CASE STUDY

Patient’s information
1) Initial: Mrs. S Diabetes
2) Age: 76 years old Mellitus (DM)
3) Complaints that cause for seeking the hospital: High blood
Poor of sugarbecause poor blood sugar controland ulcer since 1 week
knowledge ago Re
4) Vital signs: BP: 102/61, RR: 20x/m, HR: 80x/m, T: 38.39C Fever
Infection

Fever usually occurs in response to an infection as with the virus or with

inflammation that occurs with tissue injury or disease
(Davis, S.P., 2015)

Medication: Medication: Medication:

Ulceration
Aspirin
1) Augmentin 1) Metformin
2) Paracetamol 2) Glipizide

Main Problems:
Type II DM + Ulcer (DFU)

Analysis causes Poor of glycemic Less of physical

Age
from the data control activity

Reference:
Based on ADA (2015) the Duration 7 years
developing type II DM
increases with age, obesity, Type II DM
HbA1c 10%
and lack of physical
inactivity
Reference:

 Long duration of DM has significant finding associated with

DFU (Shahieal., 2012; Synder&Hanft, 2009; Deribe et al.,
2014). Long duration might be presumed to be at more risk
due to the development of long termdiabetic complications
such as PVD, neuropathy that lead to DFU (Deribe et al.,
2014)
 High of HbA1is cause DFU due to foot deformities, foot
pathologies such as fissures and biomechanical abnormalities
such as charchot (Zaine et l., 2014)
 History of Small
Type II DM Vessel Disease
The complications of DM (7 years) (SVD)
are high risk to Micro-
vascular and Macro- SVD that can be
vascular (Fioretto et al., called Micro-
vascular disease
2010; Li ro-vascylardiseas
et al., 2015)
(Irwin et al., 1988)
Macro-vascular Micro-vascular

In patient ECG showed

that patient has acute Retinopathy Nephropathy
myocardial infarction

Patient has blindness Patient said that

D in left eyes difficult to control the
Neuropathy
urine (Incontinence
A Urine)

T People with Laboratory test

Sensory Motoric Autonomy
diabetes do have a showed that Kalium
higher risk of is more than normal
A Patient said that X Dry skin and (5.7 mEq/L)
blindness than
some fingers have callus people without
feeling and some diabetes (ADA,
fingers have not 2015)
Hiperkalemia
feeling after
indicates that patient
touching by nurse Infection has renal disorder

Based on Clayton In Autonomy

&Tom(2009) Discuss to solve this
Recomme neuropathy, problem (no
explained that loss diminution in
nded to do of sensation will medication)
monofilam sweat and oil
lead to not aware gland function
ent test 10
of trauma will be happen
g
that leads to loss
of moisturize skin Those can be called co-
(Cayton& To, morbidities disease
Data: 2009)
Patient’s
position is Exacerbation
doing of injury
pressure of (Rebolledo et
the both of al., 2011)
heel Internal causes

Diabetic Foot
Ulcer
(DFU)
 External causes
Physical inactivity
References:
Merza&Tesfage, 2003;
Lee et al., 2013
Poor blood glucose
control
References:
Merza&Tesfage, 2003;
Boulton et al., 2008;
Ahmad et al., 2013;
Madanchi et al., 2013
Care Management
DFU Cure and Care
Management
(Aalaa et al., 2012)
Cure Management
Internal causes
Diabetic Foot
Ulcer
(DFU) Age
Duration of DM
Based on Wager Classification
this DFU is Grade 1 Note:
Patients always talks about
her husband that already
died every meet the nurse
 Integrity of tissue disorder
 Ineffective of peripheral tissue Identify the
perfusion depression
 Pain
 Immobility Based on Iversen et al. (2015) showed
 Intolerance activity that depression is associated with DFU.
 others This condition will lead to micro and
macro vascular complication.
 Examination and screening
 Nurse cooperation in the DFU treatment
 Nursing role in DFU care at home
 Nursing role in rehabilitation
 Treating the underlying disease process
 Ensuring adequate blood supply
 Optimizing local wound care
References:

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in diabetic foot prevention and care: a review. Journal of Diabetes & Metabolic
Disorders, 11:24
American Diabetes Association (ADA).(2015). Common Terms. Retrieved January 22, 2015
from http://www.diabetes.org/diabetes-basics/common-terms/
Boulton, A.J.M., David, G.A., Stephen, F.A., Robert, G.F., Richard, H., M. Sue, K., et al. (2008).
Comprehensive foot examination and risk assessment. Diabetes Care,Vol. 31, number 8
Clayton, W., and Tom, A.E. (2009).A review of the pathophysiology, classification, and
treatment of foot ulcers in diabetic patients.Clinical Diabetes, Vol. 27, no 2
Davis, C.P. (2015). Fever in adult. Retrieved on March 28, 2015 from
http://www.emedicinehealth.com/fever_in_adults/article_em.htm
Deribe, B., Kifle, W., and Gugsa, N. (2014).Prevalence and factors influencing diabetic foot
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Irwin, S.T., Gilmore, J., McGrann, S., Hood, J., & Allen, J.A. (1988). Blood flow in diabetes
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Iversen, Grethe S T, Birgitte E, Kristian M, Marit G, Berit R, Line I B, and Truls. (2014). Is
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Li, L., Linong, J., Xiao, G., Qiuhe, J., Weijun, G., Xinyue, Z., Xing, L., Hongyu.,Benli, S.,
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Madanchi, Nima, OzraTabatabaei-Malazy, Mohammad Pajouhi, RaminHeshmat, BagherLarijani
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