Case Presentation of Diabetes Mellitus II

Presented by:

Velasquez, Angel Mary

Villacorte, Alexandra Jane

Villafuerte, Karl Angelo

Villanueva, Anna Muriella

Villarivera, Marc Alan

Section 311- Group 4B

Presented to/Submitted to:

Ms. Julieta M. Unida, R.N., MAN

Submitted on:

November 15, 2022

 I. DEMOGRAPHIC PROFILE

Name: Mantos, Age: 78 Gender: F Marital Name of Number of

Monserat Yraula Status: spouse: children: N/A
Widower Salustiano,
Mantos

Patient I.D. Number: 24223

Room & Bed Number: 402-D

Address: 14 ARKONG BATO Kapitolyo, Pasig City, City of Pasig

Birthdate: Birthplace: Occupatio Education Religion: Race/Ethnic

August 25, 1944 Aklan n: N/A al Catholic Origin:
Attainmen Filipino
t: N/A

Chief complaint:

Date of Admission: October 4, 2022

Attending/Admitt Jalellah Bagumbaran Noor, M.D.

ing Physician:

Admitting Final Non healing wound, Left Foot

Diagnosis:

Medical Philhealth Membership Lifetime Member

Insurance:

II. NURSING HEALTH HISTORY

A. History of Present Illness
A 78 year old adult, in a wheelchair was admitted to the hospital due to a
gangrenous wound with numbness in left foot. According to the guardian, the
patient was cleaning her nails in the left foot and accidentally wounded a
digit in the foot. The patient had a history of diabetic foot resulting in a
below-knee amputation on the right. Upon admission, the vital signs of the
patient were 130/70, 50 bpm, 20cpm, and a temperature of 36.9.
B. Past Health History
 Allergies: No known medicines, food or environmental allergies
Past medical history: Hypertension
Past Surgical History: Below-knee amputation

III. GORDON’S HEALTH ASSESSMENT

A. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN

The patient does not resist any type of medication administered to her orally
parenterally.

Interpretation: NORMAL

B. COGNITIVE – PERCEPTUAL PATTERN

The patient is fully aware of where she is at. She can still open her eyes and look
around her surroundings including her physician and family members. For the
hearing, the client can hear the nurses when they introduced themselves and
explained the procedure of taking her vital signs. For the taste, the client is under
NGT. Lastly, for the client’s language, the client cannot speak in complete
sentences but she can verbalize words such as “ayaw” and “wag” as a refusion.

Interpretation: DEVIATION FROM NORMAL

Analysis: The patient is under a nasogastric tube as she is unable to eat or
swallow.

C. SELF-PERCEPTION – SELF- CONCEPT PATTERN

As examined, the patient shows nervousness as she gets scared and wary just by
taking her vital signs. She is always grouching when she thinks a healthcare
worker touch or hold her arms. Lastly, she can maintain eye contact when nurses
and doctors are talking to her.

Interpretation: DEVIATION FROM NORMAL

Analysis: It can be painful to receive medications or vaccines via needle, or to
have blood or other fluids are drawn via needle. Many people recall the
discomfort and pain and are concerned that it will happen again when they return
for needle-based medical procedures. This is a common action and could possibly
lead to phobia (Center for Disease Control and Prevention, 2022).

D. ROLE – RELATIONSHIP PATTERN

 The patient is widowed. However, her children supported him during her illness,
and always stayed by her side. They were taking care of her every day as they
took turns in the morning, afternoon, and night time.

Interpretation: NORMAL

Analysis: The client has a strong bond with her family and relationships, which is
great for the client’s well-being and is normal according to (Thomas, 2017).
E. SEXUALITY – REPRODUCTIVE PATTERN
The patient is not active in any sexual activities due to his age and health
condition.

Interpretation: Normal
Analysis: Due to the patient’s age and condition, she does not take a part in any
sexual activities.

F. COPING – STRESS TOLERANCE PATTERN

According to the patient’s guardian, the patient expresses her sudden stress
through crying, frowning, and squirming. When the patient is stressed, the
guardian is observing her progress and gives what the patient needs.

Interpretation: NORMAL
Analysis: According to (Mayo clinic, 2022), Stress management gives us a range
of tools to reset and recalibrate our alarm system. It can help our mind and body
adapt (resilience). Without it, our body might always be on high alert. Over time,
chronic stress can lead to serious health problems.

G. VALUE - BELIEF PATTERN

The patient’s religion is roman catholic. There is a cross necklace worn by the
patient as a bracelet.

Interpretation: NORMAL

H. NUTRITIONAL – METABOLIC PATTERN

The client gave consent for surgery on 14th of November, 12 P.M. The physician
in-charged then ordered for her to be NPO (Nothing per orem) prior to surgery
which halt all the oral intakes she was about to take.
 Interpretation: NORMAL
Analysis: NPO is the abbreviation term of nothing per orem. Patients are kept
NPO prior to a scheduled procedure to reduce the risk of emesis and pulmonary
aspiration of gastric contents while under general anaesthesia, both of which can
have serious consequences in terms of morbidity and mortality (Mann & Liebling,
2018).

I. ELIMINATION PATTERN
The patient is urinating well and the color of her urine from the urinalysis is
Yellow and its transparency is clear.
Interpretation: NORMAL

J. ACTIVITY – EXERCISE PATTERN

The patient’s right leg is amputated, while her left foot is infected and noted to be
gangrenous which made the patient be in bed during her whole hospital stay. She
is having a hard time moving around and sitting down straight.

Interpretation: DEVIATION FROM NORMAL

Analysis:

K. SLEEP – REST PATTERN

The patient sleeps a total of about 7 to 8 hours in the daytime and 8 hours at night.
But because she has medication to take, she must wake up every few hours to eat.

Interpretation: Normal
Analysis: According to (Cleveland clinic, 2022), Sleep is a catch-all that benefits
your physical, mental, and emotional health. Older adults have different sleep
patterns. They tend to sleep more lightly and may wake earlier in the morning.
V. PHYSICAL ASSESSMENT ( CEPHALOCAUDAL)

Assessing Appearance and Mental Status

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Observe signs of distress in No distress was There was distress
posture or facial expression. noted noted
Deviation from
Normal
The patient has acute
pain and has a pain
scale of 4/10.
Analysis: Acute pain
serves a protective
purpose by informing
and educating the
patient about the
presence of an injury
or illness. The
beginning of acute
pain without warning
encourages the patient
to seek help, aid, and
alleviation. It doesn't
last more than six
months. The
physiological
indications of acute
pain are the result of
the body's stress
response to pain.
Observe body build, height, Proportionate, The patient’s body
and weight in relation to the varies with builds, height, and
client’s age, lifestyle, and lifestyle. weight are not
Deviation from
health. proportionate in
Normal
relation to age and
lifestyle. The patient’s body
build is not consistent
anymore due to his
health condition.
Observe the client’s posture Relaxed with The patient has a
coordinated slightly curved
Normal
movements back.

Mental Status Good energy Shows signs of

Have the ability to stress and anxiety.
rest Deviation from
No anxiety Normal
The patient is having
a hard time coping
with her symptoms,
treatment, and side
effects.
Note obvious signs of health Healthy The patient is weak Deviation from normal
or illness. appearance and bedridden The patient is forced
to stay in bed to
control her illness.
Note the client’s Appropriate to the The patient is
affect/mood; assess the situation unable to respond. Deviation from
appropriateness of the Normal
client’s responses The client is having
NGT use for
decompression of the
stomach in the setting
of intestinal
obstruction or ileus.
SKIN

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Inspect Skin Color Varies from light to The patient’s skin is Deviation from
deep brown, from pale in the upper normal
ruddy pink to light pink extremities and the
skin in the left foot is
gangrenous.
Inspect uniformity of Varies from light to The patient’s skin is Normal
skin color deep brown, from pale in the upper
ruddy pink to light pink extremities and the
skin in the left foot is
gangrenous.
Assess Edema If No edema present No edema found Normal
Present

Inspect, palpate, and No abrasion or other lesion found on left Deviation from
describe skin lesions. lesion foot normal
Apply gloves if lesions
are open or draining
Observe and palpate Moisture in skin folds The patient's skin Deviation from
skin moisture and the axillae, affected folds are dry. normal
by different factors

Palpate skin Uniform within normal The patient’s skin is Deviation from
temperature range slightly cold. normal

Note skin turgor by When pinched, skin The patient’s Skin Deviation from
lifting and pinching the springs back to normal does not springs back normal
skin on an extremity state to normal state
HAIR

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Inspect the evenness of Evenly distributed hair The patient’s hair is Normal
growth over the scalp evenly distributed

Inspect hair thickness Thick hair The patient’s hair is Normal

or thinness brittle due to age
Inspect hair texture and Silky, resilient hair The patient’s hair is Normal
oiliness silky and resilient

Note presence of No infection or No infection or Normal

infection or infestation infestation infestation recorded
by parting the hair in
several areas and
checking behind the
ears and along the
hairline at the neck
Inspect the amount of Variable The amount of body Normal
body hair is variable

NAIL

AREA TO BE NORMAL ACTUAL FINDINGS INTERPRETATIO

ASSESSED FINDINGS N
Inspect Fingernail Convex curvature; The Patient’s nail shape
plate shape to angle between nail is convex curvature Normal
determine its curvature and nail bed usually
and angle 160 degrees
Inspect fingernail and Highly vascular and Slightly vascular and the
toenail bed color pink in light skinned; color is appropriate from Normal
dark skin may be the patient skin color
brown or black
Palpate Fingernail and Smooth texture The patient’s fingernail Normal
toenail texture is smooth
Inspect tissues Intact epidermis Has intact epidermis Normal
surrounding nails
Perform blanch test of Return to its original The patient’s nail color
capillary refill color, less than 4 return to its normal color Normal
seconds in less than 4 seconds

EYES

AREA TO BE NORMAL ACTUAL FINDINGS INTERPRETATI

ASSESSED FINDINGS ON
Inspect the eyelids and The upper lid margin The upper and lower lids
eyelashes should be between the close easily and meet
upper margin of the completely when closed.
pupil, the lower lid
margin rest on the The lower eyelid is
lower border of the upright with no inward
iris. No white sclera Is or outward turning. Eye
seen above or below lashes Normal
are evenly
iris. distributed and curve
outward along the lid
margins.

Observe redness, Skin on both eyelids is Skin on both eyelids is

swelling, discharge, or without redness, without redness, swelling Normal
lesions swelling or lesions. or lesions.
Observe the position Eyeballs are Eyeballs are
and alignment of the symmetrically aligned symmetrically aligned
eyeball in the eye without protruding or Normal
socket sinking

Inspect the bulbar Bulbar conjunctiva is Bulbar conjunctiva is

conjunctiva and sclera clear, moist, and clear, moist, and smooth
smooth underlying underlying structures are Normal
structures are clearly clearly visible. Sclera is
visible. Sclera is white white.
Inspect the palpebral Pinkish in color, shiny, Pinkish in color, free of
conjunctiva moist, and smooth, free swelling Normal
of swelling

NOSE

AREA TO BE NORMAL ACTUAL FINDINGS INTERPRETATI

ASSESSED FINDINGS ON
Inspect the size, shape, Symmetrical, normal The patient’s nose is
color, and lesion color and no lesion symmetrical, and no Normal
lesion found
If drainage, note White mucus and very White mucus
amount, color, and thin and watery Normal
consistency
Inspect if the nose is There is no bleeding The patient's nose is not Normal
bleeding from nose bleeding
Listen for any No abnormal sound No abnormal sound
abnormal sounds of heard Normal
breathing
MOUTH AND OROPHARYNX

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Inspect the Lips Lips are smooth and The patient's lips are Deviation from
moist without lesions dry. normal
or swelling The patient has
chapped lips that are
the result of dry,
cracked skin on our
lips due to cold or dry
weather, sun exposure,
frequently licking our
lips or dehydration. We
can treat chapped lips
at home with the use of
lip balm or ointment to
ease any discomfort.
Inspect teeth and No decayed areas, no The patient has
gums missing teeth missing teeth
Deviation from
normal
The patient's body is
getting older and her
body is not getting as
strong as it used to
be.
Inspect the buccal Tissue is smooth and Tissue is smooth and
mucosa moist without lesions moist without lesions
Normal
Inspect and palpate Tongue should be The patient's tongue
the tongue pink. Moist moderate is pink, and it is
size with papillae moist, moderate size Normal
with papillae
Inspect the tonsils Tonsils may be present Tonsil is present and
or absent, they are symmetric
pink and symmetric, Normal
and may be enlarged
to 1+ in healthy
patients. No exudate,
swelling or lesions
Inspect the posterior Throat is pink, without Throat is pink
pharyngeal wall exudate or lesions Normal

NECK

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Inspect the Neck Normal Mobility Limited mobility Deviation from
normal

Palpate the lymph No swelling, no No swelling, no Normal

nodes enlargement, and no enlargement, and no
tenderness when tenderness recorded
palpated

CHEST AND LUNGS

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Auscultate for breath Bronchial, Clear Breath sounds Normal
sounds bronchovesicular,
and vesicular
Observe for use of Use of accessory Patient uses accessory Deviation from
accessory muscle muscle is not seen muscles to breathe normal
with effort, after
strenuous exercise
the client with
normal respiratory
status may still use
neck muscle for a
short time breathing

HEART AND NECK VESSELS

AREA TO BE NORMAL ACTUAL INTERPRETATIO

ASSESSED FINDINGS FINDINGS N

Auscultate heart rate and 60 – 100, and normal 101 bpm, has a regular Normal
rhythm rhythm rhythm
During third trimester
pregnancy, according
to NallN, R. (2017)
the heart rate increases
an average of 10 to 20
beats per minute.
Auscultate to identify S1 S1 corresponds with Distinct S1 and S2 Normal
and S2 each carotid
pulsation and is
loudest at the apex of
the heart. S2
immediately follows
after S1 and is
loudest at the base of
the heart
Auscultate for murmurs No murmurs are No murmurs are heard Normal
heard
ABDOMEN

AREA TO BE NORMAL ACTUAL INTERPRETATION

ASSESSED FINDINGS FINDINGS
Observe the coloration Paler than the usual The Patient’s skin is
of the skin skin lighter compared to Normal
rest of her body

Inspect for scars Pale, smooth and no No scars

scars Normal
Assess for lesion or Abdomen is free of No lesion or rashes
rashes lesion or rashes found Normal
Inspect abdominal Abdominal Minimal movement
movement when client respiratory may be Normal
is breathing seen
Assess for abdominal No abdominal pain The patient has a Deviation from
pain mild abdominal pain normal

Analysis:
The patient feels mild
stomach pain. It is
typically mild and
temporary. Once you
become pregnant,
your uterus will
begin to grow. As it
does this, you'll
likely feel mild to
moderate cramping
in your lower
abdomen or lower
back. According to
Colleen B. (2020)
this may feel like
 pressure, stretching,
or pulling.
Sometimes, however,
abdominal pain or
cramping during
pregnancy can be a
sign of a condition
that requires medical
attention, like a
urinary tract
infection,
miscarriage, preterm
labor or
preeclampsia.
Palpate the liver Usually not palpable, N/A
but it may be felt in Normal
some thin clients
Perform Blunt No tenderness No tenderness noted
percussion on the liver Normal
and kidneys

MUSCLE, BONES, AND JOINTS

AREA TO BE NORMAL ACTUAL INTERPRETATIO

ASSESSED FINDINGS FINDINGS N
Inspect the muscles for Equal Size The Patient’s muscle is DEVIATION FROM
size not equal in size NORMAL

The patient muscle is

not in equal size.
Amputation leads to
muscle atrophy in a
tight stump resulting
in asymmetry in
muscle torque
between the
 amputated and intact
limb according to
Rutkowska-Kuchars
ka et.al.,(2018).
Inspect the muscles No contractures Contractures had seen DEVIATION FROM
and tendons for NORMAL
contractures
The amputation
contractures happen
when the soft tissue
closest to the point of
amputation is
shortened, tightening
and contracting.
(Arnold & Itkin,
2022.)
Inspect the muscle for No tremors The patient’s muscle has
tremors tremors Deviation from
Normal
Palpate muscle at rest Normally firm The patient’s muscle at
to determine muscle rest is normally firm but Deviation from
tonicity weak in tonicity normal
Palpate muscles while Smooth coordinated The patient’s muscle has
the client is active and movements, and no no pain when moving
passive for flaccidity, pain
spasticity, and Normal
smoothness of
movement.
Test muscle strength of Equal strength on The patient’s strength is Deviation from
the head and the each body side not equal on each body normal
shoulders side
Transtibial amputees
are prone to bone
mineral loss and
muscle strength
 decreases on the
amputated side.
(Tungcu, 2009.)

Test muscle strength of [CL1] Equal strength The patient’s strength is

upper extremities on each body side equal on each body side Normal
Test muscle of lower Equal strength on The patient’s strength is Deviation from
extremities each body side not equal on each body normal
side
Transtibial amputees
are prone to bone
mineral loss and
muscle strength
decreases on the
amputated side.
(Tungcu, 2009.)
Inspect the skeleton for No deformities The patient has
normal structure and presented an amputated
deformities leg from knee down to Deviation from
foot.
normal
Palpate the bones to No tenderness or The patient’s bone has
locate any areas or swelling no tenderness or
Deviation from
edema and tenderness swelling but there is a
normal
numbness in the left
foot
Inspect the joint for No swelling No swelling noted
swelling
Normal
Palpate each joint for Smooth, non-tender, The patient’s joint is
tenderness, smoothness no swelling, Smooth, non-tender, no
of movement, swelling, crepitation, and swelling, crepitation,
crepitation, and presence of nodules and presence of Normal
presence of nodules nodules
 Vital Signs

Body Temperature 36.9

Pulse Rate 50 bpm

Respiratory Rate 20 cpm

Blood Pressure 130/70 mmHg

IV. LABORATORY/DIAGNOSTIC EXAMINATIONS

Date Laboratory/Diagnostic Normal Actual Results Clinical Interpretation &

Done Examination Values Analysis (with reference)

Nov 14 Clinical chemistry

result

Creatinine 53-88 277.10 Interpretation: Deviation from

Normal

Analysis: An article presented by

Cleveland Clinic (2020) states
that creatine helps to maintain a
continuous supply of energy to
working muscles by keep
production up in working
muscles. However, abnormal
levels of creatinine in your urine
and blood could point to an issue
like kidney disease.

Sodium 136-145 135 Interpretation: Deviation from

Normal
 Analysis: Sodium is an electrolyte
that balances the amount of fluid
in the body, helps muscles and
nerves work, and regulates blood
pressure. Moreover, the term for
low sodium levels in the blood is
hyponatremia. And there are
many different causes, such as
changes in kidney function, blood
pressure medicines, or conditions
like heart or liver failure. The
seriousness of hyponatremia
depends on how low sodium
levels are and how quickly they
change. This condition can range
from very mild to severe
(Studyvin, 2022).

Potassium 3.5-5.1 3.37 Interpretation: Deviation from

Normal

Analysis: According to Mayo

Clinic (2022). Potassium helps
carry electrical signals to cells in
your body. It is critical to the
proper functioning of nerve and
muscle cells, particularly heart
muscle cells. Low potassium
(hypokalemia) refers to a lower
than normal potassium level in
your bloodstream. Normally,
your blood potassium level is 3.6
to 5.2 millimoles per liter
(mmol/L). A very low potassium
level (less than 2.5 mmol/L) can
be life-threatening and requires
urgent medical attention.

Calcium 2.12-2.58 1.70 Interpretation: Deviation from

Normal
 Analysis: Calcium is one of the
body's electrolytes, which are
minerals that carry an electric
charge when dissolved in body
fluids such as blood (but most of
the body's calcium is uncharged).
Although most of the body's
calcium is stored in bones, some
circulates in the blood. A low
calcium level may result from a
problem with the parathyroid
glands, as well as from diet,
kidney disorders, or certain
drugs. As hypocalcemia
progresses, muscle cramps are
common, and people may become
confused, depressed, and
forgetful and have tingling in
their lips, fingers, and feet as well
as stiff, achy muscles (Lewis,
2021).

Nov 11 Hematology result

Hemoglobin 120-160 115 g/L Interpretation: Deviation from

Normal

Analysis: Hemoglobin is a
protein in your red blood cells.
Your red blood cells carry oxygen
throughout your body. Oxygen
powers your cells and gives you
energy. A low hemoglobin level
may be a sign of several
conditions, including different
kinds of anemia and cancer.
 Moreover, if a disease or
condition affects your body’s
ability to produce red blood cells,
your hemoglobin levels may
drop. When your hemoglobin
level is low, it means your body
isn’t getting enough oxygen,
making you feel very tired and
weak (Mayo Clinic, 2022).

Hematocrit 0.37-0.47 0.35 L/L Interpretation: Deviation from

Normal

Analysis: According to Cleveland

Clinic (2022). A hematocrit
testing is a blood test that
measures the amount of red
blood cells in the body. Red blood
cells, white blood cells, and
platelets make up your blood.
High or to low hematocrit levels
can suggest blood disease,
anemia, or other medical issues.

RDW 11.0-16.0 28.4% Interpretation: Deviation from

Normal

Analysis: The red cell

distribution width (RDW) blood
test measures the amount of red
blood cell variation in volume
and size. If your RDW is too
high, it could be an indication of
a nutrient deficiency, such as a
deficiency of iron, folate, or
vitamin B-12. These results could
also indicate macrocytic anemia,
when your body doesn't produce
enough normal red blood cells,
and the cells it does produce are
larger than normal (Anthony,
 2019).

Leukocyte 4.00-10.00 27.54 Interpretation: Deviation from

Normal

Analysis: Leukocytes are part of

the body's immune system. They
help the body fight infection and
other diseases. However,
leukocytosis means you have a
high white blood cell count. This
means you have more white
blood cells than normal.
Leukocytosis is a normal immune
response and isn’t always a cause
for concern. Most of the time, it
means that your body is fighting
off infection or inflammation.
Moreover, there are times when a
high white blood cell count could
indicate something more serious,
such as leukemia (Cleveland
Clinic, 2022).

Neutrophils 0.35-0.65 0.79 Interpretation: Deviation from

Normal
 Analysis: Neutrophils are a type
of white blood cell. They are
essential to the functioning of the
immune system, which sees off
pathogens such as bacteria and
viruses. In fact, most of the white
blood cells that lead the immune
system’s response are
neutrophils. However, If your
neutrophil counts are high, it can
mean you have an infection or
are under a lot of stress. It can
also be a symptom of more
serious conditions (Morris, 2018).

Lymphocytes 0.2-0.4 0.14 Interpretation: Deviation from

Normal

Analysis: Lymphocytes are white

blood cells and one of the body’s
main types of immune cells. They
are made in the bone marrow
and found in the blood and
lymph tissue, these cells work
together to defend the body
against foreign substances, such
as bacteria, viruses, and cancer
cells that can threaten its
functioning. If you have low
numbers of lymphocytes
(lymphopenia), you are at higher
risk of infection. The main risk
factor for lymphopenia
worldwide is poor nutrition.
Infections, diseases, medicines,
and other factors also raise your
risk for lymphopenia (Silva,
2021).
 V. DRUG STUDY -Alex

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Reduces Primary Hypersensitivity to Headache, Potential ·Obtain

Name: plasma prevention atorvastatin. Active myalgia, for cholesterol,
Atorvastatin cholesterol of hepatic disease, rash, cataracts, triglycerides,
and cardiovascul breast-feeding, pruritus, photosensit LFT
Brand Name: lipoprotein ar disease in pregnancy or allergy, ivity,
Lipitor women who may flatulence, myalgia, · Obtain dietary
levels by high-risk
become pregnant, dyspepsia, rhabdomyo history
inhibiting patients. unexplained depression lysis
Route: PO HMG-CoA elevated LFT
reductase and ·Monitor for
Dosage: results.
cholesterol headache
20mg/tab Reduces risk
synthesis in
ODHS of stroke · Assess for
the liver and
by increasing and heart rash, pruritus,
the number of attack malaise
LDL receptors patients with
type 2 · Educate the
on liver cells
diabetes patient to
to enhance
with or report any dark
LDL uptake
without urine, muscle
and
evidence of fatigue, bone
breakdown.
heart disease pain
with
multiple risk
factors.

Pharmacothe
rapeutic:
Hydroxymethy
 lglutaryl CoA
(HMG-CoA)
reductase
inhibitor

Clinical:
Antihyperlipid
emic

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Reduces To prevent Bronchial asthma Frequent: Hypoglyce · Assess B/P,

Name: cardiac output hypertension or related fatigue, mia may apical pulse
Carvedilol and bronchospastic dizziness occur in before drug is
tachycardia, conditions; patients administered
Brand Name: cardiogenic shock; Occasional with
causes
Treatment of decompensated : diarrhea, previously
Coreg vasodilation, · Receive full
angina heart failure that bradycardia, controlled
and decreases rhinitis,
medication
Route: PO pectoris, requires I.V. diabetes.
peripheral back pain history and
inotropes; history
vascular idiopathic screen for
Dosage: 6-25 of serious
resistance, cardiomyop hypersensitivity Rare: interactions
mg/tab OD athy orthostatic,
which reduces reactions, such as
blood pressure anaphylaxis, hypotension · Monitor B/P
and cardiac angioedema, or , for
workload. Stevens–Johnson drowsiness, hypotension,
syndrome; UTI, viral respirations for
When given
hypersensitivity to infection dyspnea
for at least 4
carvedilol or its
weeks,
components; · Monitor ECG
carvedilol second- or third-
reduces for cardiac
degree AV block, arrhythmias
plasma renin severe bradycardia,
activity. or sick sinus · Assess for
syndrome unless
Pharmacothe evidence of HF
pacemaker is in
rapeutic: Beta place; severe
adrenergic hepatic impairment
 blocker

Clinical:
Antihypertensive

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Inhibits Managemen Contraindicated in Frequent: Overdose ·Assess

Name: calcium t of patients peripheral may baseline,
Amlodipine movement hypertension hypersensitive to edema, produce renal/hepatic
across cardiac , coronary drugs. Use headache, excessive function tests,
Brand Name: cautiously in flushing peripheral
and vascular artery B/P, apical
Norvasc and patients receiving vasodilatio
smooth muscle disease Occasional: pulse
Katerzia other peripheral n, marked
cell (chronic vasodilators, dizziness, hypotensio
membranes stable palpitations, ·Assess skin
especially those n with
Route: PO during angine, nausea, for flushing
with severe aortic reflex
depolarization. vasospastic) stenosis or unusual tachycardia
Dosage: 10mg fatigue or ·Question for
hypertrophic , syncope
tab OD Pharmacothe weakness headache and
cardiomyopathy
rapeutic: with outflow tract asthenia
Calcium obstruction, and in Rare: chest
channel patients with HF pain,
blocker with reduced bradycardia,
LVEF. Because the orthostatic
drug is metabolised hypotension
Clinical
by the liver, use
 Antihypertensi cautiously and in
ve, antianginal reduced dosage in
patients with severe
hepatic disease.

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Stimulates Treatment of Contraindicated in Frequent: CNS: ·Monitor bowel

Name: motility of nausea and patients drowsiness, anxiety, sounds.
Metoclopram upper GI tract, vomiting hypersensitive to restlessness, drowsiness,
ide increases drugs and in those fatigue, dystonic ·Safety and
with lethargy reactions, effectiveness of
lower
Brand Name: pheochromocytoma fatigue, drug haven't
esophageal Occasional: lassitude,
Norvasc and or other been
sphincter tone, catecholamine-rele dizziness, restlessness
Katerzia and blocks anxiety, , seizures, established for
asing
dopamine paragangliomas, headache, suicidal therapy lasting
Route: PO receptors at tardive dyskinesia, insomnia, ideation, longer than 12
the or seizure breast akathisia, weeks.
Dosage: 10mg chemoreceptor disorders. • tenderness, confusion,
tab OD Contraindicated in altered depression, ·Drug may
trigger zone.
patients for whom menstruatio dizziness, cause tardive
Pharmacothe stimulation of GI n, extrapyram dyskinesia,
rapeutic: motility might be constipation idal parkinsonian
dangerous (those , rash, dry symptoms, symptoms, and
Dopamine,
with hemorrhage, mouth, fever, motor
serotonin falactorrhea
obstruction, or restlessness.
receptor , hallucinati
perforation)
antagonist gynecomast ons,
·Monitor
ia headache,
Clinical: GI insomnia, patient for
agent, Rare: tardive involuntary
antiemetic hypotension dyskinesia. movements of
, CV: face, tongue,
hypertensio bradycardi and
n, a, extremities,
tachycardia supraventri which may
cular indicate tardive
tachycardia dyskinesia or
, other
hypotensio
extrapyramidal
n, transient
HTN, HF. adverse effects.
GI: bowel
·Monitor
 disorders, patient for
diarrhea, fever, CNS
nausea. symptoms,
GU: irregular pulse,
incontinenc
cardiac
e, urinary
frequency,
arrhythmias, or
erectile abnormal BP,
dysfunctio which may
n. indicate NMS.
Hematolog
ic: ·Monitor
agranulocy patient for
tosis, dizziness,
neutropeni headache, or
a. Skin: nervousness
rash, after
urticaria. metoclopramid
Other: loss
e is stopped;
of libido,
prolactin these may
secretion, indicate
gynecomas withdrawal.
tia,
amenorrhe ·Diphenhydrami
a. ne or
benztropine may
be used to
counteract
extrapyramidal
adverse effects
from high doses.

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Pharmacothe Managemen Hypersensitivity to Frequent: Excessive ·Assess for

Name: rapeutic: t of sodium abdominal use may symptoms of
Sodium Alkalinizing metabolic bicarbonate. distention, produce acidosis,
Bicarbonate agent acidosis Hypernatremia, flatulence, metabolic alkalosis
alkalosis, unknown belching alkalosis,
(NaHCO3)
Clinical: abdominal painm, paresthesia, ·Note to not
Brand Name: Antacid, hypocalcemia, cyanosis, give PO
severe pulmonary slow or
electrolyte medication
edema shallow
Alka Seltzer supplement, respirations within 1 hr of
urinary.system , headache, antacids
Route: PO ic alkalinizer thirst.

Dosage: 650
mg TID EBS

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Acts as the Prevention Acute dehydration, Occasional: Hyperkale · Assess for
Name: major cation in of Addison’s disease nausea, mia (more weakness,
Potassium intracellular hypokalemia (untreated), vomiting, common in fatigue,
Chloride fluid, when concurrent use with diarrhea, elderly, polyuria,
amiloride or flatulence, paresthesia,
activating necessary to polydipsia
Brand Name: triamterene abdominal motor
many avoid discomfort
Celebrex (potassium weakness, ·PO should be
enzymatic chloride or chloride), or with cold skin,
reactions acid/base distention given with
potassium-sparing hypotensio
Route: PO essential for imbalance food or after
diuretics (all forms n,
physiologic of potassium), Rare: rash confusion, meals with full
Dosage: processes, To prevent glass of water
crush syndrome, irritability,
600g/tab TID or treat to minimize GI
including disorders that may paralysis,
nerve impulse hypokalemia delay drug passing cardiac irritation
transmission in patients through GI tract arrhythmia,
and cardiac who can’t (potassium citrate), ventricular · Monitor
and skeletal ingest heat cramps, fibrillation, serum
sufficient hyperkalemia, cardiac potassium,
muscle
dietary hypersensitivity to arrest calcium,
contraction. potassium salts or
Potassium also potassium or phosphate
their components,
helps maintain who are peptic ulcer disease
electroneutralit losing ·Monitor for
(potassium citrate),
y in cells by potassium decreased
renal impairment
controlling because of a with azotemia or urinary output
exchange of condition oliguria, severe
(such as hemolytic anemia, ·Be attentive
intracellular
hepatic UTI (potassium with presence
and
cirrhosis or citrate) or evidence of
extracellular
prolonged hyperkalemia
ions. It also
vomiting) or such as skin
helps maintain
drug (such pallor,
normal renal
as coldness,
function and
paresthesia,
 acid–base potassium-w feeling of
balance. asting heaviness of
diuretics or lower
Classification: certain extremities)
antibiotics)
Pharmacothe ·Assess for
rapeutic: signs of
Electrolyte hypokalemia
such as
Clinical: arrhythmias,
Potassium fatigue and
replenisher, weakness
electrolyte
replacement

Name of Mechanism of Indication Contraindicatio Side Adverse Nursing

Drug Action n Effects Effects Responsibility

Generic Classification: A Known Common ·Stomach ·Assess

Name: Essential combination hypersensitivity to side effect: Cramp patients for
Vitamin B water soluble of B any of the ·Rashes signs of
vitamins vitamins is components is a ·Mild upset ·Itching vitamin
Brand Name: except for contained in contraindication for stomach or ·Dizziness deficiency
its use flushing
vitamin C. this product, ·Trouble in before and
Route: PO ·serious breathing
which is periodically
allergic
intended to ·Vomiting during therapy.
Dosage: 1 tab reaction
cure or ·High
OD ·Rash,
prevent blood sugar ·Assess
·Itching/sw levels
vitamin elling
nutritional
deficiencies (especially status through
brought on of the 24-hr diet
by a poor face/tongue/ recall.
diet, specific throat)
diseases, ·Severe ·Determine
alcoholism, dizziness frequency of
or while ·Trouble consumption of
pregnant. breathing vitamin-rich
Vitamins are foods
crucial for
·Therapy is
maintaining limited to
your health periods of high
because they physiologic
serve as the stress when a
body's patient is not
building able to ingest
blocks. adequate
vitamins orally.

·Monitor
patient for
anaphylaxis
(wheezing,
urticaria,
edema);
contains
thiamine.
VI. NURSING CARE PLAN

Cues Nursing Diagnosis Analysis Objectives Rationale Evaluation

Impaired skin Situational Objective ● Monitor and ● hypovolemi

Objective integrity rt analysis: document a can be
● Amputated hyperglycemia and The client was After two to six vital signs manifested
right leg neuropathy as clipping her nails hours of surgery, and by
● Gangrenous evidenced by and accidentally the patient will symptoms tachycardia
left foot gangrene and wounded her nail in recover from and
● Dry skin in numbness in the left the left foot. The sedation and free hypotension
lower foot wound progressed from gangrene in
extremities with discoloration the left foot. ● Monitor ● Check if the
● Discoloration and pus present that wound wound is
of skin also lead to appearance. able to heal.
surrounding gangrenous and
the wounded numbness.
left foot Moreover, a history ● Monitor ● An indicator
● of Diabetic Mellitus blood of the level
was also present glucose of
which hindered the levels dehydration
healing of the
wound.
● Assess skin ● To assess
Scientific turgor and the amount
Analysis: oral mucous lost in the
The nursing membranes body.
diagnosis is
Impaired skin ● Note the
integrity rt presence of ● To identify
hyperglycemia nausea, medications
and neuropathy as vomiting, that can
evidenced by and fever. alter fluid
gangrene and and
numbness in the electrolyte
left foot. Foot balance.
problems are
common in ● Review
people with client’s ● Provide the
diabetes (Medline medications, estimated
Plus, n.d.). including need for
Diabetes inhibits prescription fluid
the body's natural and OTC replacement
wound-healing drugs. .
capabilities,
which means ● Monitor
chronic wounds serum
can quickly electrolytes
become severe and report ● Accurate
and develop abnormal records are
infections if left values critical in
untreated. Having assessing
an infection and the patient's
poor blood flow ● Administe fluid.
can lead to r IVF as
gangrene which ordered by
means the death the doctor. ● Dehydrated
of the muscle, patients may
skin, and tissue. be weak and
unable to
meet
Reference: U.S. prescribed
National Library intake
of Medicine. independent
(n.d.). Diabetic ly.
foot. MedlinePlus.
Retrieved ● To promote
● Ensure
November 15, hydration.
accurate
2022, from
intake and
https://medlineplu
output
s.gov/diabeticfoot
monitorin
.html
g.
● Aid the
patient if
they
cannot eat
without
assistance,
and
encourage
the family.
● Encourage
increased
fluid
intake and
eat high
fluid
content
food.

● Assess the
wound
and its ● To check the
dressing severity of
the wound
 and necrosis

● To maintain
cleanliness
of the
wound and
free from
infection

● Provide
health
education ● To avoid
to the antibiotic
guardian resistance
that from
antibiotic bacteria.
medicatio
ns should
be taken
as
prescribed
even after
the wound
is healed
hg

References

Benefits of Exercise. (2020, May 8). https://medlineplus.gov/benefitsofexercise.html

Bigleyj. (2022, July 5). Sleep: How much you need and its 4 stages. Cleveland Clinic. Retrieved from
https://health.clevelandclinic.org/your-complete-guide-to-sleep/

Centers for Disease Control and Prevention. (2022, April 11). Needle fears and phobia – find ways to manage. Centers for
Disease Control and Prevention. Retrieved November 15, 2022, from
https://www.cdc.gov/childrensmentalhealth/features/needle-fears-and-phobia.html Mann, G., & Liebling, D. (2018). NPO
Guidelines. Anesthesiology: A Problem-Based Learning Approach, 407–414.
https://doi.org/10.1093/med/9780190850692.003.0046

Mayo Foundation for Medical Education and Research. (2022, April 8). Stress management stress basics. Mayo Clinic.
Retrieved from https://www.mayoclinic.org/healthy-lifestyle/stress-management/basics/stress-basics/hlv-20049495