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8/6/2019 Ppt Group 2 Case Pres
1/14
8/6/2019 Ppt Group 2 Case Pres
2/14
Type IIType II
Type IIType II
Type IIType II
Type IIType II
Type IIType II
Type IIType II Type IIType IIType IIType II
Type IIType II
Type IIType II
8/6/2019 Ppt Group 2 Case Pres
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Diabetes mellitus, often simplyDiabetes mellitus, often simply
referred to as Diabetes, is a chronicreferred to as Diabetes, is a chronic
metabolic disorder that causesmetabolic disorder that causes
persistent thirst (persistent thirst (polydipsiapolydipsia),),
excessive urination (excessive urination (polyuriapolyuria),),
increased hunger (increased hunger (polyphagiapolyphagia),),
weight loss and a surplus of sugar inweight loss and a surplus of sugar in
the blood and urine. Althoughthe blood and urine. Although
Diabetes can develop at any age, it isDiabetes can develop at any age, it is
more common among women thanmore common among women than
among men, with excessiveamong men, with excessive
overweight as contributing factor inoverweight as contributing factor in
later life.later life.
Patient B.T., a 49 year old male livingPatient B.T., a 49 year old male living
inin HimamaylanHimamaylan was constantly havingwas constantly having
Diabetes Mellitus type II for twoDiabetes Mellitus type II for twoyears. Patient got accidentallyyears. Patient got accidentally
wounded on the sole of his right footwounded on the sole of his right foot
and due to poor management theand due to poor management the
wound continued to progress untilwound continued to progress until
necrosis of some tissues occurred.necrosis of some tissues occurred.
Also, the patient manifested weightAlso, the patient manifested weightloss as stated by his wife.loss as stated by his wife.
For this reason, he was brought to Bacolod
our Lady of Mercy Specialty Hospital inBacolod City and was admitted where he
was diagnosed of having Diabetic Right
Foot Wagner III after a series of
assessments made. Patient was
recommended to undergo Below the Knee
Amputation to prevent the spread of
necrosis to the upper portion of his body.
This case study will surely help us students
to enhance care for patients who have
Diabetes Mellitus II through the applicationof nursing skills, interventions and
knowledge.
8/6/2019 Ppt Group 2 Case Pres
4/14
The pancreas is an elongated organ thatlies behind and below the stomach. This
mixed gland contains both exocrine andendocrine tissues. The predominantexocrine part consists of grape-likeclusters of secretory cells that form sacsknown as acini, which connect to ducts
that eventually empty into the first
portion of the intestine calledduodenum. The smaller part of the glandconsists of isolated islands of endocrine
tissue known as islets ofLangerhans which are dispersed
throughout the pancreas
Pancreas
Structure of the Pancreas
The most important hormones secreted by
the pancreas are insulin and glucagon.
Both play a role in proper metabolism of
sugars and starches in the body. Insulin
promotes the movement of glucose and
other nutrients out of the blood and into
cells. When blood glucose rises, insulin,released from the beta cells causes
glucose to enter body cells to be used for
energy. Also, it sometimes stimulates
conversion of glucose to glycogen in the
liver. Another pancreatic hormone,
glucagon, promotes the movement of
glucose into the blood when glucose
levels are below normal. It causes the
breakdown of stored liver glycogen to
glucose, so that the sugar content ofblood leaving the liver
8/6/2019 Ppt Group 2 Case Pres
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AssessAssessmentment
Date: July 15, 2010Time: 7:00 am
VitalVital SignsSigns
P-117 bpm
R-21 cpm
Musculoskeletal
Patient is able to move from side
to side with assistance from
folks. Able to perform active
range of motion. Patient is
unambulatory.
Integumentary
Patient skin is of dark complexionand is dry on lower extremities
and on palm of hands. Patient
has non-healing wound with
necrotic tissues on right foot.
8/6/2019 Ppt Group 2 Case Pres
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Predisposing Factor:
PathophPathophysiologyysiology
Predisposing FactorPredisposing Factor Precipitating Factor:Precipitating Factor:
Male and Age above 40y.oPoor lifestyle (lack of exercise andexcessive eating food high in sugar)
Destruction of beta and alpha cells
Stimulates beta cells to secrete Insulin (Malfunction of Insulin)
Unable to Transport glucose (Insulin resistant) inside the cell to oxidize it for
energy;Unable to Store glucose in the Liver as glycogen or fat.
Glucose is retained in the bloodstream (hyperglycemia)
Without insulin, excessive glucose spills in the urine because kidney
tubule cells cannot reabsorb it fast enough
8/6/2019 Ppt Group 2 Case Pres
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Polyuria
Polyuria Dehydration Diabetes Insipidus
Cells breakdown proteins
and fats to meet bodys
energy reqts
Polyphagia
Infection
Polydipsia (Increased thirst)
Non- Healing Wound
Weight loss
8/6/2019 Ppt Group 2 Case Pres
8/14
Drug StudyDrug Study
C H
E
CK
Metforminhydrochloride
5 00 mg/tab
Exactmechanism isnotunderstood:possiblyincreaseperipheralutilization of
glucose,decreaseshepatic glucoseproduction,and altersintestinalabsorption ofglucose
Antidiabetic
Adjunct to dietto lower bloodglucose withtype 2 diabetesmellitus
TID
discontinue
thismedication
without
consulting
yourhealth
care provider
Monitorblood
forglucose andketones as
prescribed.
Avoidusing
alcoholwhile
taking this
drug
Report fever,
sore throat,unusual
bleeding
Assessif there is
allergy to
metformin;diabetes
complicatedby fever,
severe infections,
severe trauma, major
surgery
Monitorurine orserumglucose levels
frequently todetermine
effectivenessofdrug
anddosage
Monitoradverse
effects:
Endocrine:
hypoglycemia, lactic
acid acidosis
GI: anorexia ,nausea,
vomiting, epigastric
discomfort, heartburn
diarrhea, flatulence
Hypersensitivty:allergi
c skin
reactions, eczema,
pruritus,erythema.
8/6/2019 Ppt Group 2 Case Pres
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Drug StudyDrug Study
CH
E CK
Meloxica
m 15 mg
Anti-inflammatory,
analgesic, and
antipyretic
activitiesrelated
toinhibitionof
enzyme
cyclooxygenase(
COX), whichis
required forthesynthesisof
prostaglandin
and
thromboxanes.
Somewhat more
selective for
COX-2 sites
(foundin the
brain, kidney,
ovary, uterus,
cartilage,bone,
andat sitesof
inflammation)
NSAID
Relief fromsignsand
symptomsof
osteoarthritis
and
rheumatoid
arthritis.
TID Take drugwithfoodif GI
upset occur
Take only
prescribed
dosage
Report sore
throat, fever,
rash, itching,weight gain,
swellingin
anklesor
fingers.
Report
changesin
vision
Assess the historyof the allergiesof
the medication
Administerdrug
with foodormilk
if GIupset occurs
Establishsafety
measuresif CNS
disturbance occurs
Monitoradverse
effects: CNS: headache,
dizziness,
somnolence,
insomnia,
fatigue,,tiredness,ti
nnitus,
ophthalmologic
effects
Dermatologic:
rash,pruritus,sweating, dry
mucous
membranes,
stomatitis
GU:Dysuria, renal
impairment
GI: nausea,
despepsia, GIpain,
diarrhea, vomiting
8/6/2019 Ppt Group 2 Case Pres
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Drug StudyDrug Study
C H E C K
Clindamycin300mg
Isotretinoinnoticeably
reduces the
production of
se bum and
shrinks the
sebaceous
glands. It
stabiliseskeratinization
and pr events
comedones
from forming.
Inhibitsprotein
synthesis in
susceptible
bacteria
causing cell
death.
BID
Ifyoumissa
dose of
Clindamycin,
take it assoon
aspossible.If
it isalmost
time foryour
next dose, skip
the missed
dose andgo
back toyourregulardosing
schedule.Do
not take 2
dosesat once.
Youmay
experience
these side
effects:nausea
andvomiting,superinfection
inmouth
Report severe
watery
diarrhea,
abdominal
pain, inflamed
mouth
Culture infection
before therapy.
Donot use for
minorbacterialor
viralinfections
MonitorAdverse
effects:
CV:hypotension,
cardiacarrest.
GI: severe colitis,
nauseaandvomitinganorexia
Hematologic:
Neutropenia,
leucopenia,
agranulocytosis
Hypersensitivity:
rashes,urticaria
8/6/2019 Ppt Group 2 Case Pres
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Nursing Care PlanNursing Care Plan
Assessment Nursing
Diagnosis
Pathophysiology Desired Outcome Nursing Interventions Justification Evaluation
A.Actual Abnormal
Cues
Objective Data:
y Presence of
necrotic tissues
onRight foot.
y Foulsmelling
odoron
affected foot.
y Poorcapillary
refillof 4-
5secondson
right foot.
y Increasedblood
sugarlevelsof
B. Risk Related
Factor:
y
Old AgeC. Strengths and
Wellness
y Availabilityof
healthservices
y Compliance of
thepatient and
herfamily to
medication
y Good family
support
Ineffective
Tissueperfusionrelated to
viscosity of
blooddue to
increase blood
sugarlevels AEB
presence of
necrotic tissues,
poorcapillary
refillonaffectedextremity, and
foulsmelling
wound.
Definition:
decrease in
oxygenresulting
in the failure to
nourish the
tissuesat the
capillarylevel.
Reference:
NursesPocket
Guide
ElevatedBlood
Sugarlevels
Increase Viscosity
ofBlood
Decrease blood
flow
NecroticRight foot
Ineffective tissue
perfusion
Reference:
Medical Surgical
Nursing
After 16 hours of
nursing care, patientwill be able to:
y Prevent the spread
ofdecreased
tissue perfusion to
otherpartsof the
body.
y Demonstrate a
positive Attitude
towards
therapeuticregimen.
Independent intervention:1. Assessvitalsignsandskin
turgor.
2. Instruct patient toperform
Range ofmotion.
3. Provide asafe
environment for the
patient.
4. Monitoranddocument
Intake and Output
5. Monitorvitalsigns every
1 to 2 hoursoras theclientscondition
indicates
6. Assessskinandmucous
membrane moisture, skin
turgor, presence of thirst,
andmentalstatus.
7. Explain to thepatient the
necessityandbenefitsin
undergoingBelow the
Knee Amputation
Collaborative intervention:
1. Collaborate withDietitian
andphysician to.
Reference: Fundamentalsof
Nursing
1,Accurate assessmentenables the nurse todevelop
appropriate plans for
therapyregimen.
2,Topromote properblood
circulation.
3.Toprevent complications
suchasskinbreakdown,
lossofskinintegrity.
4.Measuringintake and
output allows the nurse to
maximize perfusion.5.Hypotensionandan
increasedpulse rate are
indicative ofintravascular
deficit.
6.Poorskin turgor, tissue
dryness, andpresence of
thirst are indicationsof
dehydration.
7.Toincrease knowledge of
patient that BKA is
necessary toprevent the
spreadofnecrosis.
1.Toidentify foodsand
othertherapeuticregimens
indicated forpatient to
decrease viscosityof the
blood.
Reference: Nursing Care
Plans, Medical Surgical
Nursing
After 16 hours
of nursing care,
patient was able
to:
Client isabout to
undergoBelow
the knee
amputation
whichwillprevent the
spreadof
necrosis.Goal
partially met.
Demonstrate a
positivebehavior
toward
therapeutic
regimenas
evidencedby
goodcompliance
andallowing the
surgery tobe
performed.Goal
Met.
8/6/2019 Ppt Group 2 Case Pres
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Nursing Care PlanNursing Care PlanASSESSMENT NURSING
DIAGNOSIS
RATIONALE DESIREDOUTCOME
NURSING
INTERVENTIONS
JUSTIFICATION EVALUATIO
A.ActualAbnormal
Cues:
-NonHealingwoundwith Necrotic tissues
onRight foot.
B. Risk Related
Factors
y Inadequate
primarydefenses
(brokenskin,
traumatizedtissue)
y Oldage
y Decreasedlevel
ofbodyproteins
C.Strengths/Wellness
y Strongbeliefin
God
y GoodFamilysupport.
y Goodcompliance
to therapeutic
regimens.
Impaired Skin
Integrity related
toImpairedTissueper
fusionAEB
NecroticRight
Foot.
Definition:
Alterationsin
the Dermisand
Epidermis.SOURCE:
NANDA 8th
edition
Increasedblood
sugarlevels
Decreasedprotein
levels
DelayofHealing
process
Non-healing
woundwith
necrotic tissueson
right foot.
Impaired Skin
Integrity.
Source: Medical
Surgical Nursing
byBlackand
Hawks
After16 hoursof
nursinginterventions,
myclient willbe ableto:
y Identify
interventions to
reduce spread
ofinfection to
otherpartsof
the body.
y Verbalize
understandingofindividual
causative /risk
factors.
y Have a positive
Attitude
towards
therapeutic
regimen.
Independent:
1.Dailywounddressing
ofwound.2. Stressproperhand
hygiene byclient and
clientsvisitors.
3. Monitorpatients
temperature andperform
tepidsponge bathif
temperature is elevated.
4. Monitoranydrainage
comingout from the
patientswound.
5.Emphasize necessity
of takingantibioticsas
directed.
6.Explain the procedures
needed for furthercare.
Collaborative:
7.Prepare patient pre-
operatively (Below the
knee Amputation) as
ordered.
8.EncourageconsultationofDietitian.
Reference:
Fundamentals
of Nursing
Toreduce bacteria
present in the woundandprevent it fromhavinga
foulsmell.
Toprevent spreadof
infection fromdirect
contact.
Todetermine the
patientsresponse to
infectionanddecrease
temperature.
Toidentifyseverityof
the wound.
Premature
discontinuationof taking
antibioticsmay result to
increase infectionand
potentiate drug-resistant
strains.
To elicit cooperation and
alleviate anxiety.
Tohelppatient inget
ready for the upcoming
operation.
Tohave alist of foods
indicated torestore
energylevelsandprevent
worseningofcondition
(DiabeticDiet).
SOURCE: NANDA 8 th
edition
After16 hourso
nursing
interventions, myclient wasable t
Client wasable t
identify
interventions to
prevent/reduce th
riskofinfection
like requesting f
regularwoundcleaning. Goalm
Client wasable t
understand the
different causati
/risk factorslike
unhygienic
practices. Goal
Demonstrate apositivebehavio
towards therape
regimenby
cooperatingwith
theprocedures
performed. Goal
Met.
8/6/2019 Ppt Group 2 Case Pres
13/14
Nursing Care PlanNursing Care Plan
ASSESSMENT NURSING
DIAGNOSIS
RATIONALE DESIRED
OUTCOME
NURSING
INTERVENTIONS
JUSTIFICATIO
N
EVALUATION
Risk Related Factors
y Inadequate
primarydefenses
(brokenskin,
traumatized
tissue)
y Immunosuppresi
on.
y Prolongedstay
in the hospital
Strengths/Wellness
y Strongbeliefin
God
y Goodcompliance to
medications
Risk forinjury
related to
alteredphysical
mobilitydue to
necrosisof
right foot.
Definition: At
riskofinjuryas
aresult of
environmental
conditions
interactingwith
the individuals
adaptive and
defensive
resources.
SOURCE:
NANDA 8th
edition
Non-healing
woundand
NecrosisofRight
foot.
Alterationsin
mobility
Risk forinjury
Source: Medical
Surgical Nursing
byBlackand
Hawks
After16 hoursof
nursinginterventions,
myclient willbe able
to:
y Identify
interventions
to
prevent/reduce
riskofinjury.
y Verbalize
understanding
ofindividual
causative /risk
factors.
y Demonstrate
behaviors,
lifestyle
changes to
reduce risk
factorsand
protect self
frominjury.
Independent:
Provide side rails to
patient.
Teachpatient tomove
carefully.
Use wheelchair in
transportingpatient from
one area toanother.
Ascertain knowledge of
safetyneedsorinjury
preventionand
motivation toprevent
injury.
Provide information
regardingdisease or
condition that mayresult
inincrease riskofinjury.
Encourage participation
inself-helpprogramssuchasassertiveness
training, positive self-
image.
Collaborative:
Refer tophysicalor
occupational therapist as
appropriate.
Reference:
FundamentalsofNursing
Toprevent falls.
Toprevent from
gettinginjured.
Topromote safety
forthepatient
during
transportation.
To evaluate degree
orsource ofrisk
inherent in the
individuals
situation.
Tocorrect or
reduce individual
risk factors.
To enhance self-
esteem.
Tocorrect or
reduce individual
risk factors.
.
SOURCE:
NANDA 8th
edition
After40 hoursof
nursinginterventions, my
client wasable to:
Client wasable to
identify
interventions to
prevent/reduce the
riskofinfection
likeprovidinga
safe environment.
Goalmet.
Goalmet. Client
wasable to
determine the
different causative
/risk factors like
falls. Goal Met. .
Demonstrate
behaviors, lifestyle
changes toreduce
risk factorsand
protect self from
injurylike
identifying the
benefitsof
undergoing
procedures
required forhealth
maintenance. Goal
Met.
8/6/2019 Ppt Group 2 Case Pres
14/14
Health TeachingHealth Teaching
MEDICATION EXERCISE TREATMENT HYGIENE OUTPATIENT DIET
-Compliance tomedications to
promote optimal
healing.
Passive andactive range
ofmotion
helpspromote
circulation
andimprove
tissue
perfusionand
usebodyglucose for
energy
oxidation.
-Compliance to treatmenttopromote optimalhealing:
Below the Knee
Amputation toprevent the
spreadofnecrosisgoing to
the upperextremity.
Antibiotics that inhibits the
growthofbacteriawhich
causesinfection.Enoughrest andsleep to
provide the bodysneeded
energy.
Regularcleansingof
wound toprevent further
infection.
Laboratoriesordered to
detect abnormalities.Oralhypoglycemicagents
anddaily exercise.
Dailybrushingof teethdecreasesnumberof
microorganismspresent in
the mouthandprevent it
fromgettingswallowed.
Bedbathifnot
contraindicated.
Tepidspongebath to
promote comfort anddecreasebody
temperature ifpatient is
febrile.
Woundcleansingas
orderedby thephysician
toprevent infection
affectedsite.
Goodcompliance tomedicationasprescribed
by the doctor( not tomiss
ordouble the dose)
Dailywounddressing to
promote woundrecovery.
Follow the diet asadvised
tohelp the bodyrestore
energylevelsandpreventworseningofcondition.
Provide enoughrest
periodsandsleep.
Regularhealthcheckup
the doctortomonitor
patientsrecovery.
Notifyphysician forany
untowardsymptomsofmedications taken.
Daily exercise topromote
properbloodcirculation
andoxidizebodys excess
glucose.
DiabeticDiet- foods
lowinsugartoprevent
furtherworseningof
the condition.
Recommended