A CASE STUDY ABOUT

DIABETIC FOOT (at the

LEFT foot) 3RD AND 4TH
DIGIT

TEAM A GROUP 1 BLOCK A

 T R O D U C T I O N
IN
Type 2 diabetes mellitus (T2DM) is an expanding global health problem, closely linked
to the epidemic of obesity. As a result of this trend, it is fast becoming an epidemic in some
countries of the world with the number of people affected expected to double in the next
decade due to increase in ageing population, thereby adding to the already existing burden
for healthcare providers, especially in poorly developed countries. According to the statistics
record of the Department of health the death due to diabetes mellitus ranked fourth in the
year 2020. In general, the pandemic lockdown have effects on the lifestyle that could affect
the health of every individual contributed to develop such diabetes mellitus, obesity, poor
diet and cessation of activities due to the restrictions have done along the pandemic
lockdowns. According to Harvard Health
 T R O D U C T I O N
IN
Publishing, it is defined as a chronic disease. Manifestations are having a high level of
sugar in the blood. It is an adult onset type of diabetes because the occurrence is between
middle and late adulthood. Type 2 diabetes is more common than having Type 1 diabetes but
they are the same in high blood sugar.
It usually occurs when the body's cell resist the normal effect of insulin, which is the
main regulator of blood sugar in the body. The common sign and symptoms of diabetes
mellitus includes increased thirst frequent urination, increased hunger, unintended weight
loss, fatigue, blurred vision, slow-healing sores and frequent infections.
 T R O D U C T I O N
IN
According to Institute for Quality and Efficiency in Health Care, the severity of the
disease can vary quite a bit. It is a case to case basis because some patients who have this
kind of disease can control while others lead to other complications.
People living with type 2 DM are more vulnerable to various forms of both short- and
long-term complications, which often lead to their premature death. This tendency of
increased morbidity and mortality is seen in patients with type 2 DM because of the
commonness of this type of DM.
BIOG R A P H I C
D ATA
NAME: Patient DS
ADDRESS: Siay, San Miguel, Catanduanes
GENDER: Male BIRTHDATE: March 06, 1971
CIVIL STATUS: Married RELIGION: Roman Catholic
OCCUPATION: Farmer and Butcher
EDUCATIONAL BACKGROUND: High School Graduate
ADMITTING PHYSICIAN: Dr. Louie S. Panti
ATTENDING PHYSICIAN: Dr. Adelwisso Jesus V. Badong
 N AD MI SS I ON
UPO
The condition upon admission: Conscious and Coherent

Chief complaints: Infected Wound (L) Foot

Weight: 55kg
Mode of Transport: Wheel Chair
Height: 162 cm
Vital Signs: BP: 105/62mmHg Temperature:36.7°C
PR: 120 bpm 02 Sat: 98%

Contraptions: PNSS 1L
 PATIENT
ASSESSMENT
 Received lying on bed, conscious  Skin warm to touch
and looks appropriate to age
 GCS of 15
 With IVF of PNSS (R) arm 30 cc/hr
 BP of 140/90 mmhg
 With foot ulceration (L)
 T: 38.1℃
 Pale sclera
 PR:85 bpm
 Pale skin and nail beds
 RR:20
 Weak in appearance
 O2sat: 98%
 CASE SUMMARY
A 51 year old man with diabetic foot (L) 3rd & 4th digit, worked as a
farmer and butcher. Patient DS was admitted last September 25, 2022
with chief complaint of infected wound. Patient was known for having a
condition called diabetes mellitus type 2, as he was diagnosed last 2015.

IMPRESSION / DIAGNOSIS:
Diabetes Mellitus Type 2
Hyperglycemia
 PATIENT’S HISTORY
I. Chief Complaints:
 Patient was brought to the emergency room with chief complaint of
infected wound.

II. History of Present Illness:

 Known case of Diabetes Mellitus Type 2 with management

medication of Insuget 28 units am/ 20 units pm
 3 weeks prior to admission, wound (L) foot
 PATIENT’S HISTORY
III. Patient's Health History:
According to the Patient:
 “2010: Nagpa check-up kami sa EBMC ta gapaykulog po ang
sakong tagiliran tapos na diagnose ako na may kidney stones,
tinaohan lang akong bulong pampatunaw kaso bato tapos dai
na ako nag follow-up check up.”
 “2015: Nagpacheck-up po ako ta permi po akong nalibong tas
nandudulom ang paghiling, tig blood test ako tapos duman po
naisihan na may DM2 po ako.”
 PATIENT’S HISTORY
III. Patient's Health History:
According to the Patient:
 “2019: Kang sasagsagan po ning Covid-19 nagtaas po ang blood
sugar ko kaito tapos hinayaan ko lang, lalo pa dai man ako
naka inject ning tuejeo dahil nag kakaubusan tapos natakot
ako mag pa hospital dahil sa lockdown and pasakitan na
magpunta sa hospital dahil baad ang ifindings sako is covid
dahil nasasakitan akong mag hangos naribong, yasilingutan
ning kalian tapos nanagas na ang saktong ginhawa.”
 “Permi po akong gaihi, nagugutom, napaha, yasiling’otan.”
 PATIENT’S HISTORY
III. Patient's Health History:
According to the Patient:

 “ Ang namati po ko pag ga taas ang blood sugar ko naribong,

nandudulom ang panghiling, namanhid, tapos puon po kang
pagka hospital ko sa Immac napansin ko po na mabagal na ako
maghiwas-hiwas.”
 PATIENT’S HISTORY
III. Patient's Health History:
According to the Patient’s Wife:
 “2019: Dinala ko na po an ma’am sa immaculate dahil nawalan
na po an ning malay sa halong mi tapos na ICU po siya ning 4
days, ang sabi ni Dra. Rojas may diabetic ketoacidosis na po
siya, sabi ni doc dry skin na siya.”
 Ya langgam po ang ihi niya, baging yanoknok pa po sa sobrang
hamis, pati po hininga nya baging fruity po.”
 PATIENT’S HISTORY
IV. Family Health History:
 Patient’s father side has history of kidney failure and hypertension. But
no history of Diabetes.
V. Lifestyle History
According to the Patient:
 “Mahilig po ako sa karne, atay, laman loob ning baboy. Ang kanin ko
po perming dakol naka duwang luwag po.”
 ”Dai po ako gasigarilyo. Pala inom po ako ning alak ta mala buhay
soltero, 36 years old na ako nag agom. Sa ilinuman mi naka 5 na bote
kami tapos puon hapon hanggang maaga na po an. Sa salong week
halos 3 beses po or depende.”
 PATIENT’S HISTORY
V. Lifestyle History
According to the Patient:
 “70 kilos po ako dati, ngunyan 55 na sana, kang naisihan ko na may
DM ako ang diet man ako ning salong bulan tapos hanggang sa
naging normal na su blood sugar ko kaito kaya ang ginibo ko po
paka diet ko nagbalik ako sa normal kong mga yakaon tapos
hanggang sa nagisugod ako sa immac duman na ako nag start na
mag diet”
 “Kang na diagnose po ako na may diabetes kang 2015 binalewala ko
sana po dai po ako nag sunod sa doctor ko na mag diet, sige man
sympre ang inom tapos kaon ko ning dakol na kanin, matataba tas
laman loob.”
 “Dai na po ako nakalakaw ning halayo”
 Activities of Daily Living
CRITERIA PRIOR TO AFTER INTERPRETENTION /
HOSPITALIZATION HOSPITALIZATION ANALYSIS

Nutrition Usually consumed rice, Loss of appetite Abnormal

vegetables, meat and
organ meat

Elimination Defecates 3x per week IRREGULAR PATTERN Abnormal

Exercise Walking He looks weak Abnormal
Rest and sleep Sleep 8 hours He sleeps 6 hours Abnormal
Hygiene Takes a bath every day Poor hygiene Abnormal
Substance use Drinks alcoholic N/A  
beverages with friend at
least 3 times a week
 CBG MONITORING
Date and Shift Time CBG Reading
9/26/2022 5am 324mg/dL
  9am 156mg/dL
  11am 166mg/dL
9/26/2022 3-11pm 5pm 220mg/dL
  10pm 242mg/dL
9/27/2022 5am 66.6mg/dL
  8am 122mg/dL
  10am 146mg/dL
  12nn 126mg/dL
  5pm 179mg/dL
  10pm 220mg/dL
9/28/2022 5am 160mg/dL
  11am 81mg/dL
  5pm 183mg/dL
  10pm 104mg/dL
9/29/2022 5am 79mg/dL
  11am 117mg/dL
  5pm 193mg/dL
  10pm 396mg/dL
CBG MONITORING
Date and Shift Time CBG Reading
09/30/2022 5am 155mg/dL
  11am 132mg/dL
  5pm 300mg/dL
  10pm 160mg/dL
10/01/2022 5am 163.8mg/dL
  11am 79mg/dL
  12nn 84mg/dL
  5 pm 158mg/dL
  10pm 117mg/dL
10/02/2022 5am 129.6mg/dL
  11am 123mg/dL
  5pm 112mg/dL
  10pm 90mg/dL
10/03/2022 5am 162mg/dL
  11am 80mg/dL
  5pm 317mg/dL
  10pm 178mg/dL
  5am 98mg/dL
  11am 99mg/dL
INSULIN SLIDING SCALE
CBG Reading Insulin “u” SQ
≤ 70 HOLD
≤ 100  ½ dose
180 – 220 mg/dL +2
 221 – 260 mg/dL +4
261 – 300 mg/dL +6
 BLOOD PRESSURE
Date and Shift Time Blood Pressure Reading
09/30/2022 4PM 180/100mmHg
  8PM 140/90mmHg
10/01/2022 12AM 100/90mmHg
  4AM 100/99mmHg
10/03/2022 8AM 100/80mmHg
  12NN 100/80mmHg
  4PM 130/90mmHg
  8PM 150/100mmHg
10/04/2022 8AM 170/100mmHg
  12NN 160/100mmHg
  4PM 140/90mmHg
  8PM 150/100mmHg

 The patient blood pressure last September 26,2022 until September 30,2022 was normal, ranging from 110/80 up to
120/90mmHg. Then, on the afternoon of September 30, 2022, his blood pressure started to increases ranging to
180/100mmHg. As most people with Diabetes Mellitus will have high blood pressure due to having high blood sugar in the
blood. High blood sugar in the blood causes the blood vessel to be crystalized and decreases the elasticity of blood vessels and
causing it to narrow, impeding the blood flow resulting to become harden called atherosclerosis.
 LABORATORY EXAM
Hematocrit
Normal Range: M: 0.40-0.54
0.4
0.35 0.35 0.34
0.3 0.29 0.3
0.25 0.27 0.27
0.2
0.15
0.1
0.05
0
9/25/2022 9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

The laboratory result of the hematocrit levels shows that the patient is having an insufficient supply or low
levels of healthy red blood cells, which is an indication that the patient is having anemia. In which was
supported through the assessment we conducted during our shift. We observed that the patient seems to be
pale and weak, wherein having anemia is relatively common in patient with diabetes mellitus just like in our
patient.
 LABORATORY EXAM
Hemoglobin
Normal Range: M: 140-160 g/L
120
108 105
100
90 86 92
80 84
60

40

20

0
9/25/2022 9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

 Same with the hematocrit levels, if the results of the hemoglobin levels of the patient is also insufficient or
below the normal range. It indicates that the patient is experiencing: Iron deficiency (anemia), have a kidney
or liver problem, & chronic disease. There is a low hematocrit and hemoglobin concentration level because
there is a rapid decline in glomerular filtration. Definitely, patient with kidney damage they produce less
erythropoietin, with less EPO the bone marrow will make a fewer red blood cells.
 LABORATORY EXAM
WBC Count
Normal Range: 5-10x10^9/L
16
14 13.85
12
10
9.4
8 7.88 8.5
7.54
6 6.25
4
2
0
9/25/2022 9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

 The result of WBC’s count of the patient last September 25, 2022 was high, which indicates that there is an
infection or inflammation and the body produces WBC’s to fight an infection happening in his body. As our
patient chief complaint of infected wound in (L) foot with drainage of pus and has inflammation. As the time
passed, WBC’s is decreasing and not making enough defense to his body and increasing the risk for
infections.
 LABORATORY EXAM
Segmenters
Normal Range: 0.58-0.66
0.9
0.8 0.78 0.78 0.75
0.7 0.71
0.66
0.6
0.5 0.53
0.4
0.3
0.2
0.1
0
9/25/2022 9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

 High percentage of neutrophils segmenters in the blood called neutrophilia is a sign that the body has an
infection.
 LABORATORY EXAM
0.4 Lymphocytes
Normal Range: 0.21-0.3
0.35
0.34
0.3
0.25
0.2 0.2 0.22 0.2
0.15 0.15 0.14
0.1
0.05
0
9/25/2022 9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

 The recent result of our patient lypmhocytes is lower than the normal percentage of 21 to 30% or 0.21 to
0.3, which indicates that the patient is at risk in having infection or a possible infection or other significant
illness occurs and should be further investigated by the health care professionals.
 LABORATORY EXAM
Eosinophils
0.035 Normal Range: 0.02 - 0.04
0.03 0.03 0.03 0.03 0.03
0.025
0.02
0.015
0.01 0.01 0.01
0.005
0
9/25/2022 9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

 An abnormally low eosinophil count can be the result of intoxication from alcohol or excessive production of
cortisol.
 LABORATORY EXAM
Monocytes
Normal Range: 0.04-0.06
0.12

0.1 0.1
0.08
0.07
0.06 0.06
0.05
0.04

0.02
0.011
0
9/25/2022 9/28/2022 9/29/2022 10/4/2022 10/10/2022

 The recent result of monocytes are within normal but when as the time passed it decreases and the body is
more susceptible to infection.
 LABORATORY EXAM
Platelet Count
600 Normal Range: 150 - 350 X 109/L

500 484 466

400 392
300 312 335
200

100

0
9/28/2022 9/29/2022 10/3/2022 10/4/2022 10/10/2022

 A Platelet count is used to monitor or diagnose conditions that cause too much bleeding or too much
clotting. The result was too high, it indicates blood clots can form in the blood vessels. Patient with diabetes
are prone to blood clot because of the high glucose level in the blood that causes to become more viscous
and thick.
 LABORATORY EXAM
Blood Chemistry
Normal Range of Creatinine: 53-115 umol/L
500 Normal Range of Uric Acid: 150 - 450 umol/L
450
432
400 Creatinine Uric Acid
350
300 290
250
200
150 150
120
100 95
50
0 0
9/26/2022 9/28/2022 10/3/2022 10/10/2022

 Creatinine is a waste product made by our muscles. Creatinine test is a way for the doctors to measure how
well our kidney is. Creatinine is removed from the body entirely by the kidneys. If kidney function is not
normal, the creatinine level in the blood will increase. It the condition of our patient the result of the
creatinine level is too high that significantly showed kidneys are being damaged. The uric acid level of our
patient was constantly with normal range throughout his hospitalization.
 LABORATORY EXAM
Blood Chemistry
Normal Range of FBS: 3.30 - 5.60 mmol/L
Normal Range of BUN/Urea: 2.14 - 7.4 mmol/L
18 Normal Range of Cholesterol: 0.00 - 5.20 mmol/L
16.89
16
14 FBS BUN/Urea Cholesterol
12
10
8 8.15
6
4 4.64
2.84
2 2.06
0 0 0
9/26/2022 9/28/2022 10/3/2022

 Fasting blood sugar test measures blood glucose after you have eaten for at least 8 hours. The result of
fasting blood sugar of the patient was too high that it indicate the occurrence of diabetes.
 Blood Urea Nitrogen test measures the amount of urea nitrogen in the blood. Urea nitrogen is a waste
product made by the liver. The result of BUN’s level was high indicates that the kidney of our patient aren’t
working well.
 LABORATORY EXAM
NORMAL
RESULTS
VALUES
Triglyceride 0.92 0.0-1.70 mmol/L
0.93-1.56
HDL Cholesterol 0.39
mmol/L
LDL Cholesterol 2.04 < 2.6 mmol/L
VLDL Cholesterol 0.42  
HbA1c 8.5 4.5 – 6.5%
 The result of triglyceride, LDL, VLDL are within normal ranges.
 LABORATORY EXAM
Macroscopic Microscopic
Color Yellow Epithelial Cells Occasional
Transparency Slightly turbid Red Cells 20-25/hpf
Sp. Gravity 1.015 Pus Cells 2-4/hpf
Reaction (pH) Acidic Bacteria  
Albumin + Casts  
Sugar Negative    
       
Others Amorphous Urates -Few    
  Calcium Oxalates -   
Many
 LABORATORY EXAM
Urinalysis is used to detect and manage a wide range of disorders, such as urinary tract infections, kidney
disease and diabetes. Urinalysis involves checking the appearance, concentration and content of the urine.
The result of the urine examination signifies that the patient is having acidic urine that promote an
environment where calcium oxalate stone formed overtime. Due to the unhealthy diet of our patient there is
high concentration of uric acid, crystal of uric acid and sodium hydrogen urate appear to promote calcium
oxalate crystallization. If a person has low urine pH or it is more acidic, it might indicate a medical condition
such as diabetic ketoacidosis which is a complication of diabetes.
The patient’s also having the sign of albuminuria which means there are albumin present in the urine,
normally albumin found in the blood and filtered by the kidneys, because of the high concentration of blood
sugar it causes the blood vessel (nephrons) to become narrow and clogged. Without enough blood, the kidneys
become damage and albumin passes through these filters and ends up in the urine where it should not be. When
the kidney are damage or aren’t working well there is an abnormal amounts of albumin presence in the urine
which signifies leak of albumin in the kidney filtration. It also found out that there is a red blood cells in his
urine. The normal red blood cells is 4 per high power field or less, the higher the number of RBC’s in the urine
indicate a kidney problems.
Therefore, patient with diabetes mellitus is associated with an increased risk for having a kidney stone
 Ultrasound Result of the Kidney,
Urinary Bladder and Prostate Gland (09-
28-2022)
Impression:
Nephrolithiasis, right
Normal sized prostate with concretions
Normal ultrasound of the left kidney and urinary bladder
 Nephrolithiasis are hard deposits of minerals and salts that formed in the
kidneys.
 X-ray Result of FOOT APO Left
(09-26-2022)

Impression:
Consider osteomyelitis, as described
Cellulitis, left foot
Old fracture deformity, metatarsal, 2nd digit
 Osteomyelitis is an infection in a bone. Infection also begin in the bone itself if
an injury exposes the bone to germs. On the admission, the patient complaints
of infected wound, apparently due to the unhygienic wound care of the patient
it exposes to bacteria causing inflammation.
 X-ray Result of CHEST PA
(09-26-2022)

Impression:
Pneumonia, right basal lung area
Minimal Pleural effusion and or thickly, right
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective data: Infection related to Short-term Independent After 8 hours of
“Namaga po an hanggang After 8 hours of • Performed daily • To clean the wound. nursing
open wound
ngunyan may galuwas na secondary to foot nursing wound care, and intervention the
po na nana tapos mabata intervention must use exact patient
po ang lugad ko” as ulcer as evidenced by antiseptic solution
skin warm to touch patient will less • These findings will demonstrate
stated by the patient • Observe localized
  and with risk for infection give information on techniques to
size of infection e.g. the extent of the
  prevent re-
Objective data: temperature of Long-term
color, size, drainage impaired tissue
infection
38.1℃ and odor. integrity or injury.
 Swelling around the After days the • Ensure strict aseptic •
wound site   To avoid reinfection.
patient is able to technique for
 Warm to touch   do own wound dressing changes
 Purulent wound
care for better and keep wound • To avoid infection
drainage dry at all times. and promote fast
wound healing • Discuss with the
 Unpleasant odor wound healing.
patient the proper
 Pain at the wound site personal and
 BP:140/90 mmhg environmental
 T: 38.1℃ hygiene  
 PR:85 bpm Dependent: • To fight with the
 RR:20 • Give daily antibiotic infection
medication as
 O2sat: 98% prescribed
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective data: Imbalanced nutrition Short-term Independent   After 8 hours of
"Mataba po ako dati 75kg, less than body   • Monitor vital signs. • Changes in VS nursing
ngunyan 55kg na ta indicate impending
limitado na ang pwedeng
requirement related to After 8 hours of intervention
illness.
kaunon tapos paggakaon insulin deficiency as nursing maintained
• Monitor respiratory • Lungs remove
po ako ngunyan yasuka evidenced by recent intervention hydration and
pattern like carbonic acid
ko man sana po” as stated weight loss patient will demonstrate
by the patient kussmaul’s through
maintain hydrated repiration and respirations,
willingness to
 
Objective data:
  acetone breath. producing a follow dietary
Long-term compensatory instructions
 Weight 75 kg (2020)
 Weight 55 kg (2022)
Patient will follow alkalosis for
 Dry skin dietary nutritional ketoacidosis.
 Poor skin turgor requirements • Monitor
 Pale temperature, skin • Fever, chills and
 Weak in appearance color and diaphoresis, dry
 Vomited twice noted moisture. Assess skin may reflect
 Diaphoretic peripheral capillary dehydration.
 Loss of appetite refill, skin turgor.
 BP:140/90 mmhg
 T: 38.1℃ • Note the color and • Indication of
amount of gastric dehydration. 
 PR:85 bpm
 RR:20 contents.
 O2sat: 98%
 
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective data: Imbalanced nutrition Short-term Independent After 8 hours of
"Mataba po ako dati 75kg, less than body   • Monitor input and • Provides ongoing nursing
ngunyan 55kg na ta After 8 hours of output. estimate of volume intervention
limitado na ang pwedeng
requirement related to replacement needs,
nursing intervention maintained
kaunon tapos paggakaon insulin deficiency as and kidney function.
patient will maintain hydration and
po ako ngunyan yasuka evidenced by recent
hydrated • Observe patient for • Changes in level of demonstrate
ko man sana po” as stated weight loss
by the patient   the sign of hypo and consciousness could be willingness to
Long-term a sign for hypoglycemia: follow dietary
  hyperglycemia.
sweating, pallor,
Objective data: Patient will follow irritability, hunger, lack of
instructions
 Weight 75 kg (2020) dietary nutritional coordination, sleepiness.
 Weight 55 kg (2022) requirements • Hyperglycemia: dry
mouth, increased thirst,
 Dry skin
weakness, headache,
 Poor skin turgor blurred vision, frequent
 Pale urination.
 Weak in appearance
• Encourage patient to
 Vomited twice noted • To educate
follow diabetic diet
 Diaphoretic information that
and desired plan
 Loss of appetite beneficial to his
meal as prescribed.
 BP:140/90 mmhg health, eating
 
nutritious food.
 T: 38.1℃ Dependent:
 PR:85 bpm • Administer • To replenish and treat
 RR:20 intravenous fluid as moderate or severe
 O2sat: 98% indicated. dehydration. 
 
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective data: Impaired skin integrity Short-term Independent   After 8 hours of
“ Awat na po an ang lugad related to decreased   • Assess the site of • Redness, swelling, pain, nursing intervention
burning, and itching are
ko sa bitis” as stated by circulation and sensation After 8 hours of impaired tissue indications of patient
the patient caused due to peripheral nursing intervention integrity and its inflammation and the demonstrate proper
  neuropathy secondary to patient will condition. body’s immune system wound care and
Objective data: diabetic foot ulcer, as demonstrate response to localized
tissue trauma or minimize injury.
 Presence of evidenced by destruction understanding impaired tissue integrity.
wound/ulceration at of skin layers and proper foot or • Assess • These findings will give
the left foot disruption of skin wound care. characteristics of information on the
surfaces.   the wound, extent of the impaired
 Swelling and blackish   Long-term including color, size
tissue integrity or injury.
color around the Pale tissue color is a sign
  (length, width, of decreased
wound site The patient will depth), drainage, oxygenation. An odor
 Dry skin experience healing and odor. may result from the
presence of infection on
 Pale of wound and will the site; it may also be
 BP:140/90 mmhg reduce the size of coming from necrotic
ulcer and prevent tissue. Serous exudate
 T: 38.1℃ from a wound is a
 PR:85 bpm injury normal part of
 RR:20   inflammation and must
 O2sat: 98% Reduce risk for be differentiated from
infection pus or purulent
 Blood sugar level: 230 discharge present in the
mg/dl infection.
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective data: Impaired skin integrity Short-term Independent   After 8 hours of
“ Awat na po an ang lugad related to decreased   • Instruct the patient • There is a considerable nursing
ko sa bitis” as stated by circulation and sensation After 8 hours of to avoid walking in danger of trauma from intervention
the patient caused due to peripheral nursing intervention bare feet and know this, which could lead to patient
signs of scratching. infection and ulceration.
  neuropathy secondary to patient will demonstrate
Objective data: diabetic foot ulcer, as demonstrate proper wound care
evidenced by destruction understanding • Monitor the status • Individualize plan is and minimize
 Presence of of the skin around necessary according to
wound/ulceration at of skin layers and proper foot or injury.
disruption of skin wound care. the wound. Monitor the patient’s skin
the left foot patient’s skincare condition, needs, and
surfaces.   preferences.
 Swelling and blackish   Long-term practices, noting the
color around the type of soap or
 
wound site other cleansing
The patient will agents used, the
 Dry skin experience healing temperature of the
 Pale of wound and will water, and
 BP:140/90 mmhg reduce the size of frequency of skin
 T: 38.1℃ ulcer and prevent cleansing.
 PR:85 bpm injury • Keep a sterile • A sterile technique reduces
 RR:20   dressing technique the risk of infection in
impaired tissue integrity. This
 O2sat: 98% Reduce risk for during wound care. involves the use of a sterile
infection procedure field, sterile gloves,
 Blood sugar level: 230 sterile supplies and dressing,
mg/dl sterile instrument.
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective data: Impaired skin integrity Short-term Independent   After 8 hours of
“ Awat na po an ang lugad related to decreased   • Wet the dressings • Saturating nursing intervention
ko sa bitis” as stated by circulation and sensation After 8 hours of thoroughly with dressings will ease patient demonstrate
the patient caused due to peripheral nursing intervention sterile  the removal by proper wound care
  neuropathy secondary to patient will normal saline soluti loosening and minimize injury
Objective data: diabetic foot ulcer, as demonstrate on adherents and
evidenced by destruction understanding  before removal. decreasing pain.
 Presence of
• Encourage the
wound/ulceration at of skin layers and proper foot or • This is to prevent
disruption of skin wound care. patient to pressure ulcers.
the left foot immobilize or turn
surfaces.  
 Swelling and blackish   Long-term side to side.
color around the   • Encourage patient • To promote faster
wound site The patient will to increase fluid wound healing.
 Dry skin experience healing intake and vitamin
 Pale of wound and will C.
 BP:140/90 mmhg reduce the size of Dependent
 T: 38.1℃ ulcer and prevent • Administer topical • To stop the growth
injury ointment as infection causing
 PR:85 bpm
  prescribed by the fungi.
 RR:20 physician.
 O2sat: 98% Reduce risk for
infection • Administer • Reduce the risk for
 Blood sugar level: 230 antibiotic as infection
mg/dl prescribed .
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective Data: Fatigue related to Short term: Independent: • Short term:
It is critical to compare serial
laboratory values to evaluate
"Nangluluya na talaga decreased hemoglobin After 8 hours of • Monitor hemoglobin, progression or deterioration After 8 hours of
hematocrit and RBC nursing intervention,
ako pirmi bago palang and diminished oxygen- nursing counts.
in the client and to identify
changes before they become
ako iadmit hanggang sa carrying capacity of intervention, the potentially life threatening the client has
salinan ako kaito ng dugo blood evidenced by client will verbalize • A plan that balances
verbalized use of
tabi ma'am." as report of fatigue and use of energy • Assist the client in periods of activity with energy conservation
planning and periods of rest can help principles.
verbalized by the patient. lack of energy. conservation prioritizing activities of the client complete
principles.  
  daily living. desired activities without
Long term:
Objective Data:   adding levels to fatigue.
Long term: Organization and time
After week of
- Fatigue •
After 8 hrs of • Educate energy management can help nursing intervention,
- Weak in appearance conservation the client conserve the client verbalized
- Pale nailbeds, palms nursing intervention techniques. energy and reduce reduction of fatigue,
and skin client will verbalize fatigue.
as evidenced by
- Poor skin turgor reduction of fatigue • Packed RBC's increase reports of increased
• Anticipate the need
- Hematocrit level: 27 as evidenced by for the transfusion of oxygen carrying energy.
- Hemoglobin: 84 reports of increase packed RBCs capacity of the blood.
 
Vital Signs of: 09/27/22 energy. Instructs the client • Recombinant human Goal Met.
• erythropoeitin, a
- BP: 110/80 mmHg about medications hematological growth
- PR: 83bpm that may stimulate factor, increases
RBC production in the hemoglobin and
- RR: 21breaths/min bone marrow. decreases the need for
- Sp02: 99% RBC. 
 
 NURSING CARE PLAN
Assessment  Diagnosis  Planning  Intervention  Rationale  Evaluation
Subjective Data: Fatigue related to Short term: Dependent: Short term:
"Nangluluya na talaga decreased hemoglobin After 8 hours of • Transfuse blood • This method will After 8 hours of
ako pirmi bago palang and diminished oxygen- nursing components increase the nursing intervention,
ako iadmit hanggang sa carrying capacity of intervention, the (commonly packed number of RBC’s the client has
salinan ako kaito ng dugo blood evidenced by client will verbalize RBC’s via circulating in the verbalized use of
tabi ma'am." as report of fatigue and use of energy intravenous blood, which energy conservation
verbalized by the patient. lack of energy. conservation catheter as eventually increase principles.
principles. prescribed. the blood’s oxygen.  
  Long term:
Objective Data:  
Long term: After week of
- Fatigue nursing intervention,
- Weak in appearance After 8 hours of
the client verbalized
- Pale nailbeds, palms nursing intervention
reduction of fatigue,
and skin client will verbalize as evidenced by
- Poor skin turgor reduction of fatigue reports of increased
- Hematocrit level: 27 as evidenced by energy.
- Hemoglobin: 84 reports of increase  
Vital Signs of: energy. Goal Met.
- BP: 110/80 mmHg
- PR: 83bpm
- RR: 21breaths/min
- Sp02: 99%
 MEDICATIONS
Ferrous Sulfate + Folic Piperacillin +
Tazobactam
Potassium Citrate Metronidazole

Sambong Insuget 70/30

Amlodipine Tranexamic

Clonidine Omeprazole

Tramadol Metoclopramide
 MEDICATIONS
Ferrous Sulfate + Folic
1tablet BID

Ferrous sulfate and folic acid is used to treat iron deficiency

anemia (a lack of red blood cells caused by having too little iron
in the body)

Adverse Reactions: Therapeutic doses of iron may cause

gastrointestinal discomfort, diarrhoea, and vomiting.
 MEDICATIONS
Potassium Citrate
1050 mg 1 tab TID
Action: This medication is used to make the urine less acidic. This effect helps
the kidneys get rid of uric acid, thereby helping to prevent gout and kidney stones. This
medication can also prevent and treat certain metabolic problems (acidosis) caused
by kidney disease. Citric acid and citrate salts (which contain potasssium and sodium)
belong to a class of drugs known as urinary alkalinizers. Used for Uric Acid
Nephrolithiasis, Nephrolithiasis, Renal Tubular Acidosis
Adverse Effects: severe vomiting or stomach pain; high blood potassium; nausea,
weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement; signs of
stomach bleeding--bloody or tarry stools, coughing up blood or vomit that looks like
coffee grounds.
 MEDICATIONS
Sambong 500mg 1 tab TID

Action: It can be concluded from the study that Blumea

balsamifera inhibits calcium oxalate stone formation in the kidneys with
the 100% and 50% sambong treatment most effective in decreasing number
of stones and oxalate content of the kidney homogenate, respectively.
Side Effects: Sambong can cause allergic reaction for people
sensitive to ragweed plants and its relatives. Side effect may
include itching and skin irritation.
 MEDICATIONS
Amlodipine
5mg/1tablet OD

Action: Calcium channel blocker; Antianginal, antihypertensive

Inhibits calcium movement across cardiac and vascular smooth muscle cell
membranes. Dilates coronary arteries, peripheral arteries/arterioles.
Decreases total peripheral vascular resistance and BP by vasodilation.
Adverse Effects/ Toxic Reactions: Overdose may produce excessive
peripheral vasodilation, marked hypotension with reflex tachycardia,
syncopy.
 MEDICATIONS
Amlodipine
5mg/1tablet OD
Nursing Considerations/ Patient Health Teaching:
 Assess B/P (if systolic B/P is less than 90 mm Hg, withhold medication,
contact physician). Assess for peripheral edema behind medial malleolus
(sacral area in bedridden pts). Assess skin for flushing. Question for
headache, asthenia.
 Do not abruptly discontinue medication.
 Compliance with therapy regimen is essential to control hypertension.
 Avoid tasks that require alertness, motor skills until response to drug is
established.
 Do not ingest grapefruit products.
 MEDICATIONS
Clonidine 75mg PO
PRN if BP >160/90

Action: Alpha2 -adrenergic agonist; Antihypertensive.

Treatment of hypertension alone or in combination with other
antihypertensive agents. Stimulates alpha2 -adrenergic receptors, reducing
sympathetic CNS response.
Adverse Effects/ Toxic Reactions: Overdose produces profound
hypotension, irritability, bradycardia, respiratory depression, hypothermia, miosis
(pupillary constriction), arrhythmias, apnea. Abrupt withdrawal may result in rebound
hypertension associated with nervousness, agitation, anxiety, insomnia, paresthesia,
tremor, flushing, diaphoresis. May produce sedation in pts with acute CVA.
 MEDICATIONS
Clonidine 75mg PO
PRN if BP >160/90
Nursing Considerations/ Patient Health Teaching:
 Give without regard to food.
 Give last oral dose just before bedtime.
 Swallow extended-release tablets whole; do not break, crush, dissolve or
divide.
 Monitor B/P, pulse, mental status. Monitor daily pattern of bowel activity,
stool consistency. If clonidine is to be withdrawn, discontinue concurrent
betablocker therapy several days before discontinuing clonidine (prevents
clonidine withdrawal hypertensive crisis). Slowly reduce clonidine dosage
over 2–4 days.
 MEDICATIONS
Tramadol
50mg TIV Q6 for pain

Action: Analgesic.
Binds to mu-opioid receptors, inhibits reuptake of norepinephrine,
serotonin, inhibiting ascending and descending pain pathways. Therapeutic
Effect: Reduces pain.
Adverse Effects/ Toxic Reactions: Seizures reported in pts receiving
tramadol within recommended dosage range. May have prolonged duration of action,
cumulative effect in pts with hepatic/renal impairment, serotonin syndrome (agitation,
hallucinations, tachycardia, hyperreflexia). May cause suicidal ideation and behavior.
 MEDICATIONS
Tramadol
50mg TIV Q6 for pain

Nursing Considerations/ Patient Health Teaching:

 Monitor pulse, BP, renal/hepatic function. Assist with ambulation if dizziness,
vertigo occurs.
 May cause drowsiness, dizziness and blurred vision. Avoid tasks requiring
alertness, motor skills until response to drug is established.
 MEDICATIONS
Piperacillin + Tazobactam
4.5gram Q6

Action: Penicillin; Antibiotic.

Treatment of moderate to severe bacterial infections, including
communityacquired/nosocomial pneumonia, intra-abdominal, pelvic, skin, and skin
structure infections. Tazobactam expands piperacillin activity to include
betalactamase–producing strains of S. aureus, H. influenzae, Bacteroides, PsAg,
Acinetobacter, Klebsiella pneumoniae, E. coli.
Inhibits cell wall synthesis by binding to bacterial cell membranes

Side Effects: Diarrhea, headache, constipation, nausea, insomnia, rash.

 MEDICATIONS
Piperacillin + Tazobactam
4.5gram Q6
Nursing Considerations/ Patient Health Teaching:
Baseline assessment Question for history of allergies, esp. to penicillins,
cephalosporins. Obtain baseline CBC with differential, BMP, LFT; urinalysis;
PT, aPTT (if on anticoagulants or history of coagulopathy).
Monitor daily pattern of bowel activity, stool consistency; mild GI effects may
be tolerable, but increasing severity may indicate onset of antibiotic-associated
colitis. Be alert for superinfection: fever, vomiting, diarrhea, anal/genital
pruritus, oral mucosal changes (ulceration, pain, erythema). Monitor I&O,
urinalysis. Monitor serum electrolytes, esp. potassium, renal function tests.
 MEDICATIONS
Metronidazole
500mg TIV Q8

Action: Nitroimidazole derivative; Antibacterial, antiprotozoal.

Treatment of anaerobic infections (skin/skin structure, CNS, lower respiratory
tract, bone/joints, intra-abdominal, gynecologic, endocarditis, septicemia).
Side Effects: Anorexia, nausea, dry mouth, metallic taste.
Adverse Effects/ Toxic Reactions: Oral therapy may result in furry tongue,
glossitis, cystitis, dysuria, pancreatitis. Peripheral neuropathy (manifested as
numbness, tingling of hands/feet) usually is reversible if treatment is stopped
immediately upon appearance of neurologic symptoms
 MEDICATIONS
Metronidazole
500mg TIV Q8
Nursing Considerations/ Patient Health Teaching:
 Obtain baseline CBC, LFT. Question for history of hypersensitivity to
metronidazole, other nitroimidazole derivatives
 Monitor daily pattern of bowel activity, stool consistency. Monitor I&O,
assess for urinary problems. Be alert to neurologic symptoms (dizziness,
paresthesia of extremities). Assess for rash, urticaria. Monitor for onset of
superinfection (ulceration/change of oral mucosa, furry tongue, vaginal
discharge, genital/anal pruritus).
  Urine may be red-brown or dark.
 MEDICATIONS
Insuget70/30
15”u” pre BF and pre dinner

Action: Insuget 70/30 (biphasic injection, isophane suspension), is

an intermediate-acting insulin with a more rapid onset of action than NPH
alone and a duration of activity of up to 24 hrs. Insulin lowers blood glucose
levels. It regulates carbohydrate, protein and fat metabolism by inhibiting
hepatic glucose production and lipolysis, and enhancing peripheral glucose
disposal. 
Adverse Effects: Hypoglycemia, insulin resistance, lipoatrophy,
hypokalaemia, blurred vision
 MEDICATIONS
Insuget70/30
15”u” pre BF and pre dinner
Nursing Considerations/ Patient Health Teaching:
Assess for symptoms of hypoglycemia or hyperglycemia
Monitor body weight over time
 May cause decreased inorganic phosphates, potassium, and magnesium
Monitor blood sugars every 6 hours, monitor A1C every 3-6 months
Ensure uniform dispersion of insulin suspensions by rolling the vial gently
between hands; avoid vigorous shaking.
Give maintenance doses subcutaneously, rotating injection sites regularly to
decrease incidence of lipodystrophy; give regular insulin IV or IM in severe
ketoacidosis or diabetic coma.
 MEDICATIONS
Tranexamic Acid
500mg IV Q8

Action: Antifibrinolytic
Displaces plasminogen from surface of fibrin by binding to high-affinity lysine
site of plasminogen. This diminishes dissolution of hemostatic fibrin, which
decreases bleeding.
Adverse Effects: Cerebral thrombosis, dizziness, fatigue, headache, migraine,
seizures CV: Deep vein thrombosis, MI
Nursing Considerations/ Patient Health Teaching:
 Tell patient to seek emergency care immediately if she has any signs of allergic
reaction, especially dyspnea, a feeling of tightness in the throat, and facial flushing;
advise patient to report any changes in vision or ocular discomfort.
 MEDICATIONS
Omeprazole
40mg IV BID

Action: Benzimidazole; Proton pump inhibitor

Treatment of frequent, uncomplicated heartburn occurring 2 or more days/wk.
Inhibits hydrogen-potassium adenosine triphosphatase (H+ /K+ ATP pump), an
enzyme on the surface of gastric parietal cells. Therapeutic Effect: Increases
gastric pH, reduces gastric acid production.
Side Effects: Headache; Diarrhea, abdominal pain, nausea.
Adverse Effects/ Toxic Reactions: Pancreatitis, hepatotoxicity, interstitial
nephritis occur rarely. May increase risk of C. difficile infection.
 MEDICATIONS
Omeprazole
40mg IV BID

Nursing Considerations/ Patient Health Teaching:

Evaluate for therapeutic response (relief of GI symptoms). Question if GI
discomfort, nausea, diarrhea occurs.
Report headache, onset of black, tarry stools, diarrhea, abdominal pain.
Avoid alcohol.
 For Oral: Swallow capsules whole; do not chew, crush, dissolve, or divide.
Take before eating.
 MEDICATIONS
Metoclopramide
1 ampule
Action: Dopamine receptor antagonist; GI emptying adjunct, peristaltic
stimulant, antiemetic.
Symptomatic treatment of diabetic gastroparesis, gastroesophageal reflux.
Stimulates motility of upper GI tract. Blocks dopamine/serotonin receptors in
chemoreceptor trigger zone. Enhances acetylcholine response in upper GI tract;
increases lower esophageal sphincter tone. Accelerates intestinal transit, promotes
gastric emptying. Relieves nausea, vomiting.
Adverse Effects/ Toxic Reactions: Extrapyramidal reactions occur most frequently
in children, young adults (18–30 yrs) receiving large doses (2 mg/kg).Neuroleptic
malignant syndrome (diaphoresis, fever, unstable B/P, muscular rigidity) has been
reported.
 MEDICATIONS
Metoclopramide
1 ampule
Nursing Considerations/ Patient Health Teaching:
 Assess for dehydration (poor skin turgor, dry mucous membranes, longitudinal
furrows in tongue). Assess for nausea, vomiting, abdominal distention, bowel
sounds.
 Monitor for anxiety, restlessness, extrapyramidal symptoms (EPS) during IV
administration. Monitor daily pattern of bowel activity, stool consistency.
 Assess skin for rash. Evaluate for therapeutic response from gastroparesis
(nausea, vomiting, bloating). Monitor renal function, B/P, heart rate.
 Avoid tasks that require alertness, motor skills until response to drug is
established.
 Report involuntary eye, facial, limb movement (extrapyramidal reaction).
 MEDICATIONS
Paracetamol
300mg IV

Action: This medicine is an analgesic and antipyretic that contains

paracetamol. It is used to reduce fever and to relieve pain, including
osteoarthritis pain.

Adverse Reactions: allergic skin reaction, abnormal blood count.

 CONCLUSION
According to Oman Medical Journal, Type 2 DM is a metabolic disease that can be
prevented trough lifestyle of modification diet control, and control of overweight and obesity.
Education of the populace is still key to control of this emerging epidemic. Novel drugs are
being developed, yet no cure is available in sight for the disease, despite new insight into the
pathophysiology of the disease. Management should be tailored to improve the quality of life
of individuals with type II DM.
Having high cases of having Diabetes Type II has been a concern to countries especially
in the Philippines. Prevention of having type II diabetes is very beneficial if you are having an
active lifestyle with exercise that will involve all parts of the body. Diet is also a key factor
because it is a contributor to how the disease progresses. Medications and lifestyle change
with weight loss will likely reduce the incidence of having DM type II. Having all of these
approaches could make the prevalence of occurring a reality.