyelitis (Morales Lozano et al., 2010). Besides, tissue biopsy was retrieved through the curettage of the ulceration to check sensitivity (Morales Lozano et al., 2010). On the contrary, a blood test is conducted to assess the level of infection and the ability for continued antibiotic therapy.
Medium-term: (monitor infection, reduce wound size)
The blood test is repeated and referral is made to medical-grade footwear specialists for the accommodative insole. Apart from this, ABPI/TPI needs to be repeated every 3 months. The patient will be re-evaluated monthly for wound assessment based on infection, location, exudate, and color. As per case study, Mrs carols extensive medical history impede wound healing so close monitoring of the wound is essential (Burns & Begg, 2011).
Long term: (Maintain healed wound)
As per the case study, patient results reveal that she has an extensive sensory deficit in both feet. This loss of protective sensation increases her risk of unidentified trauma to her feet and places her at a higher risk of ulceration. Results indicate a patient is wearing inappropriately fitted footwear with inadequate width, depth, or support (Armstrong & Lavery, 2010). The patient will be strongly educated on commencing daily foot checks and wears enclosed appropriately fitted footwear at all times to ensuring there is no future foot complication. These self-management concerns essential when constructing an ongoing patient/clinician management plan to ensure compliance and end-stage goals can be achieved (Tavintharan et al., 2009). Apart from this, an orthotic is done to accommodate mechanical imbalance and redistribute pressure
3) Drug prescribing-related issues
High Distinction = 5%
An excellent appreciation of the drug prescribing issues, fully taking into account the medical history,...