INTEGRATING CONSERVATION AND CULTURAL CARE THEORIES IN NURSING MANAGEMENT OF DIABETIC FOOT ULCER: A CASE STUDY

Abstract

Background: Diabetic foot ulcers (DFUs) affect 26% of diabetic patients in Indonesia. Managing severe neuro-ischemic DFUs with metabolic and behavioral barriers requires bridging pathophysiology with holistic nursing models. This case reports integrating Levine’s Conservation Model and Leininger’s Cultural Care Theory. Case Summary: An 81-year-old male presented with a severe foot DFU. Advanced neuropathy caused unperceived thermal trauma, while dietary non- compliance and unsupervised dexamethasone abuse induced acute insulin resistance, accelerating tissue necrosis. Investigation and Diagnosis: Work-up revealed a maximum Leg Ulcer Measurement Tool (LUMT) score of 40/40 (severe liquefactive necrosis). Laboratories confirmed profound biochemical barriers: glucotoxicity (RBG 325 mg/dL) and inflammatory hypoalbuminemia (2.5 g/dL). The diagnosis was an infected neuro-ischemic DFU with metabolic exhaustion. Management: Levine’s model guided systemic antibiotics (Ciprofloxacin/Metronidazole), subcutaneous Insulin Detemir, and amorphous hydrogel dressings for autolytic debridement. Concurrently, Leininger’s framework guided cultural accommodation, restructuring the patient's belief that oral hypoglycemics negated high-glycemic foods by integrating glycemic boundaries into daily familial routines. Outcome: The wound bed transitioned to a responsive granular state, tracked via declining LUMT scores. Hyperalgesia and glucose stabilized, though long-term tracking was limited by brief hospitalization. Conclusion: Combining objective metrics (LUMT) with dual nursing frameworks successfully addresses complex clinical and transcultural geriatric diabetic complications.