University of Perpetual Help System DALTA

Alabang - Zapote Road, Pamplona, Las Piñas City

Diabetes Mellitus Type II,

Cellulitis Foot

A
case study presented
to the
College of Nursing

In partial fulfillment
for the Degree of Bachelor of Science
in Nursing

ABAGATNAN, Christine Patricia E.

ABAN, Aubrey A.
ABAŇO, Jover F.
ABARRO, Joey Lou B.
ABEJA, Kevin Russ A.
ABELLERA, Hazelle J.
ABENDANIO, Angelica A.
ABENES, Roman Miguel V.
ABRANTES, Robert Nicole Q.

Ms. Sheena Marie Mateo, RN

29 August 2009
I. INTRODUCTION

Diabetes mellitus often referred to simply as diabetes—is a condition in which the body does not
produce enough, or properly respond to, insulin, a hormone produced in the pancreas. Insulin
enables cells to absorb glucose in order to turn it into energy.

Many types of diabetes are recognized: The principal three are:

• Type 1: Results from the body's failure to produce insulin. Presently almost all
persons with type 1 diabetes must take insulin injections.
• Type 2: Results from Insulin resistance, a condition in which cells fail to use insulin
properly, sometimes combined with relative insulin deficiency.
• Gestational diabetes: Pregnant women who have never had diabetes before but who
have high blood sugar (glucose) levels during pregnancy are said to have gestational
diabetes. Gestational diabetes affects about 4% of all pregnant women. It may precede
development of type 2 (or rarely type 1).
• Many other forms of diabetes mellitus are categorized separately from these.
Examples include congenital diabetes 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.

Epidemiology
• In 2000, according to the World Health Organization, at least 171 million people
worldwide suffer from diabetes, or 2.8% of the population, estimated that by the year 2030,
this number will almost double.
• Diabetes mellitus occurs throughout the world, but is more common (especially type 2) in
the more developed countries.
• The greatest increase in prevalence is, however, expected to occur in Asia and Africa,
where most patients will probably be found by 2030.
• Indigenous populations in first world countries have a higher prevalence and increasing
incidence of diabetes than their corresponding non-indigenous populations.
• The most common form of diabetes is type 2 diabetes.
• About 90 to 95 percent of people with diabetes have type 2.
• About 80 percent of people with type 2 diabetes are overweight.
• Type 2 diabetes is increasingly being diagnosed in children and adolescents.
• About 3,700 people under the age of 20 were diagnosed with diabetes based on 2002-2003
data.

Causes
While, not everyone with type 2 diabetes is overweight; obesity and lack of physical activity
are two of the most common causes of this form of diabetes. It is also responsible for nearly 95%
of diabetes cases in the United States, according to the CDC.
Diabetes happens when one of the following occurs:
• When the pancreas does not produce any insulin.
• When the pancreas produces very little insulin.
• When the body does not respond appropriately to insulin, a condition called "insulin
resistance."
Insulin-resistance, type 2 diabetes produce insulin; however, the insulin pancreas secretes is
either not enough or the body is unable to recognize the insulin and use it properly.
Risk Factors
A person with some or all of the following listed health risk factors may never develop type 2
diabetes. However, the latest medical findings show that the chances of getting type 2 diabetes
increase the more health risk factors you have.
• A family history of diabetes. If a parent or sibling in your family has diabetes, your risk
of developing type 2 diabetes increases.
• Age over 45. The chance of getting type 2 diabetes increases with age.
• Race or ethnic background. The risk of type 2 diabetes is greater in Hispanics, blacks,
Native Americans, and Asians.
• Metabolic syndrome (also called insulin resistance syndrome)
• Being overweight. If you are overweight, defined as a body mass index (BMI) greater
than 25, you're at higher risk of type 2 diabetes.
• Hypertension. High blood pressure increases the risk of developing type 2 diabetes.
• Abnormal cholesterol levels. HDL ("good") cholesterol levels under 35 mg/dL
(milligrams per deciliter) and/or a triglyceride level over 250 mg/dL increases your risk
of type 2 diabetes.
• History of gestational diabetes. Getting diabetes during pregnancy or delivering a baby
over nine pounds can increase your risk of type 2 diabetes.
Other health risk factors for type 2 diabetes include:
• A history of polycystic ovary disease (PCOS)
• Habitually inactive
History of vascular disease (such as stroke)

Acute Chronic
II. GORDON’S FUNCTIONAL ASSESSMENT HISTORY TAKING

I. History

A. Demographic Data (Biographical Data)

Name: M. G

Age: 54

Sex: Male

Birth date: October 19, 1972

Birth place: Quezon Province

Marital Status: Married

Nationality: Filipino

Religion: Roman Catholic

Address: Bacoor

Occupation: None

Usual Source of Medical Care: Family Doctor, Clinic or Hospital

B. Source and Reliability of Information

The patient M.G is the primary source of information. He is conscious and coherent,
able to speak Tagalog fluently. His grandchild is also considered as source of information
regarding patient status and condition.

C. Reason for Seeking Care: for over-all physical assessment

>Medical Check-up

>Health Problems

>For Emergency Cases

D. Present & Past Medical History

a. Medical History or Past Health

 Pediatric/childhood/adult illness
-None

 Injuries or accidents
 -None

 Hospitalization and operations

-None

 Obstetrics history
-None

 Immunization
BCG: /*/ at birth / / school entrance

DPT: / / 1st dose / / 2nd doze / * / 3rd doze

OPV: / / 1st doze / / 2nd doze / */ 3rd doze

AMV: / */

TT: / / 1st doze / */ 2nd / / 3rd

/ / 4th / / 5th

Hepatitis B vaccine: / / 1st doze / / 2nd /* / 3rd

Others(Varicella vaccine, influenza vaccine, others

 Allergies
Food: None

Environmental allergens: None

 Last Examination Date (present)

10 days PTA:
Left foot, increased in severity, treatment of amoxicillin
Few days PTA:
Increased swelling of left foot, high fever, difficulty in ambulation
Past medical history:
HPN – Lopicard 10mg
DM – Glipizide, previous on insulin glucovance x 1996

Admission:
Aug. 23, 2009, 5:40pm
CC:
Cellulitis at left foot
Initial V/S
T: 36 °c
P: 84
R: 22
BP: 170/100
Initial impression: DM Type II, Cellulitis at left foot
Diet: diabetic diet, low salt – low fat
II. Functional Assessement

1. Health Perception/health management pattern

M. G, a 54 y/o, male patient. Once he felt something wrong about his condition such as
cold, slight fever or simple muscle pain, he does not often seek for medical help. He just takes some
vitamins to boost up immunity

2. Self-esteem, self-concept, self-perception pattern

Before he was diagnosed with DM type 2, M.G, is a responsible husband and father to his
wife and kids. He was able to provide the needs of his family. The client possessed a jolly and fun
loving type of personality.
Since his illness started, most of the time, he felt conscious of his physical appearance and seems
confidents of what he looks.

3. Activity/exercise pattern
He says that going to store and walking upstairs requires lot of movements and he considers
it as his daily exercise.

4. Nutritional-metabolic pattern
The patient usually takes heavy meals more frequently such as rice, pork, fish and
vegetables every meal. He typically drinks more than an 8 glasses of water per day. Patient stated that
prior to his illness he weighted 70kgs but at present he weighs 65kgs.

5. Elimination pattern
The patient had regular bowel movement everyday. He states that the color, amount and
consistency are normal.

6. Sleep-rest pattern
He has a regular sleeping hours at night. He says that he sleep in the afternoon. But during
week ends, he spends most of his time sleeping.

7. Cognitive-perceptual pattern
Sense of hearing, touch, smell, sight and taste are normal.

8. Role relationship pattern

He lives with his family. Has one sister. He is youngest in the family and states good
relationship with family and friends

9. Sexuality-reproductive pattern
Patient doesn’t want to talk about his sexual life but he is married.

10. Coping-stress tolerance pattern

When he was diagnosed of DM type 2, there have been many changes occurred that made
difficult for him to adjust. He cannot perform the usual activities that he had before. He felt conscious
of his physical appearance and seems confidents of what he looks.

11. Value-belief pattern

M.G is a Roman Catholic and according to him he went to church with his family every
Sunday. He has high regard of good character values and he believes that the way of living today is
very difficult due to poverty and economic problem. Religious effort is still a part of patient M.G.’s life.
V. Physical Assessment

SYSTEM WHAT TO ASSESS ACTUAL FINDINGS

A. Vital Signs • Temperature >36ºC

• Pulse rate
• Respiration Rate >85 bpm
• Blood Pressure
>19 cpm

>120/90 mmhg

B. Integumentary

1. Skin • Color, odor, temperature, >Light brown; (-) odor; poor skin
moisture, texture, thickness, turgor; dry skin; wound @ L foot
mobility, turgor, vascularity,
swelling, rashes

• Distribution, thickness, texture, >Evenly distributed hair; thick black

2. Hair lubrication, scalp characteristics short hair; silky and resilient; (-)
dandruff and lesions

• Nail bed color, consistency >thin nails; convex curvature; smooth

3. Nails
thickness, shape, texture, angle nails; good capillary refill
between nail and nail bed,
capillary refill
I. Musculoskeletal • Gail, stance, posture >Equal size on both sides of the body
• Backbone
• Extremities, alignment >(-) deformities, (-) tenderness or
position swelling
• muscle strength
• Range of motion of joints >Equal length and size
• Muscle coordination >Equal in strength on each body size

>(-) dislocation

>Coordinated movement

III. DIAGNOSTICS LAB EXAMS & CLINICAL FINDINGS

Test Unit Date: 08/22/09

Fluid: Serum

Test: Result: Normal Values:

Cholesterol 5.3 mmol/L 0.0 – 5.2 mmol/L

Triglycerides .72 mmol/L 0.00 – 1.69 mmol/L

Direct HDLC 1.3 mmol/L 1.0 – 1.5 mmol/L

Uric Acid 289. mmol/L 208. – 506. mmol/L

LDL 3.69 mmol/L

ULDL .33 mmol/L

CHOL / DHDL 4.16 mmol/L

Interpretation:

Cholesterol Too High: Rule out hypothyroidism, obstructive jaundice, liver disease, nephrosis, diabetes mellitus, familial,
pancreatitis, hyperadrenocorticism, diet, retained anger and resentment.

Test: Result: Normal Values:

Hemoglobin 114 g/L Male: 140 – 180 g/L

Hematocrit .35 Male: 0.40 – 0.54

RBC count 3.74 Male: 4.5 – 6.5 x 10**/L

WBC count 7.5 x 108/L 5.0 – 10.0 x 108/L

Platelet count adequate

Interpretation:

Hemoglobin Too Low: Rule out anemia due to nutritional deficiencies, blood loss, destruction of blood cells internally, or
failure to produce blood in the bone marrow.

Hematocrit Too Low: Rule out anemia due to nutritional deficiencies, blood loss, and destruction of blood cells internally,
or failure to produce blood in the bone marrow.

RBC Count Too Low: may indicate anemia, bleeding, kidney disease, bone marrow failure (for instance, from radiation or
a tumor), malnutrition, or other causes. A low count may also indicate nutritional deficiencies of iron, folate, vitamin B12,
and vitamin B6.

Arterial Blood Gas Analysis

 Parameters: pH: PCO2: PO2: HCO3: O2 Sat:

Actual 7.517 28.7 mmHg 138 mmHg 25 m/L 99%

Range:

Normal 7.35 – 7.45 36 – 45 80 -120 22 – 26 m/L 95 – 100%

Range: mmHg mmHg

Interpretation:

Respiratory alkalosis - high pH, low PaCO2, normal or high normal bicarbonate.

Causes - any cause of hyperventilation (e.g. anxiety, pain)

V. NURSING DIAGNOSIS

TYPE NURSING DIAGNOSIS

 Anxiety
Actual
Actual Impaired Skin Integrity

Actual Deficient Fluid Volume

Actual Imbalance Nutrition; Less than body requirements

Potential Risk for Infection

IV. PROBLEM PRIORITIZATION

♥ .

♥ .

♥ .

♥ .

♥ .
 NURSING CARE PLAN (ACTUAL)

Assessment Diagnosis Planning Intervention Rationale Evaluation

S: “Anong gagawin Anxiety related to After a series of • Established rapport • To maintain good Goal met, the patient
ko pag mataas ang fear of inability to nursing nurse-patient minimized anxiety by
blood sugar ko?” manage diabetes as intervention, the interaction verbalization of
manifested by patient will understanding about
verbalization of minimize anxiety diabetes and blood
• Used therapeutic • To remove anxiety and
deficient knowledge and maintain the communication and positive glucose level
O: dispel all
about diabetes control glucose to a reinforcement misconceptions about maintained to
> Anxious manageable level diabetes manageable level
• Provided health teaching • To provide information
> low tone of voice about diabetes about the disease, that
it can be handled
through monitoring
and medication
administration

• Provide quiet and calm • To ease anxiety

environment
• Monitored and recorded
intake and output
• Provided health teaching
about self-care
• Monitored blood glucose
level
• To check for possible
signs of dehydration
• Such as meal timing
for treatment
improvement
• Monitor for high or
low level for treatment/
medication
administration

• Administered prescribed
meds(antidiabetic agents,
insulin)
• For long-term blood
• Improved nutritional intake glucose control
(dietary plan)
 NURSING CARE PLAN (ACTUAL)

Assessment Diagnosis Planning Intervention Rationale Evaluation

• Established rapport o the • To maintain good Nurse-

S: NSC Impaired Skin After Nursing patient & relative. Patient relationship. GOAL MET. The
Integrity r/t altered Intervention, the • Encouraged verbalization patient was able to
O: circulation as client will be able of feelings display timely
manifested by to display timely healing of skin
 Disruption of • Assessed affected skin • To note any possible
disruption of skin healing, of skin lesions.
skin surface surface; changes in color, signs of complications
surface, (-) lesions w/o
texture, & turgor.
 (-) swelling swelling, complications.
(+)redness, (+) • Kept the site dry & clean • To assist body's natural
 (+)redness poor skin turgor, & carefully dress wounds. process of repair
(+) dry skin
 (+) poor skin • Noted appropriate barrier • To protect the wound &
turgor dressings, wound surrounding tissues
coverings, & skin
 (+) dry skin protective agents for open
wound.
 (-) edema @ L
foot • Plastic materials such as • Moisture potentiates
rubber sheet & plastic skin breakdown.
linens avoided.

• Provided comfort • To reduce pressure &

measures such as bed enhance circulation.
making, morning care

• Provided adequate period • To reduce fatigue

of rest
• Provided clean & calm • To reduce anxiety
environment
• Encourage mobilization • Promotes circulation

• Encourage ↑ oral fluid • To prevent dehydration

intake
• To promote
• Emphasized importance sensation/circulation
of proper fir of clothing
 NURSING CARE PLAN (ACTUAL)

Assessment Diagnosis Planning Intervention Rationale Evaluation

• Monitored v/s and • Cardiac Goal met.

recorded. neuropathy may
S: Fluid volume After 8 hours of block reflexes that After the shift the
deficient may be nursing intervention normally increase patient is (-) in
“Madalas related to the patient will heart rate. dehydration, good
nauuhaw ako” hyperglycemia demonstrate adequate • Indicators of level skin turgor
possible evidence by hydration as of hydration,
adequate
dry skin/mucous evidenced by stable
circulating volume.
O: membranes and poor v/s, good skin turgor,
• To estimate of
skin turgor. and individually • Assess skin turgor volume
• poor skin appropriate urinary and mucous replacement needs,
output and membranes kidney function
turgor
electrolytes levels and effectiveness
• Dry oral of therapy.
within normal range.
mucous • To maintain
hydration.
membrane • Monitored intake
and output.
• (+) Crack lips
• to identify if the
• (+) Dry Skin patient loss or gain
weigh
• thirsty
• promote
• CBG result comfortable
environment
=231mg/dl
• Maintain fluid
intake of at least
2500ml/day
• Weigh daily

• Encourage bed
rest. Cover the
patient with light
sheets.
 NURSING CARE PLAN (ACTUAL)

Assessment Diagnosis Planning Intervention Rationale Evaluation

• Established rapport o • To maintain good

S: "Nabawasan ata Imbalance After Nursing the patient & relative. Nurse-Patient GOAL MET. The
ang timbang ko." Nutrition: less than Intervention, the • Encouraged relationship. patient was able to
As verbalized by body requirements px will be able to verbalization of feelings demonstrate
the px. r/t inability to demonstrate • Discussed eating habits, • To appeal clients behaviors to maintain
utilize nutrients to behaviors, including food likes/desires appropriate weight
O: meet metabolic lifestyle changes preferences, gain.
intolerances
>muscle weakness needs as evidenced to maintain • To reduce fatigue
• Provided comfort
by muscle appropriate measures such as bed
>↑ thirst weakness, ↑ thirst, weight gain. making, morning care
↑ urination, • Provided adequate • To reduce anxiety
>↑ urination
hyperglycemic @ period of rest
>hyperglycemic @ 231 mg/dL, & Loss • Encourage client to • To stimulate
of weight ↓ from choose foods that are appetite
231 mg/dL
70kgs to 65kgs w/ appealing to eat &
>Loss of weight prescribed by the
adequate food
from 70kgs to doctor.
intake. • To enhance intake
65kgs w/ adequate • Provided clean &
relaxing environment
food intake.
• Provided oral care
before meals
• Encourage ↑ oral fluid • To prevent
intake dehydration

NURSING CARE PLAN (POTENTIAL)

 Assessment Diagnosis Planning Intervention Rationale Evaluation

S- Risk for infection After 8 hours of • Monitored v/s and • Noted for the Goal met.
related to diabetes nursing intervention recorded temperature that
“May sugat ang type II evidenced by the patient will way a nosocomial After 8 hours the
kaliwang paa ko” wound in left foot. identify intervention infection patient is still
to prevent/reduce of • Reduce risk of free from any
cross infection and
infection.
contamination. maintain in good
• High glucose in the condition.
• Promote hand blood creates an
washing excellent medium
for bacterial
growth.
• Maintain aseptic • To facilitates lung
O- technique for IV expansion: reduce
site risk of aspiration
• Wound in left
foot; covered with • To reduce risk of
bandage, dry and oral disease
intact.
• • Place the patient
• Early treatment
in semi-fowler’s
may help prevent
position
sepsis.

• Encourage the
patient with oral
hygiene
• Administer
antibiotics as
doctor’s order

Drug Name Dosage & Route
CLONIDINE Hypertension
HYDROCHLORIDE Adult: PO 0.1 mg b.i.d. or
(kloe'ni-deen) t.i.d., may increase by 0.1–
0.2 mg/d until desired
response is achieved (max:
Catapres, Catapres-
2.4 mg/d) Transdermal 0.1
TTS, Dixaril , mg patch once q7d, may
Duraclon increase by 0.1 mg q1–2
wk
Geriatric: PO Start with 0.1
Classifications:
mg once daily
cardiovascular agent;
Child: PO 5–10 mcg/kg/d
central-acting
divided q8–12h, may
antihypertensive;
increase to 5–25 mcg/kg/d
analgesic
divided q6h (max: 0.9
mg/d)
Severe Pain
Adult: Epidural start
infusion at 30 mcg/h and
titrate to response. Use
rates >40 mcg/h with
caution
Child: Epidural start
infusion at 0.5 mcg/kg/h
and titrate to response
ADDH
Child: PO 5 mcg/kg/d in 4
divided doses (average
dose, 0.15–0.2
mg/d) Transdermal 0.2–0.3
mg/d q5–7d
DRUG STUDY
Action Indication Adverse Effects Contraindication Nursing Responsibility
Centrally acting • Monitor BR closely.
antiadrenergic derivative. Step 2 drugs in CV: Hypotension Pregnancy (category C), Determine positional
Stimulates alpha2- stepped-care approach (epidural), postural lactation. Use of changes (supine,
adrenergic receptors in to treatment of hypotension (mild), clonidine patch in sitting, standing).
CNS to inhibit hypertension, either peripheral edema, ECG polyarteritis nodosa, • With epidural
sympathetic vasomotor alone or with diuretic changes, tachycardia, scleroderma, SLe administration,
centers. Central actions frequently monitor BP
or other bradycardia, flushing,
reduce plasma and HR. Hypotension
antihypertensive rapid increase in BP
concentrations of is a common side
norepinephrine. It agents. Epidural with abrupt withdrawal. effect that may require
decreases systolic and administration as GI: Dry mouth, intervention.
diastolic BP and heart adjunct therapy for constipation, abdominal • Monitor BP closely
rate. Orthostatic effects whenever a drug is
severe pain. pain, pseudo-
tend to be mild and occur added to or withdrawn
obstruction of large
infrequently. Also from therapeutic
inhibits renin release bowel, altered taste,
regimen.
from kidneys. nausea, vomiting, • Monitor I&O during
hepatitis, period of dosage
hyperbilirubinemia, adjustment. Report
weight gain (sodium change in I&O ratio or
retention). CNS: change in voiding
Drowsiness, sedation, pattern.
• Determine weight
dizziness, headache,
daily. Patients not
fatigue, weakness, receiving a
sluggishness, dyspnea, concomitant diuretic
vivid dreams, agent may gain
nightmares, insomnia, weight, particularly
behavior changes, during first 3 or 4 d of
agitation, hallucination, therapy, because of
marked sodium and
nervousness,
water retention.
restlessness, anxiety, • Supervise closely
mental depression. patients with history
Skin: Rash, pruritus, of mental depression,
thinning of hair, as they may be subject
exacerbation of to further depressive
psoriasis; with
 transdermal patch: episodes.
hyperpigmentation,
recurrent herpes
simplex, skin irritation,
contact dermatitis, mild
erythema.

Nursing
Drug Name Dosage & Route Action Indication Adverse Effects Contraindication
Responsibility

Amlodipine is a calcium Hypertension, angina, Amlodipine is well tolerated. • Report significant

ion influx inhibitor (slow myocardial ischemia. In placebo-controlled clinical swelling of face or
Norvasc HTN & angina Initially 5 mg channel blocker or Reduce the risk of coronary trials involving patients with Known sensitivity to extremities.
once daily which may be calcium ion antagonist) revascularization, fetal hypertension or angina, the dihydropyridines. • Take care to have
(am-lo’di-peen) increased to a max dose of 10 and inhibits the coronary heart disease, non- most commonly observed side support when standing
mg depending on patient's transmembrane influx of & walking due to
fatal MI & stroke. effects were headache, edema,
response. Coronary artery calcium ions into cardiac possible dose-related
and vascular smooth fatigue, somnolence, nausea,
disease 5-10 mg/day. Childn light-
muscle. abdominal pain, flushing,
6-17 yr 2.5-5 mg/day. headedness/dizziness.
palpitations and dizziness. In
Classifications: • Report shortness of
these clinical trials, no pattern breath, palpitations,
cardiovascular agent;
of clinically significant irregular heartbeat,
calcium channel
laboratory test abnormalities nausea, or constipation
blocker; to physician.
related to amlodipine has been
antihypertensive age • Do not breast feed while
observed. Less commonly
observed adverse effects in taking this drug without
marketing experience include consulting physician.
alopecia, altered bowel habits,
arthralgia, asthenia, back pain,
dyspepsia, dyspnea, gingival
hyperplasia, gynecomastia,
hyperglycemia, impotence,
increased urinary frequency,
leucopenia, malaise, mood
changes, dry mouth.
 Drug Name Dosage & Route Action Indication Adverse Effects Contraindication Nursing Responsibility

.
• Adhere closely to the
Adults: Serious Clindamycin has a Clindamycin is used Diarrhea, • Hypersensitive to established regimen
infections —150 to 300 bacteriostatic effect. It is primarily to treat pseudomembranous drugs. without schedule
me-troe-ni’da-zole) mg every 6 hours. a bacterial Protein colitis, nausea, vomiting, interruption or changing
infections caused by
Flagyl, Flagyl ER, More severe infections synthesis inhibitor by susceptible anaerobic abdominal pain or • Ulcerative colitis. the dose.
Flagyl IV RTU, Flagyl —300 to 450 mg every 6 inhibiting ribosomal cramps, rash, and/or itch. • Refrain from
translocation,[36] in a bacteria, including
375, Metizol, Metric 21, hours. • Renal intercourse during
infections of the High doses (both
similar way to impairement. therapy for
Metro I.V., MetroGel, Pediatric Patients: respiratory tract, skin intravenous and oral) may
macrolides. It does so by trichomoniasis unless
MetroGel Vaginal, Serious infections —8 to binding preferentially to and soft tissue cause a metallic taste, and
• Hepatic male partner wears a
MetroLotion, Noritate, 16 mg/kg/day (4 to 8 the 50S subunit of the infections, and topical application may condom to prevent
mg/lb/day) divided into impairement.
Protostat bacterial ribosome.[12] peritonitis.[3] In cause contact dermatitis. reinfection.
three or four equal
patients with [28] • Have sexual partners
doses. More severe The structures of the
hypersensitivity to receive concurrent
Classifications: infections —16 to 20 complexes between treatment.
mg/kg/day (8 to 10 several antibiotics penicillins, clindamycin
Asymptomatic
antiinfective; mg/lb/day) divided into (including clindamycin) may be used to treat trichomoniasis in the
antitrichomonal; three or four equal and a Deinococcus infections caused by male is a frequent
doses. radiodurans ribosome susceptible aerobic
amebicide; antibiotic source of reinfection of
have been solved by X- bacteria as well. It is the female.
ray crystallography by a also used to treat bone • Do not drink alcohol
Pregnancy Category: B team from the Max during therapy; may
and joint infections,
Planck Working Groups induce a disulfiram-type
for Structural Molecular particularly those
reaction (see Appendix
Biology, and published caused by F). Avoid alcohol or
in the journal Nature Staphylococcus aureus. alcohol-containing
[3][4] Topical medications for at least
application of 48 h after treatment is
clindamycin phosphate completed.
can be used to treat • Urine may appear dark
mild to moderate acne. or reddish brown
(especially with higher
than recommended
doses). This appears to
have no clinical
significance.

Drug Name Dosage & Route Action Indication Adverse Effects Contraindication Nursing
 Responsibility

Lopicard Initial dose: 5 mg Amlodipine is a calcium Amlodipine therapy is generally Patients with known General: The safety and
once daily. Max dose: ion influx inhibitor (slow well tolerated at doses of up to sensitivity to efficacy of amlodipine in
MIMS Class 10 mg. Elderly >65 channel blocker or Treatment of HTN & 10 mg/day. Most of the dihydropyridines, hypertensive crisis has
yr 5 mg once daily. calcium ion antagonist) prophylaxis of angina reported reactions are of mild to amlodipine or any other not been established.
: Anti-Anginal and inhibits the
Hepatic moderate severity and are components of Lopicard.
Drugs, Calcium transmembrane influx of
insufficiency Initial related to the drug's vasodilator Hypotension: Careful
Antagonists, Other calcium ions into cardiac
dose: 2.5 mg once effect on the periphery. Amlodipine should not be monitoring of blood
Antihypertensives and vascular smooth
daily. Headache and edema are used in cardiogenic shock, pressure is
muscle.
clinically significant aortic recommended,
reported most frequently.
stenosis, unstable angina especially in patients
Dizziness, flushing and with a history of
(excluding Prinzmetal's
palpitations also occur and angina). cerebrovascular
appear to be dose-related. Other insufficiency and those
adverse reactions that have Patients with severe taking medications
been reported and do not appear hypotension (<90 mm Hg known to lower blood
to be dose-related include systolic). pressure.
fatigue, nausea/vomiting,
During pregnancy and Peripheral Edema: Care
abdominal pain and drowsiness.
lactation. Not should be taken to
recommended for use in differentiate this
children. peripheral edema from
the effects of increasing
left ventricular
dysfunction.

Hepatic impairment:
When amlodipine is
used in hepatically
impaired patients, the
dosage should be
carefully and gradually
adjusted depending on
the patient's tolerance
and response.
 Drug Name Dosage & Route
Tab Adult Mild to
moderate infections 375
mg tid or 625 mg bid-tid
or 1 g bid. Severe
Augmentin
infections 2 times 375
MIMS Class : mg tid or 1-2 times 625
mg tid or 1 g bid-tid.
Penicillins
Susp Childn Skin & soft
tissue infection,
recurrent tonsillitis 25-
50 mg/kg/day tid. Otitis
media, sinusitis, lower
resp tract infection,
UTI 50-75 mg/kg/day
tid. Inj By intermittent IV
infusion. Adult & childn
>12 yr 1.2 g 8 hrly
serious infections 6 hrly
interval. Childn 3 mth-
12 yr 30 mg/kg 8 hrly
serious infection 6 hrly
interval, 0-3 mth 30
mg/kg 12 hrly in
premature infants & in
full-term infants during
perinatal period
increasing to 8 hrly
thereafter.
Action Indication Adverse Effects Contraindication Nursing Responsibility
• Adhere closely to the
established regimen without
Amoxicillin is a Infections of upper & Infections and Infestations: Hypersensitivity to schedule interruption or
semisynthetic lower resp tract, GUT, Common: Mucocutaneous penicillins & changing the dose.
antibiotic with a skin & soft tissue, bone candidiasis. cephalosporins or • Refrain from intercourse
broad spectrum of & joint, septic abortion, during therapy for
other allergen,
antibacterial activity puerperal sepsis, intra- Blood and Lymphatic Disorders: trichomoniasis unless male
abdominal sepsis, dental possible cross
against many gram- Rare: Reversible leukopenia partner wears a condom to
positive and gram- infection (for oral prep), sensitivity w/ other β-
(including neutropenia) and prevent reinfection.
negative female genital lactams. History of
thrombocytopenia. • Have sexual partners
microorganisms. infections, septicaemia, penicillin-associated receive concurrent
peritonitis & post- cholestatic treatment. Asymptomatic
surgical infections, Immune System Disorders: Very
jaundice/hepatic trichomoniasis in the male
prophylaxis against Rare: Angioneurotic edema,
dysfunction. is a frequent source of
infections associated w/ anaphylaxis, serum sickness-like reinfection of the female.
major surgical syndrome, hypersensitivity • Do not drink alcohol
procedure (for IV vasculitis. during therapy; may induce
presentations). a disulfiram-type reaction
Nervous System Disorders: (see Appendix F). Avoid
Uncommon: Dizziness, alcohol or alcohol-
headache. containing medications for
at least 48 h after treatment
Convulsions may occur in is completed.
patients with impaired renal • Urine may appear dark or
function or in those receiving reddish brown (especially
high doses. with higher than
recommended doses). This
appears to have no clinical
Gastrointestinal Disorders:
significance.
Adults: Very Common: Diarrhea
Nausea, vomiting.Children: • Report symptoms of
candidal overgrowth: Furry
Common: Diarrhea, nausea,
tongue, color changes of
vomiting. tongue, glossitis, stomatitis;
vaginitis, curd-like, milky
vaginal discharge; proctitis.
Treatment with a
candidacidal agent may be
indicated.
• Do not breast feed while
taking this drug.
DISCHARGE PLANNING:

MEDICINES

o Clindamycin- anti-infectives
o Catapres- beta adrenergic blockers
o Lopicard- anti-anginal drug/ calcium antagonist
o Augmentin- anti-infectives
o Norvasc- anti-hypertensive

ECONOMY

• Coping and Support

Fight Stress With a Positive Attitude

When things seem to be going wrong, it's always easier to see the bad instead of the good. Find
something good in each important area of your life: work, family, friends, and health. Thinking about the good
can help you get through the bad times and the stress.

Be Nice to Yourself
What are your talents, abilities, and goals? Are you expecting too much from yourself? Don't expect
more of yourself than you have or are able to give.

Accept What You Cannot Change

For those stressful situations or problems that cannot be changed, develop a simple plan of action. Ask
yourself the following questions:

• "Will this be important two years from now?"

• "Do I have control over this situation?"
• "Can I change my situation?"

Talk to Someone About Your Stress

Don't keep stress bottled up inside. If you don't want to talk with a family member or close friend, there
are counselors and clergy trained to provide support and insight. Ask your doctor for recommendations if you
would like to see a psychologist or counselor.

Exercise to Fight Stress

The benefits of exercise in reducing stress are well known, particularly for someone with diabetes.
Exercise gives you a feeling of well-being and may relieve symptoms of stress.

Take Time to Relax

Practice muscle relaxation, deep breathing, meditation, or visualization. Ask your health care provider
for information and available programs.

• Exercise

Exercise is very important in managing type 2 diabetes. Combining diet, exercise, and medicine (when
prescribed) will help control your weight and blood sugar level.
Strength Training and Type 2 Diabetes

• The latest findings show that exercise such as strength training has a profound impact on helping people
manage their diabetes. In a recent study of Hispanic men and women, 16 weeks of strength training
produced dramatic improvements in sugar control that are comparable to taking diabetes medication.
Additionally, the study volunteers were stronger, gained muscle, lost body fat, had less depression, and
felt much more self-confident.

Aerobic Fitness and Type 2 Diabetes

• Any activity that raises your heart rate and keeps it up for an extended period of time will improve your
aerobic fitness. Aerobic exercise helps decrease the risk of type 2 diabetes and helps those with diabetes
to better manage their blood sugar levels. Besides the health benefits, exercise is fun and boosts your
mood. It's hard to feel stressed when you're walking fast on a treadmill or swimming laps in a pool.

TREATMENT

Diabetes Sick Days

What Foods Should I Eat When I'm Sick?

If you are sick and have diabetes, you should eat or drink 45 to 50 grams of carbohydrate every
three to four hours to maintain your nutrition needs, to avoid ketone development and to prevent
hypoglycemia.

If you can't eat foods, you could try more easily tolerated foods, such as those listed below. Each of
these items equal one carbohydrate choice.

• 1 cup clear soup

• 1/2 cup regular gelatin
• 1/2 cup regular soft drink, like 7-up or Sprite
• 1/2 Popsicle
• 1/2 cup unsweetened applesauce
• 1/3 cup apple juice
• 1/2 cup sports drink, like Gatorade

Calorie-free liquids you may drink during an illness include water and 1/2 cup of broth or bouillon.
Treatment for type 2 diabetes requires a lifelong commitment to:

• Blood sugar monitoring

• Healthy eating
• Regular exercise
• Possibly, diabetes medication or insulin therapy

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

If managing your diabetes seems overwhelming, take it one day at a time. And remember that you're not in it
alone. You'll work closely with your diabetes treatment team — doctor, diabetes educator and registered
dietitian — to keep your blood sugar level as close to normal as possible.
Monitoring your blood sugar
Depending on your treatment plan, you may check and record your blood sugar level once a day or several times
a week. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the
only way to make sure that your blood sugar level remains within your target range.

Healthy eating
Contrary to popular perception, there's no diabetes diet. You won't be restricted to a lifetime of boring, bland
foods. Instead, you'll need plenty of:

• Fruits
• Vegetables
• Whole grains

These foods are high in nutrition and low in fat and calories. You'll also need to eat fewer animal products and
sweets.

Physical activity
Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Get your
doctor's OK before you start an exercise program. Then choose activities you enjoy, such as walking, swimming
or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30
minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too.
In fact, a combination of aerobic exercise and strength training is more effective at controlling blood sugar than
either exercise on its own. If you haven't been active for a while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar. Check your blood sugar level before any activity. You
might need to eat a snack before exercising to help prevent low blood sugar.

Diabetes medications and insulin therapy

Some people who have type 2 diabetes can manage their blood sugar with diet and exercise alone, but many
need diabetes medications or insulin therapy. The decision about which medications are best depends on many
factors, including your blood sugar level and the presence of any other health problems. Your doctor might even
combine drugs from different classes to help you control your blood sugar in several different ways.

HYGIENE

Caring for Your Feet with Diabetes

When you have diabetes, taking good care of your feet is very important. Poor foot care can lead to
serious problems, including possibly having to remove -- or amputate -- the foot or leg.
As a person with diabetes, you are more vulnerable to foot problems because the disease can damage
your nerves and reduce blood flow to your feet. The American Diabetes Association has estimated that one in
five people with diabetes who seek hospital care do so for foot problems. By taking proper care of your feet,
most serious problems can be prevented.

Here are some diabetes foot care tips to follow.

Wash and Dry Your Feet Daily

• Use mild soaps.
• Use warm water.
• Pat your skin dry; do not rub. Thoroughly dry your feet.
• After washing, use lotion on your feet to prevent cracking. Do not put lotion between your toes.
Examine Your Feet Each Day
• Check the tops and bottoms of your feet. Have someone else look at your feet if you cannot see them.
• Check for dry, cracked skin.
• Look for blisters, cuts, scratches, or other sores.
• Check for redness, increased warmth, or tenderness when touching any area of your feet.
• Check for ingrown toenails, corns, and calluses.
• If you get a blister or sore from your shoes, do not "pop" it. Apply a bandage and wear a different pair
of shoes.

Take Care of Your Toenails

• Cut toenails after bathing, when they are soft.
• Cut toenails straight across and smooth with an emery board.
• Avoid cutting into the corners of toes.
• You may want a podiatrist (foot doctor) to cut your toenails.

Be Careful When Exercising

• Walk and exercise in comfortable shoes.
• Do not exercise when you have open sores on your feet.

Protect Your Feet With Shoes and Socks

• Never go barefoot. Always protect your feet by wearing shoes or hard-soled slippers or footwear.
• Avoid shoes with high heels and pointed toes.
• Avoid shoes that expose your toes or heels (such as open-toed shoes or sandals). These types of shoes
increase your risk for injury and potential infections.
• Try on new footwear with the type of socks you usually wear.
• Do not wear new shoes for more than an hour at a time.
• Look and feel inside your shoes before putting them on to make sure there are no foreign objects or
rough areas.
• Avoid tight socks.
• Wear natural-fiber socks (cotton, wool, or a cotton-wool blend).
• Wear special shoes if your health care provider recommends them.
• Wear shoes/boots that will protect your feet from various weather conditions (cold, moisture, etc.).
• Make sure your shoes fit properly. If you have neuropathy (nerve damage), you may not notice that your
shoes are too tight. Perform the "footwear test" described below.

Footwear Test
Use this simple test to see if your shoes fit correctly:

• Stand on a piece of paper. (Make sure you are standing and not sitting, because your foot changes
shape when you stand.)
• Trace the outline of your foot.
• Trace the outline of your shoe.
• Compare the tracings: Is the shoe too narrow? Is your foot crammed into the shoe? The shoe should
be at least 1/2 inch longer than your longest toe and as wide as your foot.

Proper Shoe Choices for Those With Diabetes

When choosing the proper footwear if you have diabetes:
• Buy shoes with closed toes and heels.
• Buy shoes with leather uppers but without a seam inside.
• Make sure there is at least 1/2 inch extra space at the end of your longest toe.
• The inside of the shoe should be soft with no rough areas.
 • The outer sole should be made of stiff material.
• Your shoe should be at least as wide as your foot.

Tips for Foot Safety

To keep you feet safe if you have diabetes:

• Don't wait to treat a minor foot problem. Follow your health care provider's guidelines and first aid
guidelines.
• Report foot injuries and infections to your health care provider immediately.
• Check water temperature with your elbow, not your foot.
• Do not use a heating pad on your feet.
• Do not cross your legs.
• Do not self-treat your corns, calluses, or other foot problems. Go to your health care provider or
podiatrist to treat these conditions.

OUT PATIENT

When to Call Your Health Care Provider

See your health care provider if you have diabetes and any of the following problems with your feet:

• Athlete's foot (cracking between the toes)

• Sores or wounds on your feet
• Ingrown toenails
• Increasing numbness or pain
• Calluses
• Redness
• Blackening of skin
• Bunions
• Infection
• Hammer or mallet toes (when the middle joints of toes are permanently bent downward)

DIET

Eat a Balanced Diet

• Choose a variety of nutrient-dense foods and beverages among the basic food groups.
• Balance calories from foods and beverages with physical activity to manage body weight.
• Choose fiber-rich fruits, vegetables, and whole grains often.
• Eat 2 cups of fruit and 2 1/2 cups of vegetables daily (for someone eating 2,000 calories)
• Make at least half the grains you eat whole grains.
• Decrease saturated fats and trans fatty acids by choosing lean meats and poultry, and low-fat or non-fat
dairy products.
• Substitute monounsaturated fats and polyunsaturated fats (from fish, nuts, and vegetable oils) for
saturated and trans fat fats.
• Choose and prepare foods and beverages with little added sugars or caloric sweeteners.
• Eat less than 2,300 mg per day of sodium.
• Limit alcohol to no more than 1 drink for women and 2 drinks for men.
• Regular physical activity of at least 30 minutes a day for adults and 60 minutes for children.

Spread Your Meals Throughout the Day

• Breakfast
• A mid-morning snack
 • Lunch
• A mid-afternoon snack
• Dinner
• An evening snack

Go for Complex "Carbs"

• Shop the perimeter of grocery stores, where you'll find the freshest foods. Avoid temptation in the
middle aisles, where canned, boxed, and frozen goods are shelved.
• Reach for the least-processed version of any food. Try to cut out prepared, pre-mixed foods like stove-
top dinners: they're not "helpers" when it comes to diabetes and nerve pain.
• Have fun trying a new kind of starchy vegetable, like baked yams, oven-roasted carrots, or cooked
lentils, instead of white rice or dinner rolls.

Forget "Supersizing"
• Split entrees or dinner-size salads when you eat out, or have a small salad and appetizer instead of an
entree.
• Keep a good diabetes diet book on hand to find portion sizes for fresh foods like fruits and vegetables.
• Buy a new set of measuring cups and spoons and keep them out on the counter, so you're more
motivated to measure servings.

Jump on the Wagon

• Try a variety of mineral waters with a fresh slice of lemon, lime, or orange for flavor.
• Make a "Virgin Mary": spice up tomato juice with a splash of hot pepper sauce, lemon juice, dried
herbs, and a stalk of fresh celery - but hold the liquor.
• If you do celebrate occasionally, never drink on an empty stomach. Have your drink with or after
dinner, to help prevent sugar "lows."

Eat Less Fat

• These days, "low-fat" is everywhere. But read food labels carefully. "Lite" doesn't always mean "low-
fat." Find out how many grams of fat are in each serving of the foods you enjoy.
• No matter how rushed you feel, avoid grabbing fast foods on the go. A single fast-food meal could cost
you a week's worth of fat servings.
• Fill up on low-fat soups, salads with low-fat dressing, and raw veggies that satisfy your taste buds with
a variety of flavors and textures.

And remember to relax and enjoy your meals. That way, you're less likely to overeat from stress, and more
likely to savor the flavor of foods. Your nerves will be glad you did.

Points to Remember
• A diabetes diet should do three things; achieve ideal weight, maintain normal blood glucose levels, and
limit foods that contribute to hear disease.
• A nutritionist or dietitian can help plan a diabetes diet.
REFERENCES:

♥ http://www.wikipedia.com

♥ http://www.webmd.com

♥ http://www.scrib.com

♥ http://www.nursingcrib.com

♥ Mimsonline.com & mims drug handbook

♥ PPD

♥ Fundamentals of Nursing (Kozier)

♥ NANDA handbook