Objective To develop and implement an evidence-based nursing scheme for a patient with refractory skin ulcer of lower limb suffering from diabetes mellitus combined with essential thrombocytosis. Methods Using PICO principle,questions were put forward based on the clinical manifestations of the patient. We searched databases including UpToDate,Joanna Briggs Institute,Registered Nurses’ Association of Ontario,National Guideline Clearinghouse,National Institute for Health and Care Excellence,Scottish Intercollegiate Guidelines Network,Cochrane Library,CINAHL,Embase,Pubmed,CBM,WHO and websites of various professional associations. We included all clinical guidelines,evidence summaries,and systematic reviews on chronic wound care. After evaluating the feasibility,suitability,clinical significance and effectiveness of the evidence,we applied them to the patient and observed its effect. Results A total of 15 studies were finally included,including 3 clinical decisions,5 guidelines,1evidence summary,and 6 systematic reviews. We have formulated a targeted nursing program for the patient. On the basis of traditional treatment and nursing care,the specific program was developed and combined with the willingness of the patient,including no stopping use of hydroxyurea; Wagner grading system was utilized to grade and assess the wound comprehensively; cleaning the wound with normal saline and Compound Cortex Phellodendri liquid coating; performing the first debridement by ultrasonic debridement and adjusting the debridement method in time with the results of the wound assessment according to the wound condition; selecting the suitable dressing and combining with systemic treatment. After 16 days of active treatment,the wound infection of the patient was controlled. There was no obvious secretion,no self-reported pain and the granulation tissue grew well. The wound area was reduced and the symptoms of dry skin around the wound disappeared. The symptoms were improved and the patient was discharged. Conclusions For patients with diabetes mellitus combined with essential thrombocytosis,we can give them targeted,scientific and effective nursing measures through evidence-based methods to reduce the pain of patients,shorten wound healing time and improve the quality of life of patients.
