Endorsing to you patient BDR, 54 years old, male under the service of Dr. H,.

Ramos. Admitting diagnosis: DM type 2, gangrenous right foot

GENERAL DATA
Patient’s name: BDR
Address: Manila, Philippines
Birthday: October 4, 1967
Age: 54 years old
Sex: Male
Citizenship: Filipino
Occupation: Politician
Height: 5’ 6”
Weight: 140 lbs.
Religion: Roman Catholic
Status: Married

HISTORY OF PRESENT ILLNESS

Twenty days prior to admission, patient noted onset of bullae at right foot
dorsum about the size of one peso coin. 7 days prior to admission, bullae
spontaneously ruptured, applied Betadine once a day with no relief. Wound noted to
ulcerate spreading over foot dorsum up to proximal tibia. On day of admission, patient
had a Fever which prompted consultation at Cagayan Valley Medical Center, hence, the
admission last March 22, 2021.
Vital signs taken: BP – 130/80 mmHg, HR – 117 beats / minute, RR – 19 cycles /
minute and temp. –37.6 0C.

IV. PAST HEALTH HISTORY

Diabetic for 14 years with poor compliance to medications for diabetes like
humulin and claims no compliance for 5 years. Claim to be an alcoholic beverage and a
smoker for 1 year. He was also diagnosed with Hypertension. He has been operated for
wound suturing at the left foot dorsum last 2018 at CVMC. And on June 2020, he had
undergone Below the Knee Amputation at CVMC.
NURSING REVIEW OF SYSTEMS
1 General Appearance Patient is not having fever, conscious, coherent,
responsive when being asked. He has a slender body type; voice is clear when he
talks and appears relaxed and comfortable upon my visit.
2 Skin Patient has cool and has good skin turgor. There are no signs of skin
lesions and sores; there is absence of rashes and itchiness and no change in skin
color.
3 Head Patient is normocephalic, proportion to the body. Sometimes he
experienced headache but was relieved by taking OTC medications. There is even
distribution of hair and has slightly dry hair but has no presence of flakes.
4 Eyes He has pinkish, palpable conjunctiva, does not wear glasses and has
clear vision with absence of eye infection.
5 Ears Symmetrical, non-tender and smooth texture.

1
 6 Nose The nose is at the midline of the face, palpable, with no presence of
swelling. He also experienced colds due to weather conditions.
7 Mouth He does not wear any dentures but experiences toothaches sometimes
due to lack of oral care.
8 Neck There was no presence of neck stiffness or pain. It can move regularly
and there is no sign of swelling.
9 Upper Extremities Warm and has good skin turgor, smooth texture, and
non-tender.
10 Breast There was absence of lumps, nipple discharge, scales or cracks
around the nipples.
11 Lungs He has no cough, his not wheezing or having any lung disease.
12 Abdomen Flabby, soft and non-tender
13 Lower Extremities He had undergone Above the Knee Amputation at the
left and Below the Knee Amputation at the right due to Diabetes Mellitus. He has
impaired mobility thus he really needs assistance upon movement
14 GENITOURINARY SYSTEM No presence of sexually transmitted disease.
Foreskin retracts easily. The left sacral sac is lower than the right. Testicles are
sensitive to pressure, firm, smooth and equal in size. No swelling, lesions, itching
noted in the reproductive area..
15 NEUROLOGIC SYSTEM Has clear thinking and has slight changes in
emotional state such as changes in mood and sometimes being irritable because of
his health condition. Has a good sense of memory and shows no signs of speech
problems.
16 ENDOCRINE SYSTEM He is able to tolerate cold and hot temperature; he is
above the normal appropriate body mass index and has a history of diabetes.

PHYSICAL ASSESSMENT
The patient was observed lying on bed, able to tolerate light movements, afebrile,
comfortable and no headache. Vital signs were noted to be; BP – 130/90 mmHg, HR –
96 bpm, RR – 25 cpm and temp. – 35.90C.

1 SKIN Shows no signs of erythema, jaundice or cyanosis. Generally

has uniform pigmentation except in areas around the neck and
areas exposed to the sun. No signs of skin interruptions. Have
warm and good skin turgor.
2 HAIR Variable, no infestation, slightly dry hair, evenly distributed
hair.
3 NAILS Has smooth texture, highly vascular and pink in color, and
intact epidermis
4 HEAD Normocephalic and smooth skull contour, absence of
nodules, symmetric facial features, symmetric facial movements
5 EYES Eyebrows symmetrically aligned and equal movement, skin

2
 intact, no discharge, no discoloration, lids closed symmetrically,
approximately 15 to 20 involuntary blinks per minute, sclera
appears white, shiny, smooth and pink conjunctiva, pupils black in
color, equal in size, positive reaction to light and accommodation
able to read at a regular distance
6 EARS Color is same as facial skin, symmetric position, mobile, firm
and not tender, able to hear ticking sounds on both ears, has
smooth texture and no signs of discharges
7 NOSE Symmetric and straight, no discharge but manifests slight
flaring due to post- operative pain, has uniform color, not tender
and has no lesions, nasal septum intact and in the midline, breaths
freely and regularly
8 MOUTH AND BUCCAL CAVITY Uniform pink color, ability to
purse lips, no retraction of gums, pink gums, smooth, white, shiny
tooth enamel, lips were red, soft and symmetrical in shape, no
lesions, no bleeding noted on gums, tongue is in central position,
pink color, smooth lateral margins, moves freely and has no
lesions.
9 NECK Muscles equal in size, head centered, coordinated, smooth
movements with no discomfort, has equal strength, lymph nodes
not palpable.
10 LUNGS AND THORAX Chest is symmetrical, skin intact, uniform
temperature, full symmetric chest expansion, clear breath sounds,
respiratory rate is 25 cycles/min.
11 PERIPHERAL VASCULAR SYSTEM Full pulsations, symmetric
pulse volumes, blood pressure is noted to be 140/80; extremities
show no sign of redness, tenderness and edema.
12 BREAST AND AXILLAE Skin is uniform in color, it is also smooth
and intact, no lesions and absence of discharges. No presence of
tenderness and masses on the axillae.
13 ABDOMEN Unblemished skin, uniform in color, symmetric
contour, flabby and soft, no rashes or skin lesions, no appearance
of bulges.
14 MUSCOSKELETEL SYSTEM
UPPER EXTREMITIES Has an equal size on both sides of
the body, no contractures, no tremors, normally firm, smooth
coordinated movements, equal strength on each body’s side.
LOWER EXTREMITIES He had undergone Above the Knee
Amputation at the left and Below the Knee Amputation at the right
due to Diabetes Mellitus. He has impaired mobility thus he really
needs assistance upon movement.
15 NEUROLOGIC SYSTEM Conscious and coherent, no language
deficiency, well oriented to time and place, coordinated body
movements, smooth and steady

3
 16 MALE GENITALS AND REPRODUCTIVE TRACT Even
distribution of pubic hair, pubic skin intact and has no lesions.

MEDICATIONS
Atenolol 50mg/tab 1 tab OD q 8am
Tramadol 50mg/amp 1 amp IVTT q 6 hrs RTC
Clindamycin 300mg/cap 1 cap q 6 hrs
Humulin 70/30 35 ‘u’ SQ ACBF 15’u’ SQ AC supper
Cataflam 50mg/tab 1 tab BID

DIAGNOSTIC PROCEDURES
HEMATOLOGY
LABORATORY RESULTS
TEST RESULT UNIT REFERENCE
WBC 25.8 10^3/ul 4.8-10.8
NEU 23.2
LYM 1.65
MONO .857
EOS .020
BASO .083

RBC 3.99 10^6/ul M 4.7-6.1; F 4.2-5.4

HGB 11.7 g/dl M 14.0-18.0; F 12.0-16.0
HCT 33.6 % M 42.0-52.0; F 37.0-47.0
MCV 84.2 Fl M 80-94; F 81-99
MCH 29.4 Pg 27.0-31.0
MCHC 34.9 g/dl 33.0-37.0
Platelet 612 10^3/ul 130-400

Fasting Blood Glucose 252 Mg/dl

Total Cholesterol 186 Mg/dl
HDL Cholesterol 10 Mg/dl
Triglycerides 120 Mg/dl
VLDL Cholesterol 24 Mg/dl
LDL Cholesterol 152 Mg/dl
Glycosylated Hemoglobin 12.50 %

DATA RESULT RANGE UNIT

4
 Creatinine 0.48 0.6-1.5 Mg/dl
Sodium 130 134-148 mmol/L
Potassium 3.80 3.3-5.3 mmol/L
URINALYSIS 
MACROSCOPIC
            Color = amber - within the normal range
            Character = cloudy - within the normal range
            pH = 6.0 - within the normal range
            Sp Gravity = 1.020 - within the normal range
            Albumin = 2.51 - not normal
            Glucose = +2 - not normal
Protein = +1 - not normal
MICROSCOPE (per test)
            WBC = 0-2/hpf - within the normal range
            RBC = 1-3/hpf - within the normal range
            Epithelial cells = moderate - within the normal range
Bacteria = few - not normal
Upcoming surgery: Amputation of the right lower foot.

Tasks:
1. Make a presentation about Diabetes Mellitus Type 2.
TYPE 2 DIABETES MELLITUS

Type 2 diabetes is an impairment in the way the body regulates and uses sugar
(glucose) as a fuel. This long-term (chronic) condition results in too much sugar
circulating in the bloodstream. Eventually, high blood sugar levels can lead to disorders
of the circulatory, nervous and immune systems. In type 2 diabetes, there are primarily
two interrelated problems at work. Your pancreas does not produce enough insulin — a
hormone that regulates the movement of sugar into your cells — and cells respond
poorly to insulin and take in less sugar.

Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and
type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in
older adults, but the increase in the number of children with obesity has led to more
cases of type 2 diabetes in younger people. During digestion, food is broken down into
basic components. Carbohydrates are broken down into simple sugars, primarily
glucose. Glucose is a critically important source of energy for the body's cells. To
provide energy to the cells, glucose needs to leave the blood and get inside the cells.
Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone
produced by the pancreas. The pancreas is an organ in the abdomen. When levels of
glucose in the blood rise (for example, after a meal), the pancreas produces more

5
insulin. Type 2 diabetes occurs when your body's cells resist the normal effect of
insulin, which is to drive glucose in the blood into the inside of the cells. This condition
is called insulin resistance. As a result, glucose starts to build up in the blood. In people
with insulin resistance, the pancreas "sees" the blood glucose level rising. The pancreas
responds by making extra insulin to maintain a normal blood sugar. Over time, the
body's insulin resistance gets worse. In response the pancreas makes more and more
insulin. Finally, the pancreas gets "exhausted". It cannot keep up with the demand for
more and more insulin. It poops out. As a result, blood glucose levels start to rise. Type
2 diabetes runs in families. Obesity greatly increases the risk of diabetes.

Symptoms

The symptoms of diabetes are related to high blood glucose levels. They include:

 Excessive urination, thirst and hunger

 Weight loss
 Increased susceptibility to infections, especially yeast or fungal infections
 Extremely high blood sugar levels also can lead to a dangerous complication called
hyperosmolar syndrome. This is a life-threatening form of dehydration. In some
cases, hyperosmolar syndrome is the first sign that a person has type 2 diabetes. It
causes confused thinking, weakness, nausea and even seizure and coma.

The treatment of type 2 diabetes also can produce symptoms. Too much glucose-
lowering medicine, relative to dietary intake, can lead to the complication of low blood
sugar (called hypoglycemia). Symptoms of hypoglycemia include:

 Sweating
 Trembling
 Dizziness
 Hunger
 Confusion
 Seizures and loss of consciousness (if hypoglycemia is not recognized and
corrected)

You can correct hypoglycemia by eating or drinking something that has carbohydrates.
This raises your blood sugar level.

6
Type 2 diabetes affects all parts of the body. It can cause serious, potentially life-
threatening complications. These include:

 Atherosclerosis — Atherosclerosis is fat buildup in the artery walls. This can

impair blood flow to the all the organs. The heart, brain and legs are most often
affected.
 Retinopathy — Tiny blood vessels in the retina (the back of the eye that sees
light) can become damaged by high blood sugar. The damage can block blood flow
to the retina, and can lead to bleeding into the retina. Both damage the ability of
the retina to see light. Caught early, retinopathy damage can be minimized by
tightly controlling blood sugar and using laser therapy. Untreated retinopathy can
lead to blindness.
 Neuropathy — This is nerve damage. The most common type is peripheral
neuropathy. The nerves to the legs are damaged first, causing pain and numbness
in the feet. This can advance to cause symptoms in the legs and hands. Damage to
the nerves that control digestion, sexual function and urination can also occur.
 Foot problems — Sores and blisters on the feet occur for two reasons:

 If peripheral neuropathy causes numbness, the person may not feel irritation in
the foot. The skin can break down, form an ulcer, and the ulcer can get
infected.
 Blood circulation can be poor, leading to slow healing. Left untreated, a simple
sore can become infected and very large. If medical treatment cannot heal the
sore, an amputation may be required.

 Nephropathy — Damage to the kidneys. This is more likely if blood sugars remain
elevated and high blood pressure is not treated aggressively.

Diagnosis

Diabetes is diagnosed by testing the blood for sugar levels. Blood is tested in the
morning after you have fasted overnight.

Typically, the body keeps blood sugar levels between 70 and 100 milligrams per
deciliter (mg/dL), even after fasting. If a blood sugar level after fasting is greater than
125 mg/dL, diabetes is diagnosed.

Your doctor will examine you to look for:

7
 Obesity, especially abdominal obesity—a condition that greatly raises a person's risk
for type 2 diabetes.
 High blood pressure—a condition often present in people with type 2 diabetes, that
together with diabetes greatly increases the risk of heart disease and strokes.
 Deposits of blood, or puffy yellow spots in the retina of your eyes—complications of
both diabetes and high blood pressure, that increase the risk of blindness
 Decreased sensation in the legs—which can cause a person with diabetes to fail to
notice developing foot sores, particularly sores on the underside of the feet
 Weak pulses in the feet—a condition that can slow or prevent the healing of foot
sores, and possibly lead to amputation
 Blisters, ulcers or infections of the feet

Laboratory tests are also used routinely to evaluate diabetes. These include:

 Fasting plasma glucose (FPG) test. Blood is taken in the morning after fasting
overnight. Normally, blood sugar levels remain between 70 and 100 milligrams per
deciliter (mg/dL). Diabetes is diagnosed if a fasting blood sugar level is 126 mg/dL
or higher.
 Oral glucose tolerance test (OGTT). Blood sugar is measured two hours after
drinking 75 grams of glucose. Diabetes is diagnosed if the 2-hour blood sugar level
is 200 mg/dL or higher.
 Random blood glucose test. A blood sugar of 200 mg/dL or greater at any time
of day combined with symptoms of diabetes is sufficient to make the diagnosis.
 Hemoglobin A1C (glycohemoglobin). This test measures the average glucose
level over the prior two to three months. Diabetes is diagnosed if the hemoglobin
A1C level is 6.5% percent or higher.
 Blood creatinine and urine microalbumin. Tests for evidence of kidney disease.
 Lipid profile. Measures levels of triglycerides and total, HDL, and LDL cholesterol.
This evaluates the risk of atherosclerosis. People with diabetes who also have high
levels of total cholesterol or LDL cholesterol are at greatly increased risk for heart
disease and strokes.

Expected Duration

8
Diabetes is a lifelong illness. However, people with type 2 diabetes can sometimes
restore their blood sugar levels to normal just by eating a healthy diet, regularly
exercising, and losing weight.

Aging and episodic illness can cause the body's insulin resistance to increase. As a
result, additional treatment typically is required over time.

Prevention

If a close relative—particularly, a parent or sibling—has type 2 diabetes, or if your

blood glucose test shows "pre-diabetes"—defined as blood glucose levels between 100
and 125 mg/dL—you are at increased risk for developing type 2 diabetes. You can help
to prevent type 2 diabetes by:

 Maintaining your ideal body weight.

 Exercising regularly—like a brisk walk of 1-2 miles in 30 minutes—at least five times
a week, even if that does not result in you achieving an ideal weight. That's
because regular exercise reduces insulin resistance, even if you don't lose weight.
 Eating a healthy diet.
 Taking medication. The medication metformin (Glucophage) offers some additional
protection for people with pre-diabetes.

If you already have type 2 diabetes, you can still delay or prevent complications:

 Keep tight control of your blood sugar. This reduces the risk of most complications.
 Lower your risk of heart-related complications by:

 Taking a daily aspirin—particularly if you already have some signs of heart

disease.
 Aggressively managing other risk factors for atherosclerosis, such as:

 High blood pressure

 High cholesterol and triglycerides
 Cigarette smoking
 Obesity

 Visit an eye doctor and a foot specialist every year to reduce eye and foot
complications.

9
Treatment

Diet and Exercise

In most cases, type 2 diabetes treatment begins with weight reduction through diet
and exercise. A healthy diet for a person with diabetes is:

 Low in saturated fats and cholesterol

 Without any trans fats
 Low in total calories
 Nutritionally balanced with abundant amounts of:

 Whole-grain foods
 Monounsaturated oils
 Fruits and vegetables

A daily multivitamin is recommended for most people with diabetes. For some people,
type 2 diabetes can be controlled just with diet and exercise. Even if medications are
required, diet and exercise remain important for controlling diabetes.

Medications: Pills

These medications work in many different ways. They include medications that:

 Reduce insulin resistance in the muscles and liver.

 Increase the amount of insulin made and released by the pancreas.
 Cause a burst of insulin release with each meal.
 Delay the absorption of sugars from the intestine.
 Slow your digestion.
 Reduce your appetite for large meals.
 Decrease the conversion of fat to glucose.
 Increase the amount of sugar that flows out of the kidneys into urine.

Insulins

Because type 2 diabetes develops when the pancreas cannot make enough insulin to
overcome insulin resistance, about one of three people with this disease take some
form of insulin injection.

10
In advanced type 2 diabetes, or for people who want to tightly control glucose levels,
insulin may be needed more than once per day and in higher doses.

Treatment plans that include both very long-acting insulin and very short-acting insulin
are frequently the most successful for controlling blood sugar. Very short-acting insulin
is used with meals, to help control the spike in blood sugar levels that occur with a
meal. If a person does not eat on a regular schedule, very short-acting insulin can be
particularly helpful.

Treatment Side Effects

Medications used to treat type 2 diabetes can have side effects. These vary by
medication. Side effects may include:

 Low blood sugar levels (hypoglycemia)

 Weight gain
 Nausea
 Diarrhea
 Leg swelling
 Worsening of heart failure
 Liver inflammation
 Excessive gas and bloating
 Frequent urination In general, the benefits of treatment outweigh the risks.

People with type 2 diabetes who have other medical problems such as advanced kidney
disease need to avoid some of the pills and non-insulin injections.

In addition to medicines that help control the level of blood sugar, people with type 2
diabetes often take other medicines that reduce the risk or to slow the onset of the
complications of diabetes. These include medications that:

 Slow the worsening of kidney disease—particularly drugs called angiotensin-

converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).
 Lower cholesterol. All diabetics should consider taking medication to lower their
cholesterol, usually one of the statin medications.
 Lower blood pressure. Diabetics should use medication to control high blood
pressure if it can't be improved by lifestyle changes.
 Protect against heart attacks. Most people with diabetes benefit from daily low-
dose aspirin.

11
 2. Discuss the pathophysiology of DM.

Pathophysiology
The two main problems related to insulin in type 2 diabetes are insulin resistance
and impaired insulin secretion. Insulin resistance refers to a decreased tissue sensitivity
to insulin. Normally, insulin binds to special receptors on cell surfaces and initiates a
series of reactions involved in glucose metabolism. In type 2 diabetes, these
intracellular reactions are diminished, making insulin less effective at stimulating
glucose uptake by the tissues and at regulating glucose release by the liver. The exact
mechanisms that lead to insulin resistance and impaired insulin secretion in type 2
diabetes are unknown, although genetic factors are thought to play a role.
To overcome insulin resistance and to prevent the buildup of glucose in the
blood, increased amounts of insulin must be secreted to maintain the glucose level at a
normal or slightly elevated level. This is called metabolic syndrome, which includes
hypertension, hypercho- lesterolemia, and abdominal obesity. However, if the beta cells
cannot keep up with the increased demand for insulin, the glucose level rises and type
2 diabetes develops.
Despite the impaired insulin secretion that is characteristic of type 2 diabetes,
there is enough insulin present to prevent the breakdown of fat and the accompanying
production of ketone bodies. Therefore, Diabetic Ketone Acidosis does not typically
occur in type 2 diabetes. However, uncontrolled type 2 diabetes may lead to another
acute problem—hyperglycemic hyperosmolar nonketotic syndrome.
Key Players:
Glucose:
 “Sugar” (body needs it to survive) fuels the cells of your body so they can
work properly, but it can not enter the cell without the help of insulin
 It is stored mainly in the liver in the form of glycogen
Insulin:
 “deals with high blood sugar levels”
 A hormone that helps regulate the amount of glucose in the blood (too
much glucose is very toxic to the body).
 It allows your body to use glucose by allowing it to enter the cells (without
insulin glucose would just float around in your body)
 Secreted by the BETA cells of the pancreas from the islets of Langerhans
Glucagon:
 “deals with low blood sugar levels”
 A peptide hormone that causes the liver to turn glycogen into glucos and
does the opposite as insulin.
 Also secreted by the pancreas
Pancreas:

12
  Releases insulin and glucagon.
Liver:
 Sensitive to insulin levels and stores and turns glycogen into glucose when
the pancreas secretes glucagon. 

PATHOPHYSIOLOGY OF TYPE 2 DIABETES

MELLITUS

PRECIPITATING
PREDISPOSING FACTORS
FACTORS
- Overweight
- Age (45 and older)
- Hypertension
- Gender (Male)
- Lifestyle(Alcoholic
- Family History
and smoker)
- Inactivity

ETIOLOGY
-Insulin Resistance
-Impaired insulin secretion

Increase insulin secretion

Beta cell dysfunction

Insulin deficiency
13
Hyperglycemia

Type 2 DM

14
 3. Based from the assessment and data given, make 2 nursing care plan for the patient.

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Subjective Impaired skin After 2-3 -Assessed skin. Noted -Establishes comparative After 2-3 hour of
Data: integrity r/t hours of color, turgor, and baseline providing nursing interventions,
“ I have noted decreased nursing sensation. Described opportunity for timely the patient
the onset of circulation as interventions wounds and observed intervention. demonstrated proper
bullae at my manifested by , the patient changes. wound care and
right foot ulcerate wound will participated in
dorsum at spreading over demonstrate -Demonstrated good skin -Maintaining clean, dry skin prevention measures
first it’s like foot dorsum up proper hygiene like wash provides a barrier to and treatment
the size of to proximal tibia wound care thoroughly with mild non infection. Patting skin dry programs.
peso coin and and detergent soap and water instead of rubbing reduces
it participate in and pat dry carefully risk of dermal trauma to
spontaneously prevention fragile skin.
ruptured” as measures -Instructed family to
verbalized by and maintain clean, dry clothes -Skin friction caused by stiff
the patient. treatment preferably cotton fabric. or rough clothes leads to
programs. irritation of fragile skin and
Objective data: increases risk for infection.
- ruptured -Emphasized importance of
bullae @ adequate nutrition and -Improved nutrition and
R. dorsum fluid intake. hydration will improved skin
condition
- Ulcerate
-Encouraged and instructed
wound family members how to -Assists them in optimal
spreading make a guava decoction to healing with less expensive
over foot apply in the wound as resources.
dorsum up alternative disinfectant.
to
proximal -Encouraged use of
padding or pressure
tibia
reducing devises -To reduce pressure on
sensitive areas and enhance
15

ASSESSMENT
Subjective data: Hyperthermia related to After
“Nurse parang mainit po increased pyrogens
-Encouraged early
ambulation or mobilization
-Encouraged with periodic
weight shifts for client
-Provided preventive skin
care such as application of
protectant ointment
-Maintained appropriate
moisture environment for
wound
-Assisted the client/SO in
understanding and
following medication
regimen and developing a
program of preventive care
and daily maintenance
-Administered medications
as ordered by the physician
DIAGNOSIS PLANNING
1 hour of  Performed
comprehensive nursing
16
circulation to compromised
tissues
- Promotes circulation and
reduces risks associated with
immobility
- To reduce stress on
pressure joints and promote
circulation to tissues
-To minimize contact with
irritants like excessive
moisture
-Excess moisture is impeding
wound healing
-This enhances commitment
to plan for optimize
outcome.
-To treat underlying
condition
INTERVENTIONS RATIONALE EVALUATIO
 Sponge baths After 2 hou
tepid sponge may be used of
ako” as verbalized by the in the body as interventions the patient bath along with comprehensi
patient manifested by a temperature will decrease medicines to nursing
body temperature of from 37.6 to 37.1 C treat a fever interventions
Objective data: 37.6 C the patien
 Warm to touch  Monitored vital  For baseline data temperature
 Diaphoresis sign every 1 decreased
 Tachycardia hour and from 37.6 C
recorded 37.1 C
Vital signs
BP: 130/80 mmH  Advised to  Advice to
HR: 117 beats / minute increase fluid increase fluid
RR: 19 cycles / minute intake unless intake is a
Temp: 37.6 0C. contraindicated frequent
treatment
recommendation.

 Promoted  To reduced
adequate rest consumption of
energy

 Provided  To boosts patient

comfort satisfaction,
measures such improves
as backrub, outcomes and is
changes in the right thing to
position, and do
relaxation
techniques

 Encouraged to  Recognizing
verbalize problems and
feelings sharing feelings
is best brought
about in an
atmosphere of
17 warmth and
 trust.

 Monitored  To monitor if
intake and there are
output presence of fluid
loss or fluid
retention

 Administer
medication  To reduce fever
such antipyretic
as prescribed
by the
physician

4. Make a drug study of the patient’s medications.

18
DRUG MECHANISM INDICATION SIDE/ADVERSE EFFECTS CONTRAINDICATIONS NURSING
OF ACTION CONSIDERATION
ATENOL Atenolol belon  Treatment of SIDE EFFECTS:  2°/3° heart block in  Take drug with
OL gs to a class angina  Tiredness patients meals if GI
of drugs pectoris due  Low blood without pacemaker upset occurs.
Brand known as beta to coronary pressure (hypotension)  Cardiogenic shock  Do not stop
name: blockers. It atherosclero  Slow heart rate  Sinus bradycardia taking this drug
TENORM works by sis  Cold extremities  Sinus unless told to do
IN blocking  Hypertensio  Dizziness upon standing node dysfunction so by a health
the action of n, as a step  Depression  Hypersensitivity care provider.
certain natural 1 agent,  Nausea  Uncompensated car Avoid driving or
chemicals in alone or with  Dreaming diac failure dangerous activities if
your body, other drugs,  Drowsiness  Pulmonary edema dizziness or weakness
such as especially  Diarrhea occurs. You may
epinephrine, diuretics  Fatigue experience these side
on the heart  Treatment of  Leg pain effects: Dizziness,
and blood MI  Lethargy light-headedness, loss
vessels.  Unlabeled  Lightheadedness of appetite,
This effect low uses :  Spinning sensation (verti nightmares,
ers the heart prevention go) depression, sexual
rate, blood of migraine  Shortness of breath impotence.
pressure, and headaches;  2°/3° atrioventricular (A
strain on the alcohol V) block
heart. withdrawal
syndrome,
treatment of
ventricular
and
supraventric
ular
arrhytmias

DRUG MECHANISM INDICATION 19 SIDE/ADVERSE EFFECTS CONTRAINDICATI NURSING

 OF ACTION ONS CONSIDERATION
TRAMAD Tramadol is a Tramadol hydroc  constipation,  Significant Assessment
OL centrally acting hloride extended-  nausea, respiratory  History: Hypersensitivi
analgesic with a release capsules  vomiting, depression ty to tramadol;
Brand multimode is indicated for  stomach pain,  Acute or pregnancy; acute
name: of action. It acts the management  dizziness, severe intoxication with
ULTRAM on serotonergic of moderate to  drowsiness, bronchial alcohol, opioids,
ULTRAM and moderately  tiredness, asthma in an psychotropic drugs or
ER noradrenergic severe chronic  headache, and unmonitored other centrally acting
RYZOLT nociception, pain in adults  itching setting or in analgesics; lactation;
ConZip while its who require ADVERSE EFFECTS: the absence of seizures; concomitant
metabolite O- around-the clock  noisy breathing, resuscitative use of CNS
desmethyltrama treatment of their  sighing, equipment depressants or
dol acts on the pain for an  shallow breathing,  Known or MAOIs; renal or
µ-opioid extended period  breathing that stops suspected hepatic impairment;
receptor. Its of time. during sleep, gastrointestinal past or present history
analgesic  slow heart rate or obstruction, of opioid addiction
potency is weak pulse, including  Physical: Skin color,
claimed to be  lightheadedness, paralytic ileus  texture, lesions;
about one tenth  seizure (convulsions),  Hypersensitivit orientation, reflexes,
that of  nausea, y to tramadol, bilateral grip strength,
morphine.  vomiting, any other affect; P, auscultation,
 loss of appetite, component of BP; bowel sounds,
 dizziness, an this product or normal output; LFTs,
worsening tiredness or opioids renal function tests
weakness  Concurrent use
of monoamine
oxidase
inhibitors
(MAOIs) or use
within the last
14 days

20
 DRUG MECHANISM OF INDICATION SIDE/ CONTRAINDICATION NURSING
ACTION ADVERSE S CONSIDERATION
EFFECTS
CLINDAMYCI Clindamycin work Clindamycin is indicated SIDE EFFECTS: Clindamycin is Assessment
N s primarily by for the treatment of: -nausea contraindicated in  History: Allergy
binding to the 50s Serious infections cause -vomiting patients with a history to clindamycin,
Brand ribosomal subunit d by anaerobic bacteria, -unpleasant or of pseudomembranous history of
name: of bacteria. This including intra- metallic taste in colitis or ulcerative colitis. asthma or
Cleocin HCl agent disrupts abdominal infections, the mouth Care is also necessary for other allergies,
protein synthesis skin and soft -joint pain antibiotic use as bacterial allergy to
by interfering with tissue infections. As -pain when and fungal tartrazine (in
the needed, clindamycin swallowing superinfections may 75- and 150-
transpeptidation should be administered -heartburn occur. It is also mg capsules);
reaction, which in conjunction with -white patches in contraindicated in hepatic or
thereby inhibits another antibacterial the mouth patients renal
early chain agent that is active -thick, white with hypersensitivity to dysfunction;
elongation. against gram negative vaginal discharge clindamycin, lincomycin, lactation;
aerobic bacteria. -burning, itching, or any of their history of
and swelling of components. regional
the vagina enteritis or
ulcerative
ADVERSE colitis; history
EFFECTS: of antibiotic
-peeling or associated
blistering skin colitis
-rash  Physical: Site
-hives of infection or
-itching acne; skin
-difficulty color, lesions;
breathing or BP; R,
swallowing adventitious
sounds; bowel
sounds,
output, liver
evaluation;
21 CBC, LFTs,
 renal function
tests

DRUG MECHANISM INDICATION SIDE/ADVERSE CONTRAINDICATIONS NURSING

OF ACTION EFFECTS CONSIDERATION
Generic Lowers blood As adjunct to diet and Side Effect: -Contraindicated during -Regular insulin are
name: glucose level by exercise to improve  Low blood episode of generally used in
Insulin stimulating glycemic control in sugar hypoglycaemia regimens that also
Injection peripheral patient with type 1 (hypoglycemia). -Contraindicated in include an
Regular glucose uptake by and type 2 diabetes  Allergic patient with a history of intermediate or long
binding to insulin mellitus reactions, such hypersensitivity to drug acting insulin.
Brand receptors on as redness and or its component.
name: skeletal muscle swelling at the Severe, life threatening, -Monitor blood
Humulin R and in fat cells site where you generalized allergic glucose level and
and by inhibiting inject. reactions, including adjust insulin dosage
hepatic glucose  Skin thickening anaphylaxis, can occur as needed
production; also or pits at the with insulin products. Monitor patient
inhibits lipolysis injection site carefully when
and proteolysis, (lipodystrophy). initiating therapy.
and enhance  Itching and Time course of
protein synthesis. rash. insulin varies with
Adverse Effect: patient
CV: peripheral edema
Metabolic: - Monitor patient
hypoglycaemia, carefully for signs
hypokalemia, weight and symptoms of
gain hypoglycemia,
Skin: injection site especially in long
lipodystrophy, pruritus standing disease.
Other: allergic Treat according to
individual facility
policy if necessary.
22
 - Assess patient and
notify prescriber for
signs and symptoms
of hypoglycemia

DRUG MECHANISM INDICATION SIDE/ADVERSE CONTRAINDICATIONS NURSING

OF ACTION EFFECTS CONSIDERATION

23
Generic Reversibly inhibits  Ankylosing Side Effect:  Contraindicated  Monitor
name: cyclooxygenase 1 spondylitis -Upset stomach, for the treatment patient and
Diclofenac and 2 enzymes,  Osteoarthritis nausea, heartburn, of perioperative immediately
potassium which decrease  RA diarrhea, constipation, pain after CABG evaluate signs
Brand proinflammatory  Analgesia gas, headache, surgery and symptoms
name: processes. Has  Primary drowsiness, and Contraindicated in of heart attack
Cataflam analgesic, anti- dysmenorrhea dizziness patients hypersensitive to or stroke
inflammatory,  Migraine drug and in those with  Administer
and antipyretic Adverse Effect: hepatic porphyria or drug with food
properties. •GI disturbances; history of asthma, or after meals
headache, dizziness, urticarial, or other allergic if GI upset
rash; GI bleeding, reactions after taking occurs.
peptic ulceration; aspirin or other NSAIDs.  Arrange for
abnormalities of periodic
kidney function. Pain ophthalmologic
and tissue damage at examination
Injection site (IM); during long-
local irritation (rectal); term therapy.
transient burning and  Advice patient
stinging (ophthalmic). to take drug
Potentially Fatal: with food or
Stevens-Johnson meals if GI
syndrome, exfoliative upset occurs.
dermatitis, toxic
epidermal necrolysis.

24
 5. What are your nursing considerations prior and after foot
amputation?

NURSING CONSIDERATIONS PRIOR AND AFTER FOOT AMPUTATION

PRIOR TO FOOT AMPUTATION

Preoperative care and patient education can be done in cases of elective amputation.
There is time to prepare the patient for what lies ahead. In the case of a traumatic
amputation, this may not be possible. Preoperative nursing care and patient education
for the patient about to undergo amputation of all or part of a limb includes the
following.

Secure Informed consent. Make sure that the patient or a significant other has
signed an informed consent.
 Improve the patient's nutritional status by encouraging a balanced diet high in
vitamins and minerals and with adequate protein to enhance wound healing.
Maintain adequate hydration.
 Follow the physician's orders for therapeutic measures used to stabilize any
chronic medical conditions such as diabetes, hypertension, or any other condition
that may interfere with surgery or rehabilitation.
 If ordered, arrange preoperative counseling with the physical therapist. This
may help to alleviate the anxieties about alteration of body image.
 If authorized by the physician, schedule a visit from the prosthetic specialist.
This may help to alleviate some of the patient's anxieties about the fitting and
wear of prosthetic devices.

AFTER FOOT AMPUTATION

Postoperative nursing care involves routine nursing observation, pain control,

positioning and exercise, stump conditioning, and patient education. Patient education
should be done in conjunction with all nursing interventions.
 
Monitor the patient's vital signs closely for changes in pulse or blood pressure
that may indicate hemorrhage under the bulky dressing. A temperature elevation
may indicate the presence of infection.
Check the stump dressing regularly. Evidence of bloody drainage should be
marked with date and time, and excessive bleeding reported to the physician.
Check the proximal end of the stump dressing for swelling. The dressings are
applied to provide some compression of the stump, but a dressing that is too
tight may cause ischemia at the stump end.
Observe the patient for pain. Pain medication may be required for several days
post-operatively. Some patients experience a phenomenon known as "phantom
pain" or "phantom sensation" in which they "feel" the lost limb.

25
 Maintain the prescribed position of the stump. Depending upon the type of
procedure used, the extremity may be in a splint, in traction, or elevated on
pillows. Proper positioning will prevent contracture of the involved muscles.
Encourage prescribed exercises to preserve the range of motion in the affected
limb and to strengthen the remaining limbs.
Provide emotional support and patient teaching to help your patient deal with
altered body image and lifestyle changes.

6. Make a possible discharge plan for the patient. Take into

consideration his previous concerns of non-compliance
and his condition after amputation.

DIABETES MELLITUS DISCHARGE CARE PLAN

MEDICATION  Instruct patient to take medicine at
the exact time and at prescribed
dosage
 Instruct to take prescribed
antibiotics with prescribed duration
 Educate patient with the purpose
of each drug and it's side effect
 Continue home medications take
only the medicines prescribed by
the physician and do not self-
medicate

EXERCISE  Explain the importance and

benefits of having regular
exercises.
 Encourage the patient to have
regular exercise if not
contraindicated to ensure wellness
 Advise patient to be aware of any
restrictions on exercise or activities
that she need to follow such as do
not exercise if blood sugar level is
less than 100mg/dL.

TREATMENT  Comply with treatment regimen

 Monitor blood sugar, careful
monitoring is the only way to make
sure that your blood sugar level
remains within your target range.
26  Avoid foods high in fat because
 they slow the absorption of
carbohydrates.
 Avoid overexposing the wound site
as much as possible.

HYGIENE 17 Take a bath daily

18 Instruct on how to clean dressings
on a regular basis
19 Use only clean gauze, cotton, and
gauze bandages

OPD  Regular follow-up check up should

be greatly encourage to ensure
continuing management and
treatment. Instruct patient to see
doctor for continuing care,
treatment and home services and
to ask for additional information.

DIET  Eat healthy foods. Choose foods

lower in fat and calories and higher
in fiber. Focus on fruits, vegetables
and whole grains.
 Instruct the patient to maintain
healthy weight by eating a well-
balanced diet of whole grain foods
like nuts, seeds, fruits, vegetables
and fish and he may take
multivitamin supplements to
increased energy and enhance the
immune system.
 Watch out calories
 • Do not skip meals; eat meals and
snacks at the same time each day
 Encourage to increase oral fluid
intake

SPIRITUAL  Encourage patient to continue

spiritual relationship with God.
Attend to churches activities.
 Provide emotional support share
your frustrations and your
triumphs with people who
27 understand what you're going
 through can be very helpful. And
through this you may find that
others have great tips to share
about diabetes management.

28