Medical Surgical Nursing
Chapter One
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.
Chapter Two: Literature Review
2.0 INTRODUCTION:
This chapter provides the background and context of the research problems, reviews the existing literature on the Medical Surgical Nursing, and acknowledges the contributions of scholars who have previously conducted similar research [REV25013] …
Table of Content
Title page
Certification
Dedication
Acknowledgement
Table of content
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