ppt group 2 case pres

8/6/2019 Ppt Group 2 Case Pres

1/14


2/14

Type IIType II

Type IIType II

Type IIType II

Type IIType II

Type IIType II

Type IIType II Type IIType IIType IIType II

Type IIType II

Type IIType II


3/14

Diabetes mellitus, often simplyDiabetes mellitus, often simply

referred to as Diabetes, is a chronicreferred to as Diabetes, is a chronic

metabolic disorder that causesmetabolic disorder that causes

persistent thirst (persistent thirst (polydipsiapolydipsia),),

excessive urination (excessive urination (polyuriapolyuria),),

increased hunger (increased hunger (polyphagiapolyphagia),),

weight loss and a surplus of sugar inweight loss and a surplus of sugar in

the blood and urine. Althoughthe blood and urine. Although

Diabetes can develop at any age, it isDiabetes can develop at any age, it is

more common among women thanmore common among women than

among men, with excessiveamong men, with excessive

overweight as contributing factor inoverweight as contributing factor in

later life.later life.

Patient B.T., a 49 year old male livingPatient B.T., a 49 year old male living

inin HimamaylanHimamaylan was constantly havingwas constantly having

Diabetes Mellitus type II for twoDiabetes Mellitus type II for twoyears. Patient got accidentallyyears. Patient got accidentally

wounded on the sole of his right footwounded on the sole of his right foot

and due to poor management theand due to poor management the

wound continued to progress untilwound continued to progress until

necrosis of some tissues occurred.necrosis of some tissues occurred.

Also, the patient manifested weightAlso, the patient manifested weightloss as stated by his wife.loss as stated by his wife.

For this reason, he was brought to Bacolod

our Lady of Mercy Specialty Hospital inBacolod City and was admitted where he

was diagnosed of having Diabetic Right

Foot Wagner III after a series of

assessments made. Patient was

recommended to undergo Below the Knee

Amputation to prevent the spread of

necrosis to the upper portion of his body.

This case study will surely help us students

to enhance care for patients who have

Diabetes Mellitus II through the applicationof nursing skills, interventions and

knowledge.


4/14

The pancreas is an elongated organ thatlies behind and below the stomach. This

mixed gland contains both exocrine andendocrine tissues. The predominantexocrine part consists of grape-likeclusters of secretory cells that form sacsknown as acini, which connect to ducts

that eventually empty into the first

portion of the intestine calledduodenum. The smaller part of the glandconsists of isolated islands of endocrine

tissue known as islets ofLangerhans which are dispersed

throughout the pancreas

Pancreas

Structure of the Pancreas

The most important hormones secreted by

the pancreas are insulin and glucagon.

Both play a role in proper metabolism of

sugars and starches in the body. Insulin

promotes the movement of glucose and

other nutrients out of the blood and into

cells. When blood glucose rises, insulin,released from the beta cells causes

glucose to enter body cells to be used for

energy. Also, it sometimes stimulates

conversion of glucose to glycogen in the

liver. Another pancreatic hormone,

glucagon, promotes the movement of

glucose into the blood when glucose

levels are below normal. It causes the

breakdown of stored liver glycogen to

glucose, so that the sugar content ofblood leaving the liver


5/14

AssessAssessmentment

Date: July 15, 2010Time: 7:00 am

VitalVital SignsSigns

P-117 bpm

R-21 cpm

Musculoskeletal

Patient is able to move from side

to side with assistance from

folks. Able to perform active

range of motion. Patient is

unambulatory.

Integumentary

Patient skin is of dark complexionand is dry on lower extremities

and on palm of hands. Patient

has non-healing wound with

necrotic tissues on right foot.


6/14

Predisposing Factor:

PathophPathophysiologyysiology

Predisposing FactorPredisposing Factor Precipitating Factor:Precipitating Factor:

Male and Age above 40y.oPoor lifestyle (lack of exercise andexcessive eating food high in sugar)

Destruction of beta and alpha cells

Stimulates beta cells to secrete Insulin (Malfunction of Insulin)

Unable to Transport glucose (Insulin resistant) inside the cell to oxidize it for

energy;Unable to Store glucose in the Liver as glycogen or fat.

Glucose is retained in the bloodstream (hyperglycemia)

Without insulin, excessive glucose spills in the urine because kidney

tubule cells cannot reabsorb it fast enough


7/14

Polyuria

Polyuria Dehydration Diabetes Insipidus

Cells breakdown proteins

and fats to meet bodys

energy reqts

Polyphagia

Infection

Polydipsia (Increased thirst)

Non- Healing Wound

Weight loss


8/14

Drug StudyDrug Study

C H

E

CK

Metforminhydrochloride

5 00 mg/tab

Exactmechanism isnotunderstood:possiblyincreaseperipheralutilization of

glucose,decreaseshepatic glucoseproduction,and altersintestinalabsorption ofglucose

Antidiabetic

Adjunct to dietto lower bloodglucose withtype 2 diabetesmellitus

TID

discontinue

thismedication

without

consulting

yourhealth

care provider

Monitorblood

forglucose andketones as

prescribed.

Avoidusing

alcoholwhile

taking this

drug

Report fever,

sore throat,unusual

bleeding

Assessif there is

allergy to

metformin;diabetes

complicatedby fever,

severe infections,

severe trauma, major

surgery

Monitorurine orserumglucose levels

frequently todetermine

effectivenessofdrug

anddosage

Monitoradverse

effects:

Endocrine:

hypoglycemia, lactic

acid acidosis

GI: anorexia ,nausea,

vomiting, epigastric

discomfort, heartburn

diarrhea, flatulence

Hypersensitivty:allergi

c skin

reactions, eczema,

pruritus,erythema.


9/14


CH

E CK

Meloxica

m 15 mg

Anti-inflammatory,

analgesic, and

antipyretic

activitiesrelated

toinhibitionof

enzyme

cyclooxygenase(

COX), whichis

required forthesynthesisof

prostaglandin

and

thromboxanes.

Somewhat more

selective for

COX-2 sites

(foundin the

brain, kidney,

ovary, uterus,

cartilage,bone,

andat sitesof

inflammation)

NSAID

Relief fromsignsand

symptomsof

osteoarthritis

and

rheumatoid

arthritis.

TID Take drugwithfoodif GI

upset occur

Take only

prescribed

dosage

Report sore

throat, fever,

rash, itching,weight gain,

swellingin

anklesor

fingers.

Report

changesin

vision

Assess the historyof the allergiesof

the medication

Administerdrug

with foodormilk

if GIupset occurs

Establishsafety

measuresif CNS

disturbance occurs

Monitoradverse

effects: CNS: headache,

dizziness,

somnolence,

insomnia,

fatigue,,tiredness,ti

nnitus,

ophthalmologic

effects

Dermatologic:

rash,pruritus,sweating, dry

mucous

membranes,

stomatitis

GU:Dysuria, renal

impairment

GI: nausea,

despepsia, GIpain,

diarrhea, vomiting


10/14


C H E C K

Clindamycin300mg

Isotretinoinnoticeably

reduces the

production of

se bum and

shrinks the

sebaceous

glands. It

stabiliseskeratinization

and pr events

comedones

from forming.

Inhibitsprotein

synthesis in

susceptible

bacteria

causing cell

death.

BID

Ifyoumissa

dose of

Clindamycin,

take it assoon

aspossible.If

it isalmost

time foryour

next dose, skip

the missed

dose andgo

back toyourregulardosing

schedule.Do

not take 2

dosesat once.

Youmay

experience

these side

effects:nausea

andvomiting,superinfection

inmouth

Report severe

watery

diarrhea,

abdominal

pain, inflamed

mouth

Culture infection

before therapy.

Donot use for

minorbacterialor

viralinfections

MonitorAdverse

effects:

CV:hypotension,

cardiacarrest.

GI: severe colitis,

nauseaandvomitinganorexia

Hematologic:

Neutropenia,

leucopenia,

agranulocytosis

Hypersensitivity:

rashes,urticaria


11/14

Nursing Care PlanNursing Care Plan

Assessment Nursing

Diagnosis

Pathophysiology Desired Outcome Nursing Interventions Justification Evaluation

A.Actual Abnormal

Cues

Objective Data:

y Presence of

necrotic tissues

onRight foot.

y Foulsmelling

odoron

affected foot.

y Poorcapillary

refillof 4-

5secondson

right foot.

y Increasedblood

sugarlevelsof

B. Risk Related

Factor:

y

Old AgeC. Strengths and

Wellness

y Availabilityof

healthservices

y Compliance of

thepatient and

herfamily to

medication

y Good family

support

Ineffective

Tissueperfusionrelated to

viscosity of

blooddue to

increase blood

sugarlevels AEB

presence of

necrotic tissues,

poorcapillary

refillonaffectedextremity, and

foulsmelling

wound.

Definition:

decrease in

oxygenresulting

in the failure to

nourish the

tissuesat the

capillarylevel.

Reference:

NursesPocket

Guide

ElevatedBlood

Sugarlevels

Increase Viscosity

ofBlood

Decrease blood

flow

NecroticRight foot

Ineffective tissue

perfusion

Reference:

Medical Surgical

Nursing

After 16 hours of

nursing care, patientwill be able to:

y Prevent the spread

ofdecreased

tissue perfusion to

otherpartsof the

body.

y Demonstrate a

positive Attitude

towards

therapeuticregimen.

Independent intervention:1. Assessvitalsignsandskin

turgor.

2. Instruct patient toperform

Range ofmotion.

3. Provide asafe

environment for the

patient.

4. Monitoranddocument

Intake and Output

5. Monitorvitalsigns every

1 to 2 hoursoras theclientscondition

indicates

6. Assessskinandmucous

membrane moisture, skin

turgor, presence of thirst,

andmentalstatus.

7. Explain to thepatient the

necessityandbenefitsin

undergoingBelow the

Knee Amputation

Collaborative intervention:

1. Collaborate withDietitian

andphysician to.

Reference: Fundamentalsof

Nursing

1,Accurate assessmentenables the nurse todevelop

appropriate plans for

therapyregimen.

2,Topromote properblood

circulation.

3.Toprevent complications

suchasskinbreakdown,

lossofskinintegrity.

4.Measuringintake and

output allows the nurse to

maximize perfusion.5.Hypotensionandan

increasedpulse rate are

indicative ofintravascular

deficit.

6.Poorskin turgor, tissue

dryness, andpresence of

thirst are indicationsof

dehydration.

7.Toincrease knowledge of

patient that BKA is

necessary toprevent the

spreadofnecrosis.

1.Toidentify foodsand

othertherapeuticregimens

indicated forpatient to

decrease viscosityof the

blood.

Reference: Nursing Care

Plans, Medical Surgical

Nursing

After 16 hours

of nursing care,

patient was able

to:

Client isabout to

undergoBelow

the knee

amputation

whichwillprevent the

spreadof

necrosis.Goal

partially met.

Demonstrate a

positivebehavior

toward

therapeutic

regimenas

evidencedby

goodcompliance

andallowing the

surgery tobe

performed.Goal

Met.


12/14

Nursing Care PlanNursing Care PlanASSESSMENT NURSING

DIAGNOSIS

RATIONALE DESIREDOUTCOME

NURSING

INTERVENTIONS

JUSTIFICATION EVALUATIO

A.ActualAbnormal

Cues:

-NonHealingwoundwith Necrotic tissues

onRight foot.

B. Risk Related

Factors

y Inadequate

primarydefenses

(brokenskin,

traumatizedtissue)

y Oldage

y Decreasedlevel

ofbodyproteins

C.Strengths/Wellness

y Strongbeliefin

God

y GoodFamilysupport.

y Goodcompliance

to therapeutic

regimens.

Impaired Skin

Integrity related

toImpairedTissueper

fusionAEB

NecroticRight

Foot.

Definition:

Alterationsin

the Dermisand

Epidermis.SOURCE:

NANDA 8th

edition

Increasedblood

sugarlevels

Decreasedprotein

levels

DelayofHealing

process

Non-healing

woundwith

necrotic tissueson

right foot.

Impaired Skin

Integrity.

Source: Medical

Surgical Nursing

byBlackand

Hawks

After16 hoursof

nursinginterventions,

myclient willbe ableto:

y Identify

interventions to

reduce spread

ofinfection to

otherpartsof

the body.

y Verbalize

understandingofindividual

causative /risk

factors.

y Have a positive

Attitude

towards

therapeutic

regimen.

Independent:

1.Dailywounddressing

ofwound.2. Stressproperhand

hygiene byclient and

clientsvisitors.

3. Monitorpatients

temperature andperform

tepidsponge bathif

temperature is elevated.

4. Monitoranydrainage

comingout from the

patientswound.

5.Emphasize necessity

of takingantibioticsas

directed.

6.Explain the procedures

needed for furthercare.

Collaborative:

7.Prepare patient pre-

operatively (Below the

knee Amputation) as

ordered.

8.EncourageconsultationofDietitian.

Reference:

Fundamentals

of Nursing

Toreduce bacteria

present in the woundandprevent it fromhavinga

foulsmell.

Toprevent spreadof

infection fromdirect

contact.

Todetermine the

patientsresponse to

infectionanddecrease

temperature.

Toidentifyseverityof

the wound.

Premature

discontinuationof taking

antibioticsmay result to

increase infectionand

potentiate drug-resistant

strains.

To elicit cooperation and

alleviate anxiety.

Tohelppatient inget

ready for the upcoming

operation.

Tohave alist of foods

indicated torestore

energylevelsandprevent

worseningofcondition

(DiabeticDiet).

SOURCE: NANDA 8 th

edition

After16 hourso

nursing

interventions, myclient wasable t

Client wasable t

identify

interventions to

prevent/reduce th

riskofinfection

like requesting f

regularwoundcleaning. Goalm

Client wasable t

understand the

different causati

/risk factorslike

unhygienic

practices. Goal

Demonstrate apositivebehavio

towards therape

regimenby

cooperatingwith

theprocedures

performed. Goal

Met.


13/14

Nursing Care PlanNursing Care Plan

ASSESSMENT NURSING

DIAGNOSIS

RATIONALE DESIRED

OUTCOME

NURSING

INTERVENTIONS

JUSTIFICATIO

N

EVALUATION

Risk Related Factors

y Inadequate

primarydefenses

(brokenskin,

traumatized

tissue)

y Immunosuppresi

on.

y Prolongedstay

in the hospital

Strengths/Wellness

y Strongbeliefin

God

y Goodcompliance to

medications

Risk forinjury

related to

alteredphysical

mobilitydue to

necrosisof

right foot.

Definition: At

riskofinjuryas

aresult of

environmental

conditions

interactingwith

the individuals

adaptive and

defensive

resources.

SOURCE:

NANDA 8th

edition

Non-healing

woundand

NecrosisofRight

foot.

Alterationsin

mobility

Risk forinjury

Source: Medical

Surgical Nursing

byBlackand

Hawks

After16 hoursof

nursinginterventions,

myclient willbe able

to:

y Identify

interventions

to

prevent/reduce

riskofinjury.

y Verbalize

understanding

ofindividual

causative /risk

factors.

y Demonstrate

behaviors,

lifestyle

changes to

reduce risk

factorsand

protect self

frominjury.

Independent:

Provide side rails to

patient.

Teachpatient tomove

carefully.

Use wheelchair in

transportingpatient from

one area toanother.

Ascertain knowledge of

safetyneedsorinjury

preventionand

motivation toprevent

injury.

Provide information

regardingdisease or

condition that mayresult

inincrease riskofinjury.

Encourage participation

inself-helpprogramssuchasassertiveness

training, positive self-

image.

Collaborative:

Refer tophysicalor

occupational therapist as

appropriate.

Reference:

FundamentalsofNursing

Toprevent falls.

Toprevent from

gettinginjured.

Topromote safety

forthepatient

during

transportation.

To evaluate degree

orsource ofrisk

inherent in the

individuals

situation.

Tocorrect or

reduce individual

risk factors.

To enhance self-

esteem.

Tocorrect or

reduce individual

risk factors.

.

SOURCE:

NANDA 8th

edition

After40 hoursof

nursinginterventions, my

client wasable to:

Client wasable to

identify

interventions to

prevent/reduce the

riskofinfection

likeprovidinga

safe environment.

Goalmet.

Goalmet. Client

wasable to

determine the

different causative

/risk factors like

falls. Goal Met. .

Demonstrate

behaviors, lifestyle

changes toreduce

risk factorsand

protect self from

injurylike

identifying the

benefitsof

undergoing

procedures

required forhealth

maintenance. Goal

Met.


14/14

Health TeachingHealth Teaching

MEDICATION EXERCISE TREATMENT HYGIENE OUTPATIENT DIET

-Compliance tomedications to

promote optimal

healing.

Passive andactive range

ofmotion

helpspromote

circulation

andimprove

tissue

perfusionand

usebodyglucose for

energy

oxidation.

-Compliance to treatmenttopromote optimalhealing:

Below the Knee

Amputation toprevent the

spreadofnecrosisgoing to

the upperextremity.

Antibiotics that inhibits the

growthofbacteriawhich

causesinfection.Enoughrest andsleep to

provide the bodysneeded

energy.

Regularcleansingof

wound toprevent further

infection.

Laboratoriesordered to

detect abnormalities.Oralhypoglycemicagents

anddaily exercise.

Dailybrushingof teethdecreasesnumberof

microorganismspresent in

the mouthandprevent it

fromgettingswallowed.

Bedbathifnot

contraindicated.

Tepidspongebath to

promote comfort anddecreasebody

temperature ifpatient is

febrile.

Woundcleansingas

orderedby thephysician

toprevent infection

affectedsite.

Goodcompliance tomedicationasprescribed

by the doctor( not tomiss

ordouble the dose)

Dailywounddressing to

promote woundrecovery.

Follow the diet asadvised

tohelp the bodyrestore

energylevelsandpreventworseningofcondition.

Provide enoughrest

periodsandsleep.

Regularhealthcheckup

the doctortomonitor

patientsrecovery.

Notifyphysician forany

untowardsymptomsofmedications taken.

Daily exercise topromote

properbloodcirculation

andoxidizebodys excess

glucose.

DiabeticDiet- foods

lowinsugartoprevent

furtherworseningof

the condition.

ppt group 2 case pres

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