Scribd Logo
Upload

Welcome to Scribd!

  • Ulcer Diabetic Left Foot

    Uploaded by

    Musdah Mulya
    2 views9 pages
    The patient presented with a 10 day history of an unknown wound on their left foot. They have a history of diabetes for 9 years which they control with metformin and glibenclamide. Physical examination found the patient to be obese with normal vital signs except for a pulse of 100 and respiratory rate of 22. Examination of the left foot found an ulcer with swelling, hyperemia and pus. Laboratory tests found elevated blood glucose, white blood cells and decreased hemoglobin. X-ray of the left foot was also done. The diagnosis was left foot Wagner stage IV diabetic ulcer with differentials of cellulitis and osteomyelitis. The management plan included rest, wound care, diabetes education, IV fluids, antibiotic

    Original Description:

    KIYIKI

    Original Title

    Ulcer Diabetic Left Foot,

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The patient presented with a 10 day history of an unknown wound on their left foot. They have a history of diabetes for 9 years which they control with metformin and glibenclamide. Physical examination found the patient to be obese with normal vital signs except for a pulse of 100 and respiratory rate of 22. Examination of the left foot found an ulcer with swelling, hyperemia and pus. Laboratory tests found elevated blood glucose, white blood cells and decreased hemoglobin. X-ray of the left foot was also done. The diagnosis was left foot Wagner stage IV diabetic ulcer with differentials of cellulitis and osteomyelitis. The management plan included rest, wound care, diabetes education, IV fluids, antibiotic

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2 views9 pages

    Ulcer Diabetic Left Foot

    Uploaded by

    Musdah Mulya
    The patient presented with a 10 day history of an unknown wound on their left foot. They have a history of diabetes for 9 years which they control with metformin and glibenclamide. Physical examination found the patient to be obese with normal vital signs except for a pulse of 100 and respiratory rate of 22. Examination of the left foot found an ulcer with swelling, hyperemia and pus. Laboratory tests found elevated blood glucose, white blood cells and decreased hemoglobin. X-ray of the left foot was also done. The diagnosis was left foot Wagner stage IV diabetic ulcer with differentials of cellulitis and osteomyelitis. The management plan included rest, wound care, diabetes education, IV fluids, antibiotic

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 9

    HISTORY TAKING

     Chief complain : wound at the left foot


     Anamnesis : Patient came with chief complain wound at the left foot since 10
    days ago. The wound occurred without patient knowledge.
    .
    There was history of same previous complaint (-)
    There was history of other disease : Diabetes Mellitus (+) since 9 years ago
    There was history of previous medication (+) : Metformin and Glibenclamidd
    There was hisrtory of family same complaint (-) None
    There was no history of fever
    There was no history of weght
    There was no history of trauma
    Physical examination

    The patient was composmentis, moderate illness,


    obesity
    BP = 130/80 mmHg
    Pulse = 100x/m, , regular, strong
    RR = 22x/m, spontaneus, symmetric,
    regular, thoracoabdominal type
    Temperature = 37,2 celcius degree/axillary
    Generalized status

    Head : Normally
    Face : Normally
    Eyes : Normally
    Nose : Normally
    Mouth : Normally
    Ears : Normally
    Neck : Normally
    Chest : Normally
    Extremity Superior : Normally
    Extremity Inferior : Localized

    .
    LOCALIZED STATE

    PEDIS REGION SINISTRA


    Inspection : Ulcer (+), Swelling (+), Hiperemis (+), Pus (+)
    Palpation : Tenderness (-)
    ROM Ankle : Active and passive within normal limit
    NVD :, Decreassed sensibility, CRT difficult to evaluate,
    Plan of Diagnostic

     Routine blood (Leukosit, Hb, Trombosit)


     Blood Chemistry (GDS,Ureum,Creatini)
     X ray pedis Sinistra Ap/Obliq
    Laboratory finding
     WBC : 16.99 1 10^3/uL
     HB : 9.2 g/dl
     PLT : 515 10^6/uL

     GDS : 348 mg/dl


     Ureum : 23 mg/dl
     Creatinin : 0.8 mg/dl
    Diagnosis
    Ulcus Diabetic Foot Sinistra Wagner IV

    DD:
    Celulitis
    Osteomielitis
    Peripheral Artery Desease
    MANAGEMENT
    Non Farmakologi Farmakologi
    - Rest -IVFD
    - Wound care -Antibiotic Injection
    - Education (Life
    Style Modification)

    CONSULT ORTHOPEDIC SURGERY


    and INTERNIST
    Thank You

    BAGIAN ILMU
    BEDAH

    You might also like