MEDICAL SURGICAL NURSING (A CARE STUDY OF A PATIENT WITH DIABETES RIGHT FOOT ULCER)


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.

.


TYPE IN YOUR TOPIC AND CLICK SEARCH.






RESEARCHWAP.COM

Researchwap.com is an online repository for free project topics and research materials, articles and custom writing of research works. We’re an online resource centre that provides a vast database for students to access numerous research project topics and materials. Researchwap.com guides and assist Postgraduate, Undergraduate and Final Year Students with well researched and quality project topics, topic ideas, research guides and project materials. We’re reliable and trustworthy, and we really understand what is called “time factor”, that is why we’ve simplified the process so that students can get their research projects ready on time. Our platform provides more educational services, such as hiring a writer, research analysis, and software for computer science research and we also seriously adhere to a timely delivery.

TESTIMONIES FROM OUR CLIENTS


Please feel free to carefully review some written and captured responses from our satisfied clients.

  • "Exceptionally outstanding. Highly recommend for all who wish to have effective and excellent project defence. Easily Accessable, Affordable, Effective and effective."

    Debby Henry George, Massachusetts Institute of Technology (MIT), Cambridge, USA.
  • "I saw this website on facebook page and I did not even bother since I was in a hurry to complete my project. But I am totally amazed that when I visited the website and saw the topic I was looking for and I decided to give a try and now I have received it within an hour after ordering the material. Am grateful guys!"

    Hilary Yusuf, United States International University Africa, Nairobi, Kenya.
  • "Researchwap.com is a website I recommend to all student and researchers within and outside the country. The web owners are doing great job and I appreciate them for that. Once again, thank you very much "researchwap.com" and God bless you and your business! ."

    Debby Henry George, Massachusetts Institute of Technology (MIT), Cambridge, USA.
  • "I love what you guys are doing, your material guided me well through my research. Thank you for helping me achieve academic success."

    Sampson, University of Nigeria, Nsukka.
  • "researchwap.com is God-sent! I got good grades in my seminar and project with the help of your service, thank you soooooo much."

    Cynthia, Akwa Ibom State University .
  • "Great User Experience, Nice flows and Superb functionalities.The app is indeed a great tech innovation for greasing the wheels of final year, research and other pedagogical related project works. A trial would definitely convince you."

    Lamilare Valentine, Kwame Nkrumah University, Kumasi, Ghana.
  • "Sorry, it was in my spam folder all along, I should have looked it up properly first. Please keep up the good work, your team is quite commited. Am grateful...I will certainly refer my friends too."

    Elizabeth, Obafemi Awolowo University
  • "Am happy the defense went well, thanks to your articles. I may not be able to express how grateful I am for all your assistance, but on my honour, I owe you guys a good number of referrals. Thank you once again."

    Ali Olanrewaju, Lagos State University.
  • "My Dear Researchwap, initially I never believed one can actually do honest business transactions with Nigerians online until i stumbled into your website. You have broken a new legacy of record as far as am concerned. Keep up the good work!"

    Willie Ekereobong, University of Port Harcourt.
  • "WOW, SO IT'S TRUE??!! I can't believe I got this quality work for just 3k...I thought it was scam ooo. I wouldn't mind if it goes for over 5k, its worth it. Thank you!"

    Theressa, Igbinedion University.
  • "I did not see my project topic on your website so I decided to call your customer care number, the attention I got was epic! I got help from the beginning to the end of my project in just 3 days, they even taught me how to defend my project and I got a 'B' at the end. Thank you so much researchwap.com, infact, I owe my graduating well today to you guys...."

    Joseph, Abia state Polytechnic.
  • "My friend told me about ResearchWap website, I doubted her until I saw her receive her full project in less than 15 miniutes, I tried mine too and got it same, right now, am telling everyone in my school about researchwap.com, no one has to suffer any more writing their project. Thank you for making life easy for me and my fellow students... Keep up the good work"

    Christiana, Landmark University .
  • "I wish I knew you guys when I wrote my first degree project, it took so much time and effort then. Now, with just a click of a button, I got my complete project in less than 15 minutes. You guys are too amazing!."

    Musa, Federal University of Technology Minna
  • "I was scared at first when I saw your website but I decided to risk my last 3k and surprisingly I got my complete project in my email box instantly. This is so nice!!!."

    Ali Obafemi, Ibrahim Badamasi Babangida University, Niger State.
  • To contribute to our success story, send us a feedback or please kindly call 2348037664978.
    Then your comment and contact will be published here also with your consent.

    Thank you for choosing researchwap.com.