A male client with type 1 diabetes mellitus (DM) develops a gangrenous toe and is admitted for possible amputation. Which pathophysiological consequence of DM has contributed to this client's complication?

Pressure injuries, also known as pressure ulcers or bedsores, result from prolonged pressure on the skin, leading to tissue ischemia and damage. Early recognition of the pathophysiological processes involved in pressure injury development is crucial for prevention and timely intervention. Here's why option D is the correct choice:

A) Epidermal fragility and skin excoriation with serous drainage:

This description more closely aligns with the characteristics of a superficial wound or abrasion rather than the early stages of a pressure injury. In pressure injuries, epidermal breakdown may occur later in the process, after prolonged pressure and tissue ischemia.

B) Hypodermal fluid accumulation and blister formation:

While fluid accumulation and blister formation can occur in some types of wounds, such as friction blisters or burns, they are not typically characteristic of the early stages of pressure injury development. Pressure injuries primarily involve tissue ischemia and damage due to pressure and shear forces.

C) Necrotic tissue, purulent exudate, and eschar formation:

This description is more indicative of advanced or severe pressure injuries rather than the early stages. Necrotic tissue, purulent exudate, and eschar formation typically occur in pressure injuries that have progressed to deeper tissue involvement and infection.

D) Ischemic inflammatory response marked by erythemic skin:

Correct. In the early stages of pressure injury development, the affected area may exhibit signs of tissue ischemia and inflammation, which can manifest as erythema (redness) of the skin. This erythema is a result of the body's inflammatory response to tissue damage caused by pressure and may indicate the need for intervention to relieve pressure and prevent further injury.

DKA is a serious complication of diabetes mellitus characterized by hyperglycemia, ketosis, and metabolic acidosis. The laboratory results consistent with DKA include:

Elevated blood glucose level: A blood glucose level of 525 mg/dL (28 mmol/L) is significantly elevated and consistent with DKA.

Low arterial blood pH: A decreased arterial blood pH indicates acidosis, which is characteristic of DKA. Normal arterial blood pH ranges from 7.35 to 7.45.

Low bicarbonate (HCO3-) level: A low bicarbonate level indicates metabolic acidosis, which is also characteristic of DKA. Normal bicarbonate levels range from 21 to 28 mEq/L (21 to 28 mmol/L).

Among the options provided:

A) Arterial blood pH 7.5 and bicarbonate level 32 mEq/L (32 mmol/L):

This pH and bicarbonate level are indicative of alkalosis, which is not consistent with DKA.

B) Arterial blood pH 7.42 and bicarbonate level 18 mEq/L (18 mmol/L):

This pH is within the normal range, and the bicarbonate level is slightly decreased but not indicative of metabolic acidosis consistent with DKA.

C) Arterial blood pH 7.25 and bicarbonate level 10 mEq/L (10 mmol/L):

Correct. This pH is decreased, indicating acidosis, and the bicarbonate level is significantly below the normal range, consistent with metabolic acidosis characteristic of DKA.

D) Arterial blood pH 7.38 and bicarbonate level 29 mEq/L (29 mmol/L):

While the pH is within the normal range, the bicarbonate level is elevated, which is not consistent with metabolic acidosis seen in DKA.