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Name Age Sex IP number Education Occupation Marital status Religion Informants Date of admission


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Stable process of ventilation and stable process of gas exchange. RR= 18Bpm. Chest normal in shape. Chest expansion normal on either side. Apex beat felt on left 5th inter-costal space mid-clavicular line. Air entry equal bilaterally. No ronchi or crepitus. NVBS. S1& S2 heard. No abnormal heart sounds. Delayed capillary refill+. JVP0. Apex beat felt- normal rhythm, depth and rate. Dorsalis pedis pulsation of affected limp is not palpable. All other pulsations are normal in rate, depth, tension with regular rhythm. Cardiac dull ness heard over 3rd ICS near to sternum to left 5ht ICS mid clavicular line. S1& S2 heard. No abnormal heart sounds. BP- Normotensive. . Peripheral pulses felt-Normal rate and rhythm, no clubbing or cyanosis.

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He is on diabetic diet (1500kcal). Non vegetarian. Recently his Weight reduced markedly (10 kg/ 6 month). He has stable digestive process.

      He has complaints of anorexia and not taking adequate food. Stool is hard and he complaints of constipation. Oral mucosa is normal. No regular pattern of exercise. Activity and rest:            Taking adequate rest. No redness. Now. Pain from joints present. Percussion revealed dullness over hepatic area. Bowel sounds heard. No visible peristaltic movements. Soft on palpation. Not following any peculiar relaxation measure. Using crutches. discharge or other signs of infection. Using urinal for micturation. No contractures present. No paralysis. Sleep pattern disturbed at night due unfamiliar surrounding. Protection:         Left lower fore foot is amputated. Pain form knee and hip joint present while walking. ROM is limited in the left leg due to wound. Mobility impaired. Normal bladder pattern. No swelling over the joints. Walking with the use of left leg is not possible. . activity reduced due to amputated wound. no pain during micturation or defecation. Patient need assistance for doing the activities. Walking from home to office during morning and evening. Nomothermic. No abdominal distension. Wound healing better now. Walking with crutches. No tenderness. Like movies and reading. No difficulty to swallow food Elimination:    No signs of infections. Black discoloration present over the area.

He is anxious about the disease condition. SELF CONCEPT MODE Physical self:   He is anxious about changes in body image. Like to go home as early as possible. All peripheral pulses are present with normal rate. rhythm and depth over right leg. 5 members. Touch and pain sensation decreased in lower extremity.  No pain sensation from the wound site. and auditory senses are normal. He deprived of sexual activity after amputation. No signs of acidosis or alkalosis. Stable intake out put ratio. Relatively. Neurological function:      He is conscious and oriented. Thinking and memory is intact. Fluids and electrolytes:  Drinks approximately 2000ml of water. but accepting treatment and coping with the situation. Good interaction with the friends. Right leg is normal in length and size. Endocrine function  He is on insulin. Good relationship with the neighbours. reduced touch and pain sensation in the lower periphery. Blood glucose elevated. Using spectacle for reading. not present over the left leg. except elevated blood sugar value. Showing signs of stress. Serum electrolyte values are with in normal limit. No signs and symptoms of endocrine disorders. Moderately active in local social activities Personal self: . because of neuropathy. Belongs to a Nuclear family. Gustatory. Several papules present over the foot. olfaction. Stays along with wife and three children. No enlarged glands.   Senses: Dorsalis pedis pulsation.

He says ”all are under financial constrains”. From there. Good interaction with the friends relatives. Previously. RESIDUAL STIMULI:  He had TB attack 10 year back. and took complete course of treatment. no one is capable of helping him at this moment. he admitted in ---Hospital for leg pain about 4 year back. The wound was non-healing and gradually increased in size with pus collected over the area. During hospital stay great and second toe amputated. His role clarity is not achieved. He underwent a plastic surgery 3 week before. His role shift is not compensated. CONTEXTUAL STIMULI:  Known case DM for past 10 years. . ---.medical college. Was on oral hypoglycemic agent for initial 2 years. where he was admitted for 1 month and 4 days. Not wearing foot wear in house and premises. He believes in god and worshiping Hindu culture. but switched to insulin and using it for 8 years now. Mother had history of PTB.4 week. He is a graduate in humanities. But surgical wound turned to non. His son doesn't’t have any work. INTERDEPENDENCE MODE:  He has good relationship with the neighbors. That made them to come to ---Hospital. So the physician suggested for below knee amputation. ROLE PERFORMANCE MODE:  He was the earning member in the family. He was moderately active in local social activities SECOND LEVEL ASSESSMENT FOCAL STIMULUS  Non-healing wound after amputation of great and second toe of left leg. Self esteem disturbed because of financial burden and hospitalization. But he believes. A wound first found on the junction between first and second toe-4 month back.  He first consulted in a local (---) hospital. Mother’s brother had DM. they referred to ---.healing with pus and black colour. no special knowledge on health matters .