OSTEOMYELITIS- 

- is an infection of the bone, a rare but serious condition. Bones can become
infected in a number of ways: Infection in one part of the body may spread through the
bloodstream into the bone, or an open fracture or surgery may expose the bone to infection
Diabetic diet- high fiber, low carbs, proteins, low cholesterol less sugar. (brown rice, oatmeal,
whole grains.
PNSS 1L. because d5lr has glucose in it and that they cant metabolize glucose. Risk pagid sa
fluid retention ang highblood patients( damo solute ila blood so mag retain ang water.
Grade 3 foot ulcer - abscess with bony involvement. (as shown in XRAY)
LABS:
CBC PC- to identify presence of infection. this would also check if blood clotting is normal.
FBS- 8-12 hours- to check the blood glucose of the patient.
Creatinine- to know if the kidney is damaged since blood vessels are small. May lead to
hypertension.
Lipid Profile- to know the cholesterol level and triglycerides in the blood can clog in the arteries
which would lead to heart disease.
SGPT/ SGOT (Serum glutamic pyruvic/ oxaloacetic transaminase) an enzyme that is found
in the liver. If liver is damaged, this enzyme will release in the blood stream.
HGBA1C- mabal an kung poor compliance of oral diabetic maintenance ang patient for 2 to 3
months.
XRAY Left foot APL to know the grade of foot ulcer
ECG- for CP Clearance. To know if the patient has heart problem.
DRUG STUDY
1. NALBUPHINE HCL (NUBAIN) ½ AMP SIVP ANST NOW
- Narcotic agonist-analgesic of kappa opiate receptors and partial antagonist of
muopiate receptors; inhibits ascending pain pathways, thus altering response to
pain; produces analgesia, respiratory depression, and sedation.
- Binds to mu opiate receptors in the cns that Alters response to pain.
- For Moderate to severe pain.
- SIVP because it can cause hypotension.
- SIDE EFFECTS: Bradycardia, dizziness, blurred vision, hypotension, respiratory
depression. Gi cramps
- NSG RESPO: Monitor vs especially rr and bp before and after administering.
- Assist in changing position.
2. Paracetamol (4000mg maximum a day)
 - Reduces fever by acting directly on the hypothalamic heat-regulating center causing
vasodilation and sweating wc helps dissipate heat.
- SIDE EFFECTS: headache, chestpain, dyspnea, gi irritation
- NSG RESPO: GIVE WITH FOOD, CHECK TEMPERATURE BEFORE AND AFTER.
TSB

3. Irbesartan (ARBS)
- For the treatment of hypertension & treatment of renal disease in patients
withhypertension and type II diabetes mellitus, as part of an antihypertensive drug
regimen
- maglakat sa kidney Angio 2, maconvert na aldosterone shitsxsx tapos aring
aldosterone maka increase bp ang cause vasoconstriction
- Inhibits the vasoconstricting and aldosterone-secreting effects of angiotensin II by
selectively blocking the conversion of angiotensin II( vasoconstriction)
GS/CS to know what microorganisms and the corresponding antibiotic to be used.
REPEAT ECG - to reassure if there is heart problem.
RANITIDINE (h2 receptor blocker)
- Inhibits the action of histamine at the H2 receptor site located primarily in gastric
parietal cells, resulting in inhibition of gastric acid.
- It helps the stomach to be environment friendly in preparation for anesthesia effect.
- SIDE EFFECT: Constipation. GI discomfort
- NSG RESPO: Increase fluid intake to prevent constipation.

METOCLOPRAMIDE (anti-emetic,dopamine receptor)

- Inhibits chemoreceptor trigger zone and vomiting center to prevent vomiting.
- Strengthen LES tone.
- Prepares the environment of stomach for anesthesia effect or interaction.
- SIDE EFFECT: Diarrhea, drowsiness, dizziness. Involuntary movement.
Constipation.
- NSG RESPO: monitor pt for involuntary movements. Assist coz makacause
drowsiness.
CLINDAMYCIN
- Inhibits bacterial protein synthesis. Kills susceptible bacteria
- Treats Infection
 - SIDE EFFECTS: dizziness, headache, vertigo, nausea, vomiting, diarrhea, rash,
- NSG RESPO: Take with food. Follow the prescribed treatment regimen. Do not miss
to administer.
TRAMADOL ( Analgesic)
- Moderate to severe pain.
- Mngment of pain in the operation site.
- Binds to the opiate receptors in the CNS causing inhibition of ascending pain
pathways, altering the perception and response to pain.
- SIDE EFFECTS: dyspepsia, constipation, sweating, hypotension, bradycardia,
seizsures. Dry mouth.
- assess bp and rr before and after administering.
- Assess previous analgesic history. Not recommended with patients dependent with
opioid (taken more than 1 wk.) may cause opioid withdrawal symptoms(vomiting,
sweating, diarrrhea, shaking, insomnia, muscle pain.
- Increase fluid intake because it can cause dry mouth.