Introduction

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects

in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with
long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves,
heart, and blood vessels.

Several pathogenic processes are involved in the development of diabetes. These range from
autoimmune destruction of the -cells of the pancreas with consequent insulin deficiency to
abnormalities that result in resistance to insulin action. The basis of the abnormalities in carbohydrate,
fat, and protein metabolism in diabetes is deficient action of insulin on target tissues. Deficient insulin
action results from inadequate insulin secretion and/or diminished tissue responses to insulin at one or
more points in the complex pathways of hormone action. Impairment of insulin secretion and defects in
insulin action frequently coexist in the same patient, and it is often unclear which abnormality, if either
alone, is the primary cause of the hyperglycemia.

Symptoms of marked hyperglycemia include polyuria, polydipsia, weight loss, sometimes with
polyphagia, and blurred vision. Impairment of growth and susceptibility to certain infections may also
accompany chronic hyperglycemia. Acute, life-threatening consequences of uncontrolled diabetes are
hyperglycemia with ketoacidosis or the nonketotic hyperosmolar syndrome.

"Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb
amputation" -WHO.

There are two(2) Types of diabetes, Type 1 diabetes (previously known as insulin-dependent,
juvenile or childhood-onset) is characterized by deficient insulin production and requires daily
administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with
current knowledge. Symptoms include excessive excretion of urine(polyuria), thirst(polydipsia),
constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.
Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the bodys
ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the
world, and is largely the result of excess body weight and physical inactivity.
Symptoms may be similar to those of type 1 diabetes, but are often less marked. As a result, the
disease may be diagnosed several years after onset, once complications have already arisen.
Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly
frequently in children.(World Health Organization)

Globally, The number of people with diabetes has risen from 108 million in 1980 to 422
million in 2014. In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another
2.2 million deaths were attributable to high blood glucose in 2012. Almost half of all deaths
attributable to high blood glucose occur before the age of 70 years. WHO projects that diabetes will
be the seventh leading cause of death in 2030 (World Health Organization)

In the Philippines, At least six million Filipinos all over the country have been diagnosed to
have diabetes (Philippine Daily Inquirer. Aug 13 2016) Dr. Augusto Litonjua, president of the
Philippine Center for Diabetes Education Foundation, warned that this figure could double to 12
million or even more by 2040 because of undiagnosed diabetes cases.

1|Page
 Introduction

"We are losing the war againts diabetes because diabetes keeps increasing in prevalence around
the world." -Dr. Litonjua

Diabetes Mellitus indeed is a very deadly and scary disease which could be 1 of the leading
causes of death in the near future if we don't act today, but even diabetes is very deadly we can prevent
through our lifestyle, Lifestyle plays a very important role in maintaining our health, even the simplest of
exercise can reduce the risk of developing diabetes, Diet which is also very vital in preventing the
occurence of diabetes mellitus, As said by Dr. Litonjua we should avoid the "Ks" which is
Katakawan(Gluttony), Katamaran(laziness), Katabaan(Obesity) to increase our defense against this
deadly disease.

2|Page
 Personal Information

PERSONAL DATA

Patient's Name : Ladica, Elizer Calanday

Religion: Roman Catholic

Nationality: Filipino

Address: Calandagan, Aracelli

Birthday: 1/ 25/1960

Age: 57

Contact Person: Ester Ladica (Grandson)

Physician: Dr. Ladica

Date of Admission: August 13, 2017

Final Diagnosis: Diabetic Foot (R), Sever anemia, Acute Renal Failure 2 infection of CKD 2 DM
nephropathy, S/P BKA

PRESENT MEDICAL HISTORY

Mr. E.L is a 57 year old male admitted on Aug. 13, 2017 with a past medical history of DM who present
himself today complaining of non-healing wound. The wound has been gradually worsening over the
past months. on Aug. 14 Mr. E.L undergone the procedure insertion of Intra Jugular Catheter. August 15
Mr. E.L undergone his first Hemodialysis . August 18 Mr. E.L undergone another Hemodialysis. August
19 Mr. E.L undergone BKA or Below Knee Amputation to control the necrosis of the skin. August 20
Client undergone another Hemodialysis. August 22 Mr. E.L was ordered of MGH.

PAST MEDICAL HISTORY

Mr. E.L was hospitalized on 2011 due to DM foot(L) but was able to save the foot and didn't
undergone any amputation. Mr. E.L recalled that his parents doesn't have any history of the disease and
verbalized that it was his lifestyle that caused the said illness as he was very fond of eating sweet foods
prepared by his wife. Mr. E.L is the Eldest among 9 siblings and could not remember any immunizations
he was able to take. He verbalized that he experience colds, lbm , measles, chicken pox before when he
was young. His wife is monitoring his blood glucose in their house as they have their own glucometer.

3|Page
 Physical Assesment

Integument

Skin: The clients skin is yellowish in color, both Right and Left lower leg skin is dark, dry and shiny.

presence of foul odor on right foot.

Hair: The hair of the client is thin, hair is no evenly distributed and most part of the scalp is bald with

presence of hair in parietal region.

Nails: The client has a light brown nails and has the shape of convex curve and slightly longer than the

normal height due to failure of cutting which is advised by the AP to avoid injury. When nails pressed

between the fingers (Blanch Test), the nails return to usual color in more than 3 seconds.

Head

Head: The head of the client is round in shape

Skull: There are no nodules or masses and depressions when palpated.

Face: The face of the client appeared smooth but saggy and has uniform consistency and with no

presence of nodules or masses.

10 | P a g e
 Physical Assesment

EENT

Eyebrows: Hair is evenly distributed..

Eyelashes: Eyelashes appeared to be equally distributed and curled slightly outward.

Eyelids: There were no presence of discharges, no discoloration and lids close symmetrically with

involuntary blinks approximately 10-12 times per minute.

Eyes: The pupils of the eyes are black and equal in size. The iris is flat and round. PERRLA (pupils equally

round respond to light accommodation), sclera is in jaundice

Ears: The Auricles are symmetrical and has the same color with his facial skin. The client is able to hear

clearly

Nose: The nose appeared symmetric, straight and uniform in color. There was no presence of discharge

or flaring. When lightly palpated, there were no tenderness and lesions

Mouth: The lips of the client are uniformly pink; moist, symmetric and have a smooth texture.

Teeth and Gums: enamels light yellow in color, no retraction of gums, pinkish in color of gums. The

buccal mucosa of the client appeared as uniformly pink; moist, soft, glistening and with elastic texture.

The tongue of the client is centrally positioned. It is yellowish in color, moist and slightly rough. There is

a presence of thin whitish coating.

10 | P a g e
 Physical Assesment

Neck: The neck muscles are equal in size. The client showed coordinated, smooth head movement with

no discomfort. The lymph nodes of the client are not palpable. The trachea is placed in the midline of

the neck. The thyroid gland is not visible on inspection and the glands ascend during swallowing but are

not visible.

Thorax, Lungs, and Abdomen

Lungs / Chest: The chest wall is intact with no tenderness and masses. Theres a full and symmetric

expansion and the thumbs separate 2-3 cm during deep inspiration when assessing for the respiratory

excursion. The client manifested crackles during respiration. Heart: There were no visible pulsations on

the aortic and pulmonic areas. There is no presence of heaves or lifts.

Abdomen: The abdomen of the client has a saggy skin and is uniform in color. The abdomen has a

symmetric contour. There were symmetric movements caused associated with clients respiration.

There is presence of Intra Jugular Catheter Attached to (R) Intra-Jugular Vein.

The extremities are symmetrical in size and length. After Aug. 19 2017, S/P BKA on (R) Leg the

extremities are non-symmetrical in size and length.

Muscles: The muscles are not palpable with the absence of tremors. (R) Lower leg is exhibiting necrosis

with dark, dry and shiny in appearance. After Aug. 19 2017, S/P BKA on (R) Leg exhibited tremors when

trying to lift the leg for wound dressing.

Bones: There were no presence of bone deformities before BKA procedure.

10 | P a g e
 Anatomy and Physiology

When a bone is broken, the periosteum and blood vessels in the cortex, marrow, and surrounding soft

tissues are disrupted. Bleeding occurs from the damaged ends of the bone and from the neighboring

soft tissue. A clot (hematoma) forms within the medullary canal, between the fractured ends of the

bone, and beneath the periosteum. Bone tissue immediately adjacent to the fracture dies. This necrotic

tissue along with any debris in thefracture area stimulates an intense inflammatory response

characterized by vasodilation,exudation of plasma and leukocytes, and infiltration by inflammatory

leukocytes andmast cells. [for information on the pathophysiology of the immune response,

seehttp://allnurses.com/forums/f50/histamine-effect-244836.html]". Within 48 hours after the injury,

vascular tissue invades the fracture area from surrounding soft tissue and themarrow cavity, and blood

flow to the entire bone is increased. Bone-forming cells in the periosteum, endosteum, and marrow are

activated to produce subperiosteal procallusalong the outer surface of the shaft and over the broken

ends of the bone. Osteoblastswithin the procallus synthesize collagen and matrix, which becomes

mineralized to formcallus (woven bone). As the repair process continues, remodeling occurs, during

whichunnecessary callus is resorbed and trabeculae are formed along lines of stress. Except for the liver,

bone is unique among all body tissues in that it will form new bone, not scar tissue, when it heals after a

fracture

10 | P a g e
 Bibliography

https://s-media-cache-ak0.pinimg.com/736x/32/b6/fc/32b6fc55087bf90d696220df05fe574b--teaching-

tools-teaching-resources.jpg (August 10, 2017)

http://www.medindia.net/surgicalprocedures/fracture-neck-of-femur.htm (August 10, 2017)

https://www.scribd.com/doc/102257963/Pathophysiology-of-Fracture (August 10, 2017)

https://www.nurseslearning.com/courses/nrp/labtest/course/labtests.pdf ( August 10, 2017)

http://www.robholland.com/Nursing/Drug_Guide/ (August 10, 2017)

https://www.fadavis.com/product/nursing-pharmacology-davis-drug-guide-deglin-vallerand-sanoski-

12?&RequestId=-1198579082 (August 10, 2017)

https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/complete-blood-count-cbc/

(August 10, 2017)

https://www.britannica.com/science/hip-fracture(August 10, 2017)

Books

Judith Hopfer Deglin PharmD, April Hazard Vallerand PhD, RN, FAAN
Cynthia A. Sanoski BS, PharmD, FCCP, BCPS. Davis Drug Guide 12th Edition (August 9, 2017)

13 | P a g e