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Left Diabetic Mellitus Foot

Surgical Unit - (1) , Yangon General Hospital
(from 14.7.23 to 27.7.23)

Presented by

Zar Ni Oo

Du -81
 Group members

1.Ma Su Latt Phyu (Du – 78 )

2.Ma Hsu Mon Thet (Du -79)

3.Ma Hsu Yi Mon (Du- 80)

4.Ma Zar Ni Oo (Du -81)

5.Ma Nway Nway Lwin (Du -82)

 Introduction
Diabetic foot ulcers are among the most common complications of patients who
have diabetes mellitus which is not well controlled . It is usually the result of poor
glycemic control , underlying neuropathy , peripheral vascular disease , or poor foot care
. It is also one of the common cause for osteomyelitis of the foot and amputation of lower
extremities . These ulcers are usually in the areas of the foot which encounters repetitive
trauma and pressure sensations .
Causes
The common underlying causes are poor glycemic control , calluses ,
foot deformities , improper foot care , ill-fitting footwear , underlying
peripheral neuropathy and poor circulation , dry skin , etc .About 60%
of diabetics will develop neuropathy eventually leading to a foot ulcer.
 Brief History

Name - U Kyaw Win

Age - 71 years old
Sex - Male
Race - Burmese
Religion - Buddhism
Marital status - Married
Occupation - Captain (Local)
Address - Seint – Kyi , Kha Naung Do , Yangon
R/ N - 371465
Bed No. - 19
Admission date - 13.7.23
Chief complaint - numbness , gangrene at left 5th toe
Diagnosis - Left DM foot
Procedure performed - Ray’s amputation
Treatment
• Vital signs are T – 99°F , BP – 113/85 mmHg , PR - 85/min , SPO2 - 99% ,
RBS - 212 mg/dl ,

• PO Flumox 500mg (1) tds

• PO tramadol 50 mg (1) tds

• PO linagliptin 10 mg (1) OD before lunch

• PO metformin 500mg (1) tds

• IV NS infusion , DS , DW

• Paracetamol IV 100ml (for fever )

• Metronidazole 100ml IV 8H
Investigation
HbA1C - 7.2 %
WBC -19.36/L
RBC - 4.39 /L
HGB - 11.2 g/dl
PLT - 492 /L
Urea - 8.6 mmol/L
Sodium - 134 mmol/L
Potassium - 3.8 mmol/L
Chloride - 99 mmol/L
Bicarbonate – 19 mmol/L
Creatinine - 205 mmol/L
CRP - 255.8 mg/dl
 RBS Chart
Date /time FBS P4 L 2HPPD B4D 2HPPD BT Remark

14.7.23 171mg/dL 212mg/dL 208mg/dL Monitor

15.7.23 172mg/dL 170mg/dL 215mg/dL

16.7.23 164mg/dL 202mg/dL 184mg/dL

17.7.23 142mg/dL 170mg/dL 186mg/dL
18.7.23 158mg/dL 198mg/dL 159mg/dL
19.7.23 116mg/dL 146mg/dL 195mg/dL
20.7.23 202mg/dL 236mg/dL 187mg/dL
21.7.23 186mg/dL 202mg/dL 188mg/dL
22.7.23 152mg/dL 115mg/dL 186mg/dL
23.7.23 149mg/dL 235mg/dL 183mg/dL
24.7.23 123mg/dL 171mg/dL 141mg/dL
25.7.23 127mg/dL 172mg/dL 160mg/dL
26.7.23 139mg/dL 173mg/dL 200mg/dL
 Assessment Data
Subjective Data Objective Data
• The patient said , • Facial grimacing , surgical wound (removal
• of 5th little toe )
• I feel painful at my foot .
• Tissue trauma , open wound , IV cannula
• I feel hot and red at my left foot.
insertion , Pain , Ray’s amputation .
• I feel discomfort .
• Using assistive devices , dependence on
• I can’t do my daily activities well . family members . Unfamiliar hospital setting

• I can’t go to toilet by myself . • Loss of appetite , weight loss 3 lb , changes in

health status ,
• I can’t sleep well at night .
• No smile , confusion .
• I don’t want to eat anything .

• I feel anxiety . • Asking questions about the disease

• I feel fearful . • Inadequate knowledge about the disease

• I don’t know about my disease .
 Nursing diagnosis with prioritization

1. Altered comfort (acute pain ) related to surgical wound as evidenced by facial grimacing .

2. Impaired skin integrity related to tissue trauma as evidenced by open wound .

3. Risk for infection related to cannula insertion as evidenced by swelling at the cannula
insertion site .

4. Impaired physical mobility related to pain as evidenced by removal of left 5th little toe .

5. Self – care deficit related to impaired to perform toileting , bathing by self as evidenced
by dependence on family members and assistive devices .
(6) Sleep pattern disturbance related to unfamiliar hospital setting as evidenced by
dark circles under eyes .

(7) Altered nutrition less than body requirement related to loss of appetite as
evidenced by weight loss 3 lb.

(8) Anxiety related to changes in health status as evidenced by no smile , confusion .

(9) Fear related to changes in health status as evidenced by asking a lot of questions
about the disease .

(10) Knowledge deficit related to inadequate knowledge about the disease process as
evidenced by frequent questioning .
 Nursing Care Plan (1)

Assessment data Nursing Expected Nursing interventions Evaluation

diagnosis outcomes

Subjective data Altered comfort After nursing • Monitor vital signs . After nursing
(acute pain) interventions , interventions , the
The patient related to the patient will • Assess pain levels . patient relieved
said , surgical wound relieve pain . pain .
as evidenced by • Assess the location ,
I feel painful . facial characteristics , onset ,
grimacing . duration , frequency .

Objective data • Determine signs and

symptoms related to the
- Facial patient’s pain .
grimacing
- Surgical • Determine how
wound comfortable the patient is
using non-
pharmacological pain
management .
 Nursing Care Plan (2)
Assessment data Nursing Expected Nursing interventions Evaluation
diagnosis outcomes
Subjective data Impaired skin After nursing • Monitor vital signs . After nursing
integrity interventions , interventions ,
The patient related to tissue the patient will • Determine the patient’s the patient
said , trauma as relieve feeling of wound condition including relieved feeling
evidenced by hot and red at the color , presence of necrosis of hot and red
I feel hot and open wound . left foot . . at left foot .
red at my left
foot . • Measure ulcer’s size and take
note of any undermining .

Objective data • Assess the patient’s wound for

exudates .
- Tissue
trauma • Instruct patient to avoid
- Open wound walking in bare foot .
 Nursing Care Plan (3)

Assessment data Nursing Expected Nursing interventions Evaluation

diagnosis outcomes
Subjective data Risk for After nursing • Assess the patient’s cannula After nursing
infection related interventions , site such as swelling , edema. interventions ,
The patient to cannula the patient will the patient
said , insertion as relieve feeling of • Monitor the patient’s body relieved feeling
evidenced by discomfort . temperature. of discomfort .
I feel swelling at
discomfort . cannula • Provide precise care to the
insertion site . patient by gently massaging
the cannula site .
Objective data
• Keep the skin dry .
- Cannula
insertion • Promote to cut nails .
- Swelling at
cannula
insertion site
 Nursing Care Plan (4)

Assessment data Nursing Expected Nursing interventions Evaluation

diagnosis outcomes
Subjective data Impaired After nursing • Assess the patient’s skin After nursing
physical interventions , integrity for symptoms of interventions ,
The patient mobility related the patient will ischemia and redness the patient was
said , to pain as be able to do especially over the heels , able to do daily
evidenced by daily activities ankles and toes . activities by
I can’t do my removal of 5th by self . self .
daily activities little toe . • Encourage the patient to
by myself . perform passive or active
range of motion exercises .

Objective data • Offer the patient diversional

• Pain , open activities .
wound
• Ray’s • Assess the patient’s strength
amputation and range of motion.
 Nursing Care Plan (5)

Assessment data Nursing Expected Nursing interventions Evaluation

diagnosis outcomes
Subjective data Self care deficit After nursing • Assess the patient’s skin After nursing
related impaired interventions , integrity for symptoms of interventions ,
The patient to perform the patient will ischemia and redness the patient was
said , toileting , be able to do especially over the heels , able to do daily
bathing as daily activities ankles and toes . activities by
I can’t go to the evidenced by by self . self .
toilet . dependence on • Encourage the patient to
family members perform passive or active
and assistive range of motion exercises .
Objective data devices .
• Offer the patient diversional
• Using activities .
assistive
devices ,depe • Assess the patient’s strength
ndence on and range of motion.
family
members
 Discharge Plan
• Check your foot every day .

• Use the mirror to look at the bottom of your foot .

• Make sure to check between your toes , it helps to catch small skin changes before they
got infected .

• Instruct the patient to control blood sugar level .

• Instruct the patient to avoid walking in bare foot .

• Teach the patient how to perform wound care .

• Explain the patient the complications of DM.

• Instruct the patient to take suitable diet for DM and check the follow up visit .
 Conclusion

We presented about DM foot , we provided health education for DM

foot patients . we performed nursing care for patients . We did so well
during our field study .