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INTRODUCTION

Diabetes mellitus, often simply referred to as diabetesis a group of metabolic diseases in which a person has high blood

sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.

This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst)

and polyphagia (increased hunger).

There are three main types of diabetes:

Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also

referred to as insulin-dependent diabetes mellitus, IDDM for short, and juvenile diabetes.)

Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined

with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short,

and adult-onset diabetes.)

Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during

pregnancy. It may precede development of type 2 DM.

Other forms of diabetes mellitus include congenital diabetes, which is due to genetic defects of insulin secretion, cystic fibrosis-

related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes.

All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with

medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with

limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM.

Gestational diabetes usually resolves after delivery. Diabetes without proper treatments can cause many

complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious

long-term complications include cardiovascular disease, chronic renal failure, and retinal damage. Adequate treatment of

diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a

healthy body weight.

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I. Biographic DataName: Patient K

Age: 57 y/o Gender: Male

Religion: Catholic

Marital status: Single Occupation: Private Guard

Room and Bed no.: PS 2

Chief Complaint: wound that does not heal

Diagnosis: DM II gangrene right foot; uncontrolled

Attending Physician: Dr. Bathan

II. Nursing HistoryA. Past Health History

1. Childhood Illness:Cough and colds

2. Immunizations:The client stated that he had completed his childhood immunization

3. Allergies:The client stated that he had no food and drug allergies.

4. Accidents:The client stated that he had previous accidents in motor vehicle

5. Hospitalizations:The clients last hospitalization was due to his motor vehicle accident

Medications currently taken:

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Ceftriaxone

Ketorolac

6. Foreign Travel (when, length of stay)The client had no previous foreign travel

B. History of Present Illness:1 day prior to admission the client feels severe pain on his right gangrenous foot, he decided to choose BRH for his

treatment.

C. Family History/Genogram:

Legend:

w/ HPN

w/ DM

Mother Father

Patient K Sister Brother

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III. Activities of Daily Living

ADL Before Hospitalization During Hospitalization

1. Nutrition Patient stated that he eat vegetables especially

root crops.

He usually eat foods with soup like sinigang & nilaga.

2. Elimination Hindi naman ako hirap sa pag-ihi; siguro, mga

limang beses ako umiihi sa isang araw as

verbalized by the patient

According to the patient, he voids atleast 3-4 times a

day.

3. Exercise Naglalakad-lakad ako minsan saka ngjajogging

as stated by the patient.

The patient cannot perform exercise due to his present

condition.

4. Hygiene Patient stated that he takes a bath everyday. punas-punas laang dahil sa kalagayan ko ngayon as

verbalized by the patient.

5. Substance

use

The patient stated: wala akong iniinom na kahit

anong gamot

--Ketorolac

-Ceftriaxone

6. Sleep and

Rest

Nakakatulog naman ako ng maayos sa bahay

as stated by the patient.

The patient cannot sleep well in the hospital due to the

pain he feels.

7. Sexual

Activity

matanda na ako ey! Hindi na to natayow! No sexual activity

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Steps Normal findings Findings

1. General Appearance

1.1 Observe body built,height and weight

1.2 Observe the clientsposture and gait

1.3 Observe the clientsover all hygiene and

grooming

-The client is cooperative and responds to questions

nicely.

-Speech is clear and understandable.

-The size of the body is proportion with the size of

the head.

-Slouched

-slightly groomed

2. Skin

2.1.Inspect skin color

2.2.Assess edema

2.3.Inspect, palpate anddescribe skin lesions

2.4.Observe and palpateskin moisture

2.5.2.6.Note the skin turgor

In white skin: light to dark

pink

In dark skin: light to dark

brown, oliveEdema: no swelling, pitting

or edema.

Skin lesion: none

Skin moisture: warm dry.

Skin texture: smooth, soft.

Skin turgor: pinched up

skin returns immediately to

original position

The skin complexion is brown.

No presence of edema or swelling.

No skin lesion

The skin is warm to touch

Skin returns immediately to its original position

when pinched.

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deposits, streak, freckles

5. Skull and face

5.1.Inspect the skull for sizeshape and symmetry

5.2.Palpate the skull fornodules or masses and

depressions

5.3.Inspect facial features5.4.The eyes for edema or

hollowness

5.5.Note symmethry offacial movements

Size, shape, symmetry:

rounded, smooth skull

contour

Smooth, uniform

consistency, absence of

nodules and masses

Facial features:

Symmetric/slightly

asymmetrical facial

features, palpebral fissures,

equal in size; symmetric

nasolabial folds

The skull is symmetrical in shape.

Elicit facial features

Theres a symmetry of facial features

6. Eye structure and Visual

Acuity

6.1.Inspect the eyebrows,eyelashes and eyelids

Eyebrows: Hair evenly

distributed; curled slightly

outward. Eyebrows

symmetrically aligned;

Equal movement

Eyelashes: Equally

Eyebrows hair were evenly distribution,

symmetrically aligned

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6.2.Inspect the bulbar andpalpebral conjunctiva

6.3.Inspect and palpate thelacrimal gland, lacrimal

sac and nasolacrimal

duct

6.4.Perform the cornealsensitivity reflex test

6.5.Inspect the pupils forcolor, shape symmetry

of size

distributed; curled slightly

outward

Eyelids: Lid margins moist

and pink. Skin intact; no

discharge; no discoloration

Bulbar conjunctiva: Shiny.

Smooth and pink or red

Lacrimal gland: no edema

or tenderness

Lacrimal sac and

nasolacrimal duct: no

edema or tearing

Client blinks when the

cornea is touch, indicating

that the trigeminal nerve is

intact

Color: Black

Equal in size, normally 3-7

mm diameter; round,

smooth border iris flat and

round

Elicit corneal sensitivity reflex test

Pupils color were black

Equal in size

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6.6.Assess the pupils directconsensual reaction to

light and

accommodation

6.7.Assess peripheral visualfields

6.8.Assess six ocularmovements

6.9.Assess visual acuity

Illuminated pupil

constricts.

Non illuminated constricts

When looking straight

ahead, client can see the

objects in the periphery.

Both eyes coordinated,

move in unison, with

parallel alignment

Able to read newsprint

When light passes through the pupil, it constrict

7. Ears and hearing

7.1.Inspect and palpateauricles

Color; same as facial skin

Symmetry of size is

symmetrical.

The auricle aligned with

outer canthus of eye, about

10 from vertical

Mobile, firm, and not

tender, pinna recoils after

Pinna recoils when folded

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7.2.Inspect the external earcanal for cerumen skin

lesions, pus and blood

and the tymphanic

membrane for color

and gloss

7.3.Palpate the maxillaryand frontal sinuses for

tenderness

it is folded

Distal third contains hair

follicles and glands. Dry

cerumen, grayish-tan

color; or sticky wet

cerumen in various shades

of brown

No masses in maxillary and

frontal sinuses.

No presence of masses in maxillary or frontal

sinuses

8. Nose

8.1.Inspect and palpate theexternal nose

8.2.Determine the patencyof both nasal cavities

Symmetric and straight, no

discharge or flaring

Color is uniform; not

tender and no lesions

Air moves freely as the

client breaths through the

nares

Theres no discharge

No lesions

9. Mouth and Oropharynx

9.1.Inspect and palpate lips Color of outer lids is Color of lips were slightly pink

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9.2.Inspect the teeth andgums

9.3.Inspect and palpate thetongue, mouth floor and

frenulum

9.4.Inspect the tongue

uniform, pink, (darker in

dark skinned clients)

Texture is soft, moist and

smooth.

Symmetry of contour

Inner lips color is uniform

(Freckled brown

pigmentation in dark skin

client)

32 adult teeth

smooth, white, shiny tooth

enamel

Pink gums

Moist, firm texture to gums

No retraction of gums

Central position; pink

color; the mouth floor is

moist; slightly rough; thin

whitish coating. Smooth,

lateral margins; no lesions

Raised papillae or taste

buds

Texture is slightly rough

Tooth were no longer complete

Has pink gums

The tongue is pink in color

Tongue moves freely

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movement

9.5.Inspect the hard andsoft palate

9.6.Inspect the ovula forcolor, discharge and

mobility

9.7.Inspect the tonsils forcolor, discharge and

size

9.8. Elicit the gag reflex

Moves freely

Light pink, smooth, soft

palate. Lighter pink hard

palate, more irregular

texture

Positioned in midline of

soft palate

Tonsils color is pink and

smooth

No discharge and normal

size or not visible

Present

Elicit the gag reflex test

10. Neck

10.1.Assess head movementand muscle strength

10.2.Palpate the neck forenlarge lymphnodes

10.3.Palpate the thorax forbulges and tenderness

10.4.Inspect and palpate

Coordinated, smooth

movements with no

discomfort

No enlarge lymph nodes

Central placement in

Can move freely without discomfort

No presence of enlarge lymph nodes

Thorax were in the midline of neck

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the thyroid gland midline of neck

Not visible on inspection

11. Thorax and lungs

11.1.Inspect the shape andsymmetry of the

thorax

11.2.Inspect the spinalalignment for

deformities

11.3.Palpate the thorax forbulges and tenderness

11.4.Palpate the chest forrespiratory excursion

11.5.Palpate the chest forvocal or tactile

fremitus

11.6.Percuss for

Anteroposterior to

transverse diameter in

ratio 0f 1:2

Chest symmetric

Spine vertically aligned

Spinal column is straight,

right and left shoulders and

hips are at the same height

Skin intact; uniform

temperature

Full and symmetric chest

expansion

Bilateral symmetry of vocal

fremitus

Fremitus is heard most

nearly at the apex of the

Theres no spinal deformities

Theres symmetry of chest expansion when the

patient inhales.

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diaphragmatic

excursion

11.7.Auscultate the chest

lungs

Excursion is 3-5 cm (11/2to

2 in.) bilaterally in woman

in 5-6 cm (2-3 in.) in men

Diaphragm is usually

slightly higher on the right

side

Vesicular and

bronchovesicular breathe

sounds.

12. Heart

12.1.Auscultate the heart inall four anatomic sites:

aortic, pulmonic,

tricuspid and mitral

12.1.Palpate the peripheralpulses both sides of the

body

Usually louder at base of

heart.

Systole: silent interval;

slightly shorter duration

than diastole at normal

heart rate (60-90 beats per

minute)

Diastole: silent interval;

slightly longer duration

than systole at normal

heart rate

Heart rhythm were above normal

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Symmetric pulse volume;

full pulsations

13.Sensory function13.1.Light touch sensation13.2.Pain sensation

13.3.Position or kinestheticposition

13.4.Tactile discriminationstereognosis

Light tickling or touch

sensation

Able to discriminate

sharp and dull

sensations

Can readily determine the

position of fingers and toes

Recognizes common

objects

Can feel light touch

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I. Physical Assessment

T: 39.1

P: 110 bpm

R: 24

BP: 120/80

II. Laboratory and Diagnostic Examination results

CBG

CBG RESULTS NORMAL VALUES INTERPRETATION &

ANALYSIS

450 mg/dl 80-120 mg/dl

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III. Medication

Drug Name Dosage Classification Indication Side Effect Contraindications Nursing Responsibility

Ketorolac 30mg/amp1

amp IM

Nonsteroidal

anti-

inflammatory

agents, nonopioid

analagesics

Inhibits

prostaglandin

synthesis, producing

peripherally

mediated analgesia

- Also has

antipyretic and anti-

inflammatory

properties.

- Therapeutic

effect:Decreased

pain

dizziness Hypersensitivity

- Cross-sensitivity

with other NSAIDs

may existPre- or

perioperative use

- Known alcohol

intoleranceUse

cautiously in:

-cardiovascular

disease.

- Ketorolac therapy should

always be given initially by

the IM or IV route. Oral

therapy should be used only

as a continuation of

parenteral therapy.

-Caution patient to avoid

concurrent use of alcohol,

aspirin, NSAIDs,

acetaminophen, or other

OTC medications without

consulting health care

professional.

- Advise patient to consult

if rash, itching, visual

disturbances, tinnitus,

weight gain, edema, black

stools, persistent headche,

or influenza-like syndromes

(chills,fever,muscles aches,

pain) occur.

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Etoricoxib 120mg

OD

NSAIDS ARCOXIAselectively

inhibits

cyclooxygenase

(COX)-2, the

isoform associated

with pain and

inflammation

Relief of acute

pain

The patient should

tell the doctor his

medical history,

especially of: angina,

heart attack or a

blocked artery in the

heart, narrow or

blocked arteries of

the extremities

kidney disease, liver

disease, heart failure,

high blood pressure

-Check if the patient have a

history of stoke.

- If the patient have any

allergies to any other

medicines or any other

substances, such as foods,

preservatives or dyes.

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Pathophysiology

Heredity

Age

Food Eating habit

(Rich in glucose)

Blurred visionIncreased thirst

FatigueFrequent urination

Slow wound healing

Since the body cells and tissues are non responsive to insulin,

lucose remains in the bloodstream.

There is normal production of insulin

hormone but the body cells are

resistant to insulin

Leads to hyperglycemia

Predisposing Precipitating

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IV. Nursing Care Plan

Cues Analysis Goal/objective Nursing

Intervention

Rationale Evaluation

S: ang sakit ng

sugat ko as

verbalize by the

client.

O: restlessness

Facial

Grimace

Guarding

Behavior

Pain scale: 7/10

Temp:37.5

PR: 100 bpm

RR: 24

Acute pain

related to right

knee amputation

After an hour of

nursing

intervention the

clients pain will

be lowered downfrom 7-4.

>assist patient to

assume position of

comfort

>monitor painclosely

>administer

analgesics as

ordered by the

physician

>to obtain some

pain relief

>to assessincreases in

severity

>to maintain

acceptable level

of pain

After an hour of

nursing

intervention

GOAL WAS

MET; the clientspain was lowered

down from 7-4.

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V. Discharge PlanMedication

Take etoricoxib once pain was felt.

Exercise

Encourage Passive Range Of Motion exercises on the unaffected leg.

Treatment

HCG monitoring and insulin therapy.

Health teaching

The patient should watch for what he eats. Should take the prescribed medications to help him in his early recovery andfollow the suggested diet.

Out Patient Follow Up

The patient needs to go back in the outpatient department after 1 week of being discharged in the hospital.

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Diet

You can keep your blood glucose at a healthy level if you:

y Every day, choose foods from these food groups: starches, vegetables, fruit, meat and meat substitutes, and milk and yogurt.

y Limit the amounts of fats and sweets you eat each day.

Spiritual Counseling

The patient should have faith inGod and try to go to church every Sunday and attend the mass. And never stop praying.