MEDICAL SURGICAL NURSING (A CARE STUDY OF A PATIENT WITH DIABETES RIGHT FOOT ULCER)
TABLE OF CONTENT
Title page ………………………………………………………………………… i
Certification ……………………………………………………………………… ii
Dedication ………………………………………………………………………… iii
Acknowledgement ………………………………………………………………… iv
Table of content ……………………………………………………………………v
CHAPTER ONE
INTRODUCTION
Background of the study ……………………………………………………………. 1
Purpose of the study ………………………………………………………………… 2
Significant of the study …………………………………………………………… 3
CHAPTER TWO
LITERATURE REVIEW OF DIABETES MELLITUS FOOT ULCER
Definition of diabetic foot ulcer …………………………………………………… 5
Causes of diabetes foot ulcer ………………………………………………………. 6
Risk factor for diabetes foot ulcer …………………………………………………… 6
Foot ulcer assessment and classification …………………………………………… 11
Pathophysiology of diabetes foot ulcer ……………………………………………… 13
Clinical manifestation of diabetes foot ulcer ………………………………………… 14
Complication of diabetes foot ulcer ………………………………………………… 15
Wound healing ……………………………………………………………………… 16
Factor influencing wound healing in diabetic patient ……………………………… 18
How to improve diabetes foot ulcer healing ……………………………………… 20
Management of patient with diabetes foot ulcer ……………………………….. 21
Prevention of diabetes mellitus foot ulcer ……………………………………… 25
Prognosis ………………………………………………………………………… 26
CHAPTER THREE
Demographic data and history of the patient …………………………………… .28
Source of data …………………………………………………………………… 29
Patient family and social history…........................................................................... 29
Past medical history ……………………………………………………………………. 29
Present history of illness………………………………………………………………. 30
Clinical features presented by the patient …………………………………………….. 30
Nursing history/ assessment ………………………………………………………….. 31
CHAPTER FOUR
MANAGEMENT OF THE PATIENT WITH DIABETES MELLITUS FOOT ULCER
Physician systemic review ………………………………………………………………. 34
Physician diagnosis ……………………………………………………………………… 36
Medical management of the patient with diabetic foot ulcer …………………………… 36
Pharmacology of drug used on the patient ……………………………………………. 37
Daily nursing care and progress of the patient ………………………………………… 42
Health education ……………………………………………………………………….. 48
Rehabilitation ………………………………………………………………………….. 49
Discharge ……………………………………………………………………………… 50
Home visit …………………………………………………………………………….. 50
CHAPTER FIVE
Summary ……………………………………………………………………………… 53
Conclusion ……………………………………………………………………………. 53
Recommendation……………………………………………………………………… 53
Reference ……………………………………………………………………………… 54
Drug Indication Mode of action Dosage Route Side effect Contra
indication Nursing
Responsibility
Nifedipine Angina pectoris, arterial hypertention myocardiopathy It dilates the coronary arteries reducing the contration and oxygen demand of the myocardium 10-20mg 4hrly daily Orally Headache nausea
Skin rash
Dizziness Pregnancy
Lactation
Hypersensitivity reaction It should not be given to patient with pregnancy, hypertention and it should be taking with plenty of water
Capitopril Hypertention, congestive cardiac failure
Renal artery stenosis It reduces cardiac overload and increase cardiac output 25mg twice daily Orally Hypotension
Proteinuria
Lost of taste
Anaemia Aortic stenosis
Pregnancy
Lactation Care must be taken not to give the patient potassium supliment so as not to cause hyperkalaemia
Soluble insulin Diabetes mellitus schizophrenia, anorexia in under nourish patient It facilitate the transportation of glucose to the body tissue and also enhance proper ultilisation and oxidation of blood glucose by the body cell0.5-5mls half hour before meal
Subcutenously,intramuscularly and intravenously
Hypoglyc
emia
systemic hypersensitivity cutenous reaction like lipodystrophy Urticaria or hypotension hypersensitivity Test the urine for glucose and acetone before each meal and to help determine dose of insulin to administer.
Glucophage Non insulin dependent diabetes mellitus It promote glucose uptake by body cell Inicially 500mg bd then can be increase to Orally Nausea vomiting lactidosidosis Diabetes coma ketoacidosis, renal insufficiency Should not be given to patient with impaired renal or hepatic disfunction
Vitamin B Beriberi
Pellagra The cyanocobalamin contain help in maturation of erythrocyte during erythropoises One to two tablet three time daily before are after meal Orally
Intramuscullarly No noticeable side effect Incompactable with kenamicin injection Serve the correct dose and avoid giving it kenemycin injection
CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
This case study was carried on Alhaja A.H, a 60years old trader who has right foot ulcer, patient was brought to accident and emergency unit on 30th march, 2017 with clinical diagnosis of right foot ulcer and later transfer to ward 2.
Approximately 15 to 20 percent of estimated 16million persons in the united state with diabetes mellitus will be hospitalized with a foot complication and also estimated in Nigeria (Harrison, 2012).
Mustapha (2010) define diabetes mellitus as an endocrine disorder in which there is deficiency or lack of insulin production leading to metabolic disorder of carbohydrate, fat and protein and characterized by hyperglycemia, dehydrative vascular changes and neuropathy.
Foot ulcers are significant complication of diabetes mellitus and after precede lower- extremity amputation. The most frequent underlying etiologies are neuropathy, trauma, deformity, higher planter pressure and peripheral arterial disease. Thorough systemic evaluation and categorization of foot ulcer help guild appropriate treatment (Fryberg, 2011)
Foot disorder such as ulceration, infection and gangrene are the leading causes of hospitalization in patient with diabetes mellitus. Unfortunately many of those patients will require amputation with the foot or above the ankle as a consequence of severe infection or peripheral ischemia (Mustapha, 2011).
Approximately 85 percent of the diabetes – related lower extremity amputation are preceded by foot ulcer. Sharp debridement, management of underlying infection, and ischemia as well as relief of pressure using total contact cast, removable cast walker or half shoe are mainstay of initial treatment of diabetic foot ulcer. The aim of therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed. Multidisciplinary management programs that focus on prevention, education, regular foot examination, aggressive intervention and optimal use of significant reductions in the incidence of lower extremity amputation. (Fryberg,2011)
PURPOSE OF THE STUDY
To critically look at concept of diabetes complication i.e. diabetes mellitus foot ulcer, causes, sign and symptoms, predisposing factor, prevention and management of the condition
To provide adequate care for diabetic mellitus foot ulcer patient and prevent further complication that can arise from diabetes foot ulcer such as amputation and even death
To increase knowledge in medical field from latest discovery and management of diabetes foot ulcer. Hence preventing or minimize the rate at which other complication arise
To create awareness about the disease and health educate the people on how it can be detected and prevented
To serves as an award of certificate in general nursing as required by the nursing and midwifery council of Nigeria
SIGNIFICANCE OF THE STUDY
The importance of this study cannot be overemphasized based on the following point
i. This care study provide patient the opportunity to have close access to health practitioner and hence benefitting from therapeutic health education
ii. It increase nurse-patient relationship by improving an individualized care for the patient
iii. It will serve as base line for further studies about diabetes mellitus foot ulcer and it will help in the reduction of mortality rate in patient with diabetes mellitus foot ulcer, thereby improving economic standard of the patient
iv. It provide information necessary to carryout research for junior nurse who might be faced with the challenge of care study in the course of his/her study
v. It enhances the nurse ability to give an appropriate health education to the people as the nurse is better equip with updated knowledge.
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