Kwara State College Of Nursing And Midwifery, Ilorin

Description

TABLE OF CONTENT

Title page …………………………………………………………………………               i

Certification ………………………………………………………………………               ii

Dedication …………………………………………………………………………             iii

Acknowledgement …………………………………………………………………             iv

Table of content ……………………………………………………………………             v

CHAPTER ONE

INTRODUCTION

1.1       Background of the study …………………………………………………………….          1

1.2       Purpose of the study …………………………………………………………………          2

1.3       Significant of the study ……………………………………………………………             3

CHAPTER  TWO

LITERATURE REVIEW OF DIABETES MELLITUS FOOT ULCER

2.1       Definition of diabetic foot ulcer  ……………………………………………………           5

2.2       Causes of diabetes foot ulcer ……………………………………………………….            6

2.3       Risk factor for diabetes foot ulcer ……………………………………………………         6

2.4       Foot ulcer assessment and classification ……………………………………………            11

2.5       Pathophysiology of diabetes foot ulcer ………………………………………………         13

2.6       Clinical manifestation of diabetes foot ulcer …………………………………………         14

2.7       Complication of diabetes foot ulcer …………………………………………………          15

2.8       Wound healing ………………………………………………………………………           16

2.9       Factor influencing wound healing in diabetic patient ………………………………           18

2.10     How to improve diabetes foot ulcer healing ………………………………………              20

2.11     Management of patient with diabetes foot ulcer ………………………………..                 21

2.12     Prevention of diabetes mellitus foot ulcer ………………………………………                 25

2.13     Prognosis …………………………………………………………………………                26

CHAPTER THREE

3.1       Demographic data and history of the patient ……………………………………                .28

3.2       Source of data ……………………………………………………………………                29

3.3       Patient family and social history……………………………………………………………………              29

3.4       Past medical history …………………………………………………………………….      29

3.5       Present history of illness……………………………………………………………….        30

3.6       Clinical features presented by the patient ……………………………………………..        30

3.7       Nursing history/ assessment …………………………………………………………..         31

CHAPTER FOUR

MANAGEMENT OF THE PATIENT WITH DIABETES MELLITUS  FOOT ULCER

4.1       Physician systemic review ……………………………………………………………….    34

4.2       Physician diagnosis ………………………………………………………………………    36

4.3       Medical management of the patient with diabetic foot ulcer ……………………………    36

4.4       Pharmacology of drug used on the patient …………………………………………….       37

4.5       Daily nursing care and progress of the patient …………………………………………      42

4.6       Health education ………………………………………………………………………..      48

4.7       Rehabilitation …………………………………………………………………………..       49

4.8       Discharge ………………………………………………………………………………       50

4.9       Home visit ……………………………………………………………………………..        50

CHAPTER FIVE

5.1       Summary ………………………………………………………………………………        53

5.2       Conclusion …………………………………………………………………………….        53

5.3       Recommendation………………………………………………………………………        53

Reference ………………………………………………………………………………       54

Drug	Indication	Mode of action	Dosage	Route	Side effect	Contraindication	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 nauseaSkin rashDizziness	PregnancyLactationHypersensitivity reaction	It should not be given to patient with pregnancy, hypertention and it should be taking with plenty of water
Capitopril	Hypertention, congestive cardiac failureRenal artery stenosis	It reduces cardiac overload and increase cardiac output	25mg twice daily	Orally	HypotensionProteinuriaLost of tasteAnaemia	Aortic stenosisPregnancyLactation	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 cell	0.5-5mls half hour before meal	Subcutenously,intramuscularly and intravenously	Hypoglycemiasystemic 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	BeriberiPellagra	The cyanocobalamin contain help in maturation of erythrocyte during erythropoises	One to two tablet three time daily before are after meal	OrallyIntramuscullarly	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)

1.2       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

1.3 SIGNIFICANCE OF THE STUDY

The importance of this study cannot be overemphasized based on the following point

1. This care study provide patient the opportunity to have close access to health practitioner and hence benefitting from therapeutic health education
2. 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

1. 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
2. It enhances the nurse ability to give an appropriate health education to the people as the nurse is better equip with updated knowledge.