PATIENT’S PROFILE

Name: Tita Tumibay

Age: 60 yrs. old
Gender: Female
Address: San Josef Sur, Cabanatuan City, Nueva Ecija
Birthdate: September 28, 1961
Birthplace: Cabanatuan City, Nueva Ecija
Nationality: Filipino
Religion: Jehova’s Witness
Civil Status: Married
Occupation: None
Date of Admission: June 9, 2022
Time of Admission: 6:38PM
Chief complaint: Anemia secondary
Admitting Diagnosis: TO CONSIDER CHRONIC KIDNEY DISEASE SECONDARY TO DIABETES
MELLITUS NEPHROPATHY; NON-HEALING WOUND 1ST DIGIT FOOT LEFT; ANEMIA
SECONDARY
Attending Physician: Wilfredo S. Corpus, MD
Surgery: “E” Excision of Gangrenous skin/ soft tissue; debridement of devitalized tissues;
Date of Surgery: June 11, 2022
 DIABETIC NEPHROPATHY
Overview
Diabetic nephropathy is a serious complication of type 1 diabetes and type 2 diabetes. It's also called
diabetic kidney disease. In the United States, about 1 in 3 people living with diabetes have diabetic
nephropathy.
Diabetic nephropathy affects the kidneys' ability to do their usual work of removing waste products and
extra fluid from your body. The best way to prevent or delay diabetic nephropathy is by maintaining a
healthy lifestyle and adequately managing your diabetes and high blood pressure.
Over many years, the condition slowly damages your kidneys' delicate filtering system. Early treatment
may prevent or slow the disease's progress and reduce the chance of complications.
Kidney disease may progress to kidney failure, also called end-stage kidney disease. Kidney failure is a
life-threatening condition. At this stage, treatment options are dialysis or a kidney transplant.
Symptoms
In the early stages of diabetic nephropathy, the patient would most likely not notice any signs or
symptoms. In later stages, signs and symptoms may include:
 Worsening blood pressure control
 Protein in the urine
 Swelling of feet, ankles, hands or eyes
 Increased need to urinate
 Reduced need for insulin or diabetes medicine
 Confusion or difficulty concentrating
 Shortness of breath
 Loss of appetite
 Nausea and vomiting
 Persistent itching
 Fatigue

Causes
 Diabetic nephropathy results when diabetes damages blood vessels and other cells in your
kidneys.
 Diabetic nephropathy is a common complication of type 1 and type 2 diabetes.
 Over time, poorly controlled diabetes can cause damage to blood vessel clusters in your kidneys
that filter waste from your blood. This can lead to kidney damage and cause high blood pressure.
 High blood pressure can cause further kidney damage by increasing the pressure in the delicate
filtering system of the kidneys.

Risk Factors
If you're living with diabetes, factors that can increase your risk of diabetic nephropathy include:
 Uncontrolled high blood sugar (hyperglycemia)
 Uncontrolled high blood pressure (hypertension)
 Being a smoker
 High blood cholesterol
 Obesity
 A family history of diabetes and kidney disease
 Drug Study

Drugs Mechanism of Action Indication Contra Adverse Nursing Consideration

Indication Effect

Algena This medicine contains This medicine is used Hypersensitivity, Diahrrea Encourage patient to
sodium alginate, sodium for the treatment of low-sodium diet, drink plenty of fluids to
bicarbonate, and symptoms of congestive heart avoid dehydration
calcium carbonate. gastroesophageal failure, renal
Sodium alginate, a reflux such as acid failure, edema, Nausea Encourage ice chips, sips
natural polysaccharide, regurgitation, cirrhosis. of cold water and ginger
has been used for heartburn, and products when nauseous.
heartburn and acid indigestion due to
reflux. It effectively reflux of stomach
provides physical contents
barriers to acidic gastric
contents and can
significantly reduce
reflux episodes.
Coversyl It is thought that ACE Coversyl helps lower In patients with a Headache Teach the patient some
inhibitors reduce blood your blood pressure. history of techniques that may
pressure by inhibiting It may be prescribed previous control migraine such as
the enzyme which Coversyl for heart hypersensitivity relaxation, music
catalyses the conversion failure. Some people to the active therapy, guided imagery,
of angiotensin I to develop heart failure ingredient and deep breathing
angiotensin II. after having had a perindopril, ACE- exercises These
Decreased plasma heart attack. inhibitors or any techniques can help
angiotensin II leads to of the excipient patients relieve pain and
increased plasma renin ingredients discomfort.
activity and a decrease present in
in aldosterone. Coversyl Raise side rails of the
Dizziness, bed to prevent fall
vertigo
Ketoanalogue Ketobest allows the For chronic renal Nausea, Position the patient
intake of essential insufficiency with the vomiting upright while eating and
amino acids while following conditions: for 1 to 2 hours post-
minimizing the amino- Given with high meal
nitrogen calorie, low protein
intake. Following food <40 g daily; Diarrhea Encourage patient to
ingestion, the Compensated or drink water to prevent
ketoanalogues are decompensated dehydration
transaminated by taking retention; Glomerular
nitrogen from non- filtration rate (GFR) Teach the patient to
essential amino acids, of 5-50 mL/minute. Abdominal
pain. Avoid eating foods that
thereby decreasing the can cause bloating or
formation of urea by re- indigestion.
using the amino group.
Levofloxacin Levofloxacin is a Used to A low seizure Nausea Tell patient to avoid
bactericidal antibiotic of treat infections of the threshold. foods and smells that
the fluoroquinolone sinuses, skin, lungs, pseudotumor trigger nausea.
drug class that directly ears, airways, bones, cerebri, a
inhibits bacterial DNA and joints caused by condition with Diarrhea Advise patient to Avoid
synthesis. Levofloxacin susceptible bacteria. high fluid caffeine and alcohol and
promotes the breakage Levofloxacin is pressure in the drink plenty of fluids
of DNA strands by frequently used to brain. a painful
 inhibiting DNA-gyrase treat urinary condition that Inform the patient to lie
in susceptible infections affects the nerves Dizziness down and not to move so
organisms, which in the legs and as not to accumulate
inhibits the relaxation of arms called injuries or pain.
supercoiled DNA. peripheral
neuropathy.
myasthenia
gravis, a skeletal
muscle disorder.
Tazocin Piperacillin kills Used against bacteria  Patients with a Dizziness Raise side rails of the
bacteria by inhibiting which cause serious history of allergic bed to prevent fall
the synthesis of bacterial infections such as reactions to any
cell walls. It binds chest infections, urine of the penicillins Trouble Educate the patient on
preferentially to specific infections, stomach and/or sleeping the proper food and fluid
penicillin-binding infections, skin cephalosporins or intake such as avoiding
proteins (PBPs) located infections, β-lactamase heavy meals, alcohol,
inside bacterial cell gynaecological inhibitors. caffeine, or smoking
walls. infections, before bedtime.
septicaemia (blood
poisoning)
Position the patient
Nausea,
upright while eating and
vomiting
for 1 to 2 hours post-
meal

Advise patient to Avoid

Diarrhea caffeine and alcohol and
drink plenty of fluids

Mosegor Vita Pizotifen has an Anorexia of somatic Hypersensitivity Dizziness Place the patient in bed
appetite-stimulating or psychogenic origin to the drug and raise the side rails
action suitable in underweight for safety. 
for increasing body patients, in whom
weight in underweight prevention of vitamin Dry mouth, Sip water or sugar-free
anorectic patients. The B deficiency drinks or suck ice chips
compound is well secondary to throughout the day to
tolerated, permitting impaired dietary moisten your mouth
treatment of anorexia. intake or absorption
(e.g. as a Advise to take laxatives
consequence of Constipation
To help evacuate stools
antibiotics or other
drug therapy
interfering with
absorption or
utilization of B-group
vitamins).
Linezolid Linezolid is the first  It is indicated Linezolid should Pain Teach the patient some
available oxazolidinone for gram-positive not be used techniques that may
to inhibit bacterial infections and in patients taking reduce pain such as
protein synthesis by approved for the any medicinal relaxation, music
interfering with treatment of bacterial product which therapy, guided imagery,
translation. Linezolid pneumonia, skin and inhibits and deep breathing
binds to a site on the skin structure monoamine exercises These
 bacterial 23S ribosomal infections, and VRE oxidases A or techniques can help
RNA of the 50S subunit, infections, including B (e.g., patients relieve pain and
which prevents the infections phenelzine, discomfort.
formation of a complicated by isocarboxazid) or
functional 70S initiation bacteremia within two weeks Provide passive ROM
complex of taking any
Numbness
such medicinal
product
Mucosta Prostaglandin Treatment of gastric Patients with a Dry mouth Sip water or sugar-free
Increasing Effect: mucosal lesions history of drinks or suck ice chips
Rebamipide increased (erosions, bleeding, hypersensitivity throughout the day to
the endogenous redness and edema) to any ingredient moisten your mouth
prostaglandin E2 in the following of this drug.
(PGE2) content in the conditions: Acute Diarrhea, Encourage the patient to
gastric mucosa in rats. gastritis and acute drink plenty of fluids to
The drug also increased exacerbation of prevent dehydration
PGE2 and PGI2 content chronic
in the gastric juice, as gastritis. Gastric Position the patient
well as the content of ulcers. Nausea and
upright while eating and
15-keto-13, 14-PGE2, a vomiting
for 1 to 2 hours post-
metabolite of PGE2. meal
heartburn,
Teach the patient to
Abdominal
Avoid eating foods that
pain
can cause bloating or
indigestion.