I.                    INTRODUCTION

Diabetes mellitus is a condition in which the pancreas no longer produces enough

insulin or cells stop responding to the insulin that is produced, so that glucose in the

blood cannot be absorbed into the cells of the body. Symptoms include frequent

urination, lethargy, excessive thirst, and hunger. The treatment includes changes in diet,

oral medications, and in some cases, daily injections of insulin.

The most common form of diabetes is Type II, It is sometimes called age-onset or adult-

onset diabetes, and this form of diabetes occurs most often in people who are overweight

and who do not exercise. Type II is considered a milder form of diabetes because of its

slow onset (sometimes developing over the course of several years) and because it

usually can be controlled with diet and oral medication. The consequences of

uncontrolled and untreated Type II diabetes, however, are the just as serious as those for

Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat

misleading. Many people with Type II diabetes can control the condition with diet and

oral medications, however, insulin injections are sometimes necessary if treatment with

diet and oral medication is not working.

The causes of diabetes mellitus are unclear, however, there seem to be both hereditary

(genetic factors passed on in families) and environmental factors involved. Research has

shown that some people who develop diabetes have common genetic markers. In Type I

diabetes, the immune system, the body’s defense system against infection, is believed to

be triggered by a virus or another microorganism that destroys cells in the pancreas that

produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a

role.

In Type II diabetes, the pancreas may produce enough insulin, however, cells

have become resistant to the insulin produced and it may not work as effectively.

Symptoms of Type II diabetes can begin so gradually that a person may not know that he

or she has it. Early signs are lethargy, extreme thirst, and frequent urination. Other

symptoms may include sudden weight loss, slow wound healing, urinary tract infections,

gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected while

a patient is seeing a doctor about another health concern that is actually being caused by

the yet undiagnosed diabetes.

Individuals who are at high risk of developing Type II diabetes mellitus include people

who:

are obese (more than 20% above their ideal body weight)

have a relative with diabetes mellitus

belong to a high-risk ethnic population (African-American, Native American,

Hispanic, or Native Hawaiian)

have been diagnosed with gestational diabetes or have delivered a baby weighing

more than 9 lbs (4 kg)

have high blood pressure (140/90 mmHg or above)

have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL

and/or a triglyceride level greater than or equal to 250 mg/dL

have had impaired glucose tolerance or impaired fasting glucose on previous

testing

MORBIDITY

Ten Leading Causes of Morbidity

Number, Rate/100,000 Population & Percentage

Philippines, 2002

MORTALITY

Ten Leading Causes of Mortality by Sex

Number, Rate/100,000 Population & Percentage

Philippines, 2002

Diabetes mellitus is a common chronic disease requiring lifelong behavioral and

lifestyle changes. It is best managed with a team approach to empower the client to

successfully manage the disease. As part of the team the, the nurse plans, organizes, and

coordinates care among the various health disciplines involved; provides care and

education and promotes the client’s health and well being. Diabetes is a major public

health worldwide. Its complications cause many devastating health problems.

II.            PATIENT PROFILE Ward: 6th Main

Date of Admission: July 18, 2009

Patient Name: R. R

Address: Sampaloc Manila

Age: 54

Gender: Male

Birth Date: November 13,1954

Educational Status: High School Undergraduate (3rd year)

Religion: Roman Catholic

Nationality: Filipino

Civil Status: Married

Occupation: Tricycle Driver

Health Care Financing: SSS

Informant: Patient, Wife and the Daughter

Reliability: 100 %

Admission Data

1.    Chief Complaint: Wound right big toe

2.    Initial Diagnosis: Gangrene big toe right foot related to Diabetes

mellitus type II

3.    Final Diagnosis: Gangrene big toe right foot related to Diabetes

mellitus type II  

4.    Attending Physician: Dr. Fuentes and Dr. Sison

 

 III.           PATIENT HISTORY/ NURSING HISTORY

a.    History of Present Illness

Eight months prior to admission patient noticed blisters of his right

big toe ventral surface area. Patient self medicate metformin 500 mg/tab

and glimeperamide 2mg/tab. No consultation done.

One week and 6 days prior to admission, patient noticed swelling

of the right foot no other associated signs and symptoms were noted.

Patient sought consult in Rizal Medical Center, and then patient referred to

our institution private physician. Patient advised to continue the

medication that he takes.

Three days prior to admission, patient noticed that his right big toe

become black, the wound become bigger, patient sought consult at our

institution at out patient department. Patient was advised for surgical

procedure hence admission.

b.    Past Medical History

No previous hospitalization. No known food and drug allergies.

Patient diagnosed last April 28, 2008, Diabetes Mellitus type II,

maintenance medication metformin 500 mg TID and Diclofenac 500 mg.

c. Family Health History

The patient’s father has a cyst on his breast. And his mother is

hypertensive. Most of his siblings are hypertensive which is a risk factor

of diabetes mellitus. But our patient is not hypertensive.

d. Personal and Social History

Patient is a highschool undergraduate. He is a tricycle driver since

2000. He started smoking and drinking alcoholic beverages when he was

15 years old and stopped 20 years ago.

 

IV. LEVEL OF HEALTH FUNCTIONING

LEVEL OF

FUNCTIONING

a. health perception

and management

c. elimination pattern

BEFORE

HOSPITALIZATION

“The client defined

health as an important

thing that you should

take care of. Even

though he has diabetes

mellitus he still

considered himself as a

healthy person because

he can still do his daily

activity.”

The patient urinates 4-5

times a day.

The color of the urine

is light yellow.

The patient defecates

regularly.

DURING

HOSPITALIZATION

He considers himself as a

healthy person despite of

what happened to him

The client urinate 2x a

day.

The color of the urine is

yellowish.

The patient can’t manage

to go to Comfort Room

by himself alone that’s

ANALYSIS/

INFERENCE

Based from the

gathered

According to the data

collected, the patient

having difficulty in

elimination due to the

operation conducted.

d. activity exercise

pattern

e. sleep rest pattern

“araw araw akong

namamasada simula

6am-12nn ang tulog ko

ay 4 hours

lang.pagkagising ko ng

4am nag-eexercise ako

hanggang 5 ng

umaga,tapos 6 ng

umaga balik pasada na

ulit.”

He usually wakes up

around 4:00 in the

morning to prepare for

his work. The client

also stated that he

doesn’t have enough

sleep everyday because

of his work.

why his wife assists him

to defecate.

“.nahihirapan akong

gumalaw-galaw dahil sa

pagkakaputol ng paa ko.

Ngayon tinutulungan ako

ng asawa ko para

makakilos papunta sa

C.R at bumangon. Hindi

ko na rin mkuha pang

mag-exercise ngayon.” as

vervalized by our client.

“paputol-putol ang tulog

ko,3 hours lang

pinakamatagal kong

tulog ditto”

The client wasn’t able

to do things

independently.

Before

hospitalixation the

patient can only

acquire a little time

for rest and sleep

because of his work.

During

hospitalization the

patient can’t sleep

f. Cognitive

perceptual pattern

g. self perception

pattern and self

concept pattern

“Malabo na ang mata

ko at gumagamit na rin

ako ng salamin sa mata

kapag ako ay may

babasahin” as

verbalized by the client

-Impaired vision

-comprehension is still

at best

-nothing wrong with

his sense of hearing

High self esteem

believes in facts and

believes in what she

believe is right

-Impaired vision

-comprehension is still at

best

-nothing wrong with his

sense of hearing

He believes in facts and

believes in what he

believe is right

well because of the

pain brought by his

amputated leg.

Having a poor sense

of sight could cause

delay of what he

does. It is really

important for us to

have a good sense of

sight especially when

driving and reading.

Adjusted because of

the discomfort caused

by the pain of the

amputation

Has irritations and set

of boundaries for

himself

Intakes medications

and vitamins

Pushes himself to the

limits by working

overtime and doing

extra activities

Sees himself as a

strong individual,

competitive type of

person and is confident

regarding him self

Has irritations and

boundaries hor himself

Intakes medications and

vitamins

Pushes himself to the

limits by working

overtime

and doing extra

activities

Sees himself as a strong

individual, competitive

type of person and is

confident regarding

himself

Changed due to the

operation happened

Gained additional for

fast recovery

Adjusted because of

the immobility

Increased due to the

operation

h. role relationship

pattern

They are all living

together in the same

house. And they have a

good relationship with

each other.

Their major problem is

that if how can they pay

his hospital bills. And he

feels that he is not

capable of doing because

 V.                  PHYSICAL ASSESSMENT

Biographic data:

 

Name: R. R Weight:

Address: Sampaloc Manila     Height:

 B.P.:

Age:   54                                                                              Temperatures: 36.8

Sex:   Male                                                                    Pulse Rate:72

Race/Ethnic Origin:      None                                Respiratory Rate: 21

Marital Status: married                                      Reason from admission: Wound of his right big toe

Occupation:        Tricycle Driver                                                    

Religious orientation: Roman Catholic IBM:

Educational Attainment: High School Undergraduate

Health care financing and usual source of medical care: SSS

 

 

Areas to be Asses Actual Findings Normal findings Interpretation/ Analysis

Body built, height &

weight

>proprtionate, varie with

lifestyle

Proportionate & varies

with life style

Posture & Gait > not relaxed and erect

posture and no

coordinated movements

Relax, erect posture &

coordinated movements

Hygiene Not neat and clean Clean & Neat

Body/breath Odor No body odor and no

breath odor

No body odor or minor

body odor relative to

work of exercise; no

breath odor

Facial Expression Distress noted No distress noted

Signs of health/illness Unhealthy appearance Healthy appearance

Client’s attitude Cooperative, able to

follow instructions

Cooperative, able to

follow instructions

Client’s Response Understandable & clear

tone

Understandable & clear

tone

Quantity of speech Associated with the

thoughts

Associated with the

thoughts

Organization of thoughts Logical sequence, has a

sense of reality

Logical sequence, has a

sense of reality

SKIN  

Skin color Varies from light to deep

brown; from ruddy pink

to light pink; from

yellow overtones to

olive.

Varies from light to dark

brown

Uniformity of skin color Generally, uniform

except for areas expose

to the sun

Generally, uniform

except for areas expose

to the sun

Edema No edema No edema

Skin lesion No edema Freckles, birth marks,

some flat and raised

abrasions or other lesion

Skin moisture Moisture in skin folds

and the axillae

Moisture in skin folds

and the axillae

Skin turgor When pinched, skin

brings back to previos

state

When pinched, skin

brings back to previous

state

HAIR  

Evenness of growth Evenly distributed hair Evenly distributed hair

Hair thickness or

thinness

Thick hair Thick hair

Texture and oiliness Silky resilient hair Silky resilient hair

Infections No infection No infection

Body hair Various and equal

distribution

Varies and equal

distribution

Nails  

Finger nail plate Convex curvature, nail

plate is about 160

Convex curvature, nail

plate is about 160

Texture Smooth texture Smooth texture

Bed color Highly vascular and light

pink in color

Highly vascular and light

pink in color

Tissue surrounding the

nails

Intact epidermis Intact epidermis

Skull and face  

Skull size, shape &

symmetry

Rounded smooth skull

contour

Rounded smooth skull

contour

Nodules & depressions Absense of nodules and

masses

Absence of nodules and

masses

Facial features Symmetric, palperable

fissures, equal in size

Symmetric, palperable

fissures, equal in size

Eyes for edema and

hollowness

No edema and

hallowness

No edema and

hollowness

Facial movements Symmetric Symmetric

EYES  

Eye brows Hair evenly distributed,

symmetrically aligned

Hair evenly distributed,

symmetrically aligned

equal movement equal movement

Eye lashes Equally distributed equally distributed

curves lightly outward

Eye lids Skin intact no discharges Skin intact no discharges

Bulbar conjunctiva Transparent capillaries Transparent capillaries

Palberbal conjunctiva Shiny, smooth pink or

red

Shiny, smooth pink or

red

Lacrimal glands No edema or enderness

over lacrimal glands

No edema or tenderness

over lacrimal glands

Lacrimal sac & naso

lacrimal duct

No edema or tearing No edema or tearing

Cornea Transparent, shiny &

smooth

Transparent, shiny &

smooth

Anterior chamber Transparent no shadow

of light in iris depth 3mm

Transparent no shadow

of light in iris depth 3mm

Pupils Black in color equal in

size, 3-7 in diameer

Black in color equal in

size, 3-7 in diameter

Direct and consensual

reaction

Illuminated pupil

constrict (direct

response) non

illuminated pupils dilate

Illuminated pupil

constrict (direct

response) non

illuminated pupils dilate

Pupils accommodation Pupils constrict when

looking to the near

Pupils constrict when

looking to the near

object, dilate when

looking to the far object

object, dilate when

looking to the far object

Peripheral visual fields When looking straight

ahead client can see in

periphery

When looking straight

ahead client can see in

the periphary

Extracellular muscle test Both eyes coordinated,

parallel alignment

Both eyes coordinated,

parallel alignment

Cover test Cover eye does not move Cover eye does not move

Client read from

magazine

Can’t able to read news

print without eyeglasses

Able to read news print

Distance vision 20/20 vision on senellen

type chart

Ears  

Auricle (inspection) Color same as facial

skin’ symmetrical

Color same as facial

skin’ symmetrical

Auricles (palpation) Firm no tenderness pinna

recoils after it is folded

Firm no tenderness pinna

recoils after it is folded

Normal voice tone Normal voice tone

audible

Normal voice tone

audible

Watch tick test Able to hear both ear Able to hear both ear

Weber’s test Sound is heard in both

ear or is localized at the

center

Sound is heard in both

ears or is localized at the

center

Rinne test AC > BC AC > BC

NOSE  

Externls nose

(inspection)

Symmetrical, no

discharge or flarinf

uniform color

Symmetrical, no

discharge or flaring

uniform color

External nose (palpation) No tenderness, no lession No tenderness, no lesion

Patency Air moves freely as

client breath through the

nose

Air moves freely as

client breath through the

nose

Presence of redness Lucossa pink, clear,

watery discharge, no

lesion

Lucosa pink, clear,

watery discharge, no

lesion

Nasal septum Intact & in midline Intact & in midline

Maxillary & frontal

sinuses

No tender No tender

MOUTH  

Outer lips (inspection) Uniform pink in color

soft moist smooth,

symmetry contour

Uniform pink in color

soft moist smooth,

symmetry contour

Inner lips Pink in color, moist

smooth and elastic

texture

Pink in color, moist

smooth and elastic

texture

Teeth gums No teeth and he doesn’t 32 adult teeth smooth

use artificial teeth white, shiny teeth, pink

gums moist firm texture

no retraction of gums

Surface of tongue Central in position, pink

color, smooth laterally

margins, no lesions

raised papillae

Central position, pink

color, smooth laterally

margins, no lesions

raised papillae

Tongue movement Moves freely no

tenderness

Moves freely no

tenderness

Base of the tongue Smooth tongue base with

prominent veins

Smooth tongue base with

prominent veins

Tongue and floor of the

mouth (palpation)

Smooth, no palpable

nodules

Smooth, no palpable

nodules

Hard palate Lighter pink, irregular

texture

Lighter pink, irregular

texture

Soft palate Light pink, smooth, soft

palate

Light pink, smooth, soft

palate

Uvula Position in the midline of

the soft palate

Position in the midline of

the soft palate

Oropharynx Pink and smooth

posterior walls

Pink and smooth

posterior walls

Tonsils Pink and smooth, no

discharge of normal size

Pink and smooth , no

discharge of normal size

NECK  

Neck muscles Muscles equalize, head

centered

Muscles equalize, head

centered

Head movement Coordinated, smooth

movements with no

discomfort

Coordinated, smooth

movements with no

discomfort

Lymph nodes Not palpable Not palpable

Trachea Central placement in the

midline of the neck

Central placement in

midline of the neck

Thyroid gland Not visible for inspection Not visible for inspection

Extend head and swallow Glands ascends during

swallowing but it is

visible

Glands ascends during

swallowing but it is

visible

Thyroid gland’s masses

& nodules

Lobes may not be

palpated, lobes are small,

smooth painless and rise

free when swallowing

Lobes may not be

palpated, lobes are small,

smooth painless and rise

free when swallowing

Thorax  

Thorax shape &

symmetry

Anteroposterior to

transverse diameter in

ratio of 1:2

Anteroposterior to

transverse diameter in

ratio of 1:2

 

Spinal alignment Spine vertically aligned Spine vertical aligned

Lateral deviation of spine Spinal column is straight

right and left shoulders

and hips are at the same

height

Spinal column is straight

right and left shoulders

and hips are at the same

height

T  , integrity of all chest

skin

Skin intact and uniform

temperature

Skin intact and uniform

temperature

Chest areas for bulges,

tenderness or

abnormalities in

movement

Chest walls intact, no

tenderness, no masses

Chest walls intact, no

tenderness, no masses

Posterior chest

respiratory excursion

Full and symmetric chest

expansion

Full and symmetric chest

expansion

Vocal fremitus Bilateral symmetry of

vocal fremitus

Bi lateral symmetr of

vocal fremitus

Percuss underlying

hungtissue

Percission notes

resonale, except over

scapula

Percission notes

resonale, except over

scapula

Ascultate chest Vesicular and

bronchovesicular breath

Vesicular and

bronchovesicular breath

Breathing pattern Quiet, rhytmic, and

effortless

Quiet, rhythmic, and

effortless

Costal < Costal < is less than 90 Costal < is less than 90

Anterior chest Fully symmetric Fully symmetric

(respiratory excursion) excursion excursion

Tactile fermitus Same as posterior vocal

fremitus, decreased over

heart and breast tissue

Same as posterior vocal

fermitus, decreased over

heart and breast tissue

Percuss anterior chest Symmetry in percussion

notes

Symmetry in percussion

notes

Auscultate trachea Bronchial & tubular

sounds

Bronchial & tubular

sounds

Auscultate anterior chest Bronchiovesicular &

vesicular breath sounds

Bronchiovesicular &

vesicular breath sounds

HEART  

Precordium  

Aortic & pulmonic areas No pulsation No pulsations

Tricuspid area No lift No lift

Apical area No lift No lift

Epigastic area Aortic pulsation Aortic pulsation

Auscultate artery No sounds heard No sounds heard

Jugular veins Veins not visible Veins not visible

BREAST  

Breast size, symmetry,

shape

Rounded shape, slightly

unequal generally

symmetric

Rounded shape, slightly

unequal generally

symmetric

Skin of breast Uniform in color Uniform in color

Retraction  

Areola (inspection) Round and bilaterally the

same color varies widely

frm light pink to dark

brown

Round and bilaterally the

same color varies widely

from light pink to dark

brown

Nipples (inspection) Round everted and equal

size, similar in color soft,

smooth; poont in the

same direction no

discharge

Round everted and equal

size, similar in color soft,

smoot ; point in the same

direction no discharge

Lymph nodes No tenderness, masses or

nodules

No tenderness, masses or

nodules

Breast, masses,

tenderness

No tenderness, masses or

nodules or nipple

discharge

No tenderness, masses

nodules or nipple

discharge

Areola & nipples for

masses

No tenderness, masses,

nodules or nipple

discharge

No tendernedd, masses,

nodules or nipple

discharge

Abdomen  

Abdomen skin integrity Uniform color surgical

scar

Uniform color surgical

scar

Abdomen for contours & Flat rounded or scaphoid Flat rounded or scaphoid

symmetry no evidense of

enlargement of liver,

symmetricalcontour

no evidence of

enlargement of liver,

symmetrical contour

Abdominal movements Symmetric movements Symmetric movements

Vascular patterns No visible vascular

patterns

No visible vascular

patterns

Bowel sounds, vascular

friction rubs

Audible bowel sounds,

absence of atrial bruits,

Absence of frictionrub

Audible bowelsound,

absence of atrial bruits,

absence of frictionrub

percuss abdomen Tymphany over the

stomach and gas field

bowels, dullness,

especially over the liver

and spleen

Tympany over the

stomach and gas field

bowels, dullness,

especially over the liver

and spleen

Percuss liver 6-12 cm in the mid

clavicular line

6-12 cm in the mid

clavicular line

Palpation of the abdomen No tenderness, relaxed

abdomen with smooth

consistent tension

No tenderness, relaxed

abdomen with smooth

consistent tension

Palpation of liver May not be palpable May not be palpable

MUSCULOSKELETAL  

Muscles & tendons

contractures

No contractures No contractures

Tremors No tremors No tremors

Muscle tonicity Normally firm Normally firm

Palpate muscles (active) Smooth coordinate

movement

Smooth coordinate

movements

Muscle strength Not equal because he has

been amputated on the

right toe

Equal strength on each

body side

Skeleton structure With deformities No deformities

Bones to locate edema or

tenderness

No tenderness or

swelling

No tenderness or

swelling

Joints swelling,

movement, nodules

No swelling & nodules

smooth movement

No swelling & nodules

smooth movement

 

VI.                ANATOMY AND PHYSIOLOGY

VII.              PATHOPHYSIOLOGY

 

 

VIII.            LABORATORY RESULTS

 

LABORATORY/ DIAGNOSTIC TEST

ACTUAL RESULT

NORMAL VALUE

ANALYSIS/INFERENCE

REFERENCE

 July 18Clinicl chemistry.. GlucoseUrea nitrogencreatinine

July 18ImmunochemExamination: Glycosylated hemoglobin(HBAIC)

July 19Clinical microscopyExamination:Routine fecalisis

July 20Clinical chem.Creatinin.

July 20HematologyCBGWBC CountHemoglobinHematocritSegmentersLymphocytesMonocyteseosinophils

july 21Microbiology

 187mg/dl32mg/dl1.46mg/dl

10.8% AIC

Color: brownConsistency: H2O

19,600/cu.m12.5gms/dl37vol%85%9%5%1%

Moderate growth of

 65 – 1107-20.52- 1.25

4.2-6.5

5,000-10,000M: 13.5-18; F:12.0-15.0M: 40.0-48.0; F:37.0-45.055-6526-352-6

 Diabetic syndromenephroticnephritis

Diabetic

 

Examination: wound exudates culture and sensitivity

July 27HematologyCBGWBC CountHemoglobinHematocritSegmentersLymphocytesMonocytesEosinophils

July 27Clinical chem.SodiumPotassiumCreatinine

July 27HematologyExam: protrombin time and actProtimeControl% act.INR

July 28HematologyExam: protrombin time and actProtimeControl% act.INR

Aug.1HematologyCBGWBC CountHemoglobin

klebsiella pneumonia isolated

19,700/cu.m12.1gms/dl36vol%77%19%2%2%

130 mnol/L5.0 mno/L.92 mg/dL

14.4 secs.12.9secs67.4%1.26

13.5 secs.12.5secs74.9%1.18

15,600/cu.m10.4gms/dl31vol%88%11%

1-5

5,000-10,000M: 13.5-18; F:12.0-15.0M: 40.0-48.0; F:37.0-45.055-6526-352-61-5

137-1503.6-5.0.52-1.25

10.0-14.0

10.0-14.0

HematocritSegmentersLymphocytesMonocytes

1%

5,000-10,000M: 13.5-18; F:12.0-15.0M: 40.0-48.0; F:37.0-45.055-6526-352-6

 IX.          COURSE IN THE WARD

  Upon admission patient was scheduled for disarticulation of right big toe with debridement. The surgical procedure was done on the same day. Capillary blood glucose monitoring.

On the second day post operatively patient was on diabetic diet medication was given. Capillary Blood Glucose monitoring was done. Capillary blood glucose monitoring.

On the third day diet medication was given and also Capillary Blood Glucose monitoring was done.

Fourth hospital day patient was scheduled for repeat debridement of right foot, where wound exudates was sent for Culture and Sensitivity test was given. Capillary blood glucose monitoring.

On the fifth day debridement of foot was done. Capillary blood glucose monitoring.

On the 6th hospital day patient complaint pain on the wound site but tolerable and patient was advised for below knee amputation where Cardio Pulmonary clearance was requested and done. Capillary blood glucose monitoring.

On the 7th day Vital signs monitoring was done. Capillary blood glucose monitoring.

On the 8th day Capillary Blood Glucose monitoring and vital signs was done. On the 9th day wound cleaning was done. Capillary blood glucose

monitoring. On the 10th day intravenous fluid of PNSS 1L was started. Capillary blood

glucose monitoring. Intravenous fluid of PNSS was continued and was operated on the 11th

hospital day for below knee amputation patient tolerated the procedure well with no subjective complaint, medication was continued. Capillary blood glucose monitoring.

Surgical procedure and date performed, July 29- below the right knee amputation. Capillary blood glucose monitoring.

X.           NURSING CARE PLAN 

CUES

Subjective:“hindi gumagaling ang sugat ko” (my wounds are not healing) as verbalized by the patient

Objective:Wound at the right big toe

INFERENCE/ANALYSISMINI-PATHOPHYSIOLOGY

Increased in blood sugar level.

Poor circulation

Poor wound healing

NURSING DIAGNOSIS

Poor wound healing related to

GOAL/PLAN

INTERVENTION/ IMPLEMENTATION

Independent:Observe for sign of infections and inflammations.

Promote good hand washing by nurse and patient

Maintain aseptic technique for IV insertion procedure, administration of medication, and providing maintenance and side care.Rotate IV sites as indicated.

provide conscientious skin care, gently massage bony areas. Keep the skin dry, linens dry

RATIONALE

Patient may be admitted with infection, which could have. precipitated ketoacidotic state, or may develop a nosocomial infection.

Reduces the risk of cross contamination

high glucose in the blood creates an excellent medium

EVALUATIONt

After 8 hours of nursing interventions, the patient was able to identify interventions to prevent or reduce risk of infection.

and wrinkle free.

Place in semi fowler’s positions.

Encourage adequate dietary and fluid intake of 3000 ml per day.

Collaborative:Obtain specimen for culture and sensitivities as indicated

forfection.

Minimizes the risk in bacterial growth.

Peripheral circulation may be impared, placing patient at increased risk for skin irritation or breakdown and infection.

Facilitates lung expansion and reduces risk of aspiration

Decrease susceptibility to infection.Identifies organisms so

the most appropriate drug therapy can be instituted.

XI.                DISCHARGE PLANNINGMEDICATION

Amlodipine 10mg 1tab (morning)

Glimeperide 2mg 1tab OD

Metformin 500mg 1tab TID

Tramadol + Paracetamol 1tab TID

EXERCISEPractice bending the amputated leg

TREATMENTCBG monitoring TID a.c

HEALTH TEACHING

OUT-PATIENT FOLLOW UPFollow- up at IM OPD 1 week after discharge

DIETBreakfast: (360 calories, 52.5 grams carbohydrate)

1 slice toasted whole wheat bread with 1 teaspoon margarine1/4 cup egg substitute or cottage cheese1/2 cup oatmeal1/2 cup skim milk1/2 small banana

Snack: (Each has 60 calories or 15 grams carbohydrate. Pick two per day.)16 fat-free tortilla chips with salsa1/2 cup artificially sweetened chocolate pudding1 ounce string cheese plus one small piece of fruit3 cups "lite" popcorn

Lunch: (535 calories, 75 grams carbohydrate)

1 cup vegetable soup with 4-6 crackers1 turkey sandwich (2 slices whole wheat bread, 1 ounce turkey and 1 ounce low-fat cheese, 1 teaspoon mayonnaise)1 small apple

Dinner: (635 calories, 65 grams carbohydrate)4 ounces broiled chicken breast with basil and oregano sprinkled on top2/3 cup cooked brown rice1/2 cup cooked carrots1 small whole grain dinner roll with 1 teaspoon margarineTossed salad with 2 tablespoons low-fat salad dressing4 unsweetened canned apricot halves or 1 small slice of angel food cake

 XII.              DRUG STUDY