CASE

OF
DIABETIC
NEUROPATHY
 Presented by:
BSN III – Group A
Jenny Juniora Ajoc George Palteng Jr.

Vanessa Azurin Marikit Ramirez

Jessica Bearmesa Katrina Sangueza

Cristel Mari De Torres Alyssa Marie Valerio

Clinical Instructor:
Jhea Pauline Montes, RN
Objectives
General Objective:
• This study aims to acquire understanding about diabetic neuropathy and
its possible complication.

Specific objectives:
 To perform physical assessment and history taking of a patient with
diabetic neuropathy
 To understand the pathophysiology of diabetic neuropathy.
 To determine various methods of diagnostic procedures done for patients
with diabetic neuropathy and wound infection.
 To identify medical and surgical management of diabetic wound.

 To develop a comprehensive nursing care plan addressing diabetic

neuropathy and wound infection.
Overview
 OVERVIEW

Diabetic neuropathy is the result of damage to the nerves.

Nerves help us to feel sensations and also play an important part in
the function of our organs. Diabetic neuropathy is a long term
complication of diabetes and tends to develop over a period of
years or decades. High blood sugar (glucose) can injure nerves
throughout the body. It most often damages the nerves in legs and
feet.
Patient’s
Profile
 PATIENT’S PROFILE
Name: Nardo Bartolome
Age: 68 years old
Date of Birth: March 7, 1953
Gender: Male
Civil Status: Widower
Address: Cabanatuan City, N.E.
Nationality: Filipino
Religion: Roman Catholic
Occupation: Retired Foreman
Chief Complain: fever for two days prior to admission with wound on left foot for two
weeks
Admission Date: April 7, 2021
Admitting Diagnosis: Infected Wound on Left Foot secondary to Diabetic Neuropathy
Attending Physician: Dr. Dela Cruz
 Patient’s Medical
History

Present Past
History History

Socio Family
Economic
History History
 Present History
The patient has type 1 Diabetes Mellitus since he was 28 y/o. He
did not have any checkups ever since the pandemic happened, and
was not compliant to his maintenance medications. Last March 24,
2021, while he was cleaning their backyard, he got punctured by a
rusty nail at the sole of his feet. He did not treat the wound. According
to the patient and relative, days had passed they noticed that the
wound was getting bigger and was warm to touch. Two days prior to
admission the patient developed a fever which made him consult at
the hospital.
 Present History
The open wound is 3 inches in diameter, warm to touch,
erythematous with a purulent drainage. The peri-wound is
macerated and denuded. The whole left foot up to the ankle is also
swollen and warm to touch. Complete blood count was done, with
a result of increase in white blood cell count. Fasting Blood sugar
was also taken with a result of elevated blood sugar. The patient
was admitted with the diagnosis of Infected Wound on Left Foot
secondary to Diabetic Neuropathy.
 Patient’s Medical
History

Present Past
History History

Socio Family
Economic
History History
 Past History

Patient had his diabetes at his 20’s, since then he has insulin
maintenance. He was also known to have a history of
hypertension, but is non-compliant to his medications. He was
experiencing burning and tingling sensation, as well as numbness
and unable to feel pain and temperature on his lower extremities
for months. Since he was living on his own, he just ignored it and
did not seek any medical treatment or advice.
 Patient’s Medical
History

Present Past
History History

Socio Family
Economic
History History
 Socio Economic History

The patient live on his own since her wife died 3 years ago
while his children started a family of their own. He was a retired
foreman and his wife was a pastry chef. They loved eating a variety
of foods, especially sweets, when her wife was still alive. Ever since
her wife died, he’s not active like before and had a sedentary
lifestyle . He spends most of the day in his backyard smoking
cigarrete. As of now he doesn’t have any source of income, he only
receives his monthly senior citizen pension to provide his daily
needs.
 Patient’s Medical
History

Present Past
History History

Socio Family
Economic
History History
Family History
 Physical
Assessment
 CEPHALO-CAUDAL ASSESSMENT
BODY PARTS TECHNIQUES NORMAL/STANDARD ACTUAL FINDINGS INTERPRETATION
1. Skull Inspection of size, Proportional to the size of Normal cephalic, Normal
shape, contour, lumps, the round with prominence proportional to the size of
deformities in frontal, parietal and the body, asymmetrical
occipital area, asymmetrical with no lumps
to all planes gently curved,
no lumps, smooth skill
contour

2. Scalp/ Hair Inspection of the White scalp, no lice and Hair evenly distributed, Normal
appearance, hair dandruff, no lesion, hair shiny, free from lice and
color, distribution, evenly distributed, thick, dandruff, no lesions and
texture, presence of shin, free from split ends white scalp
lice, nits and dandruff.

3. Face Inspection Symmetrical, no edema and Face is symmetrical with Normal

Symmetry, shape, no swelling of the face no signs of abnormalities
expression,
appearance and
movement
4. Skin Inspection Clear, no rashes, no Redness, swelling of the Abnormal
Lesions, bruising, pressure areas, no bruising, skin at pressure areas in  
pressure areas, rashes no swelling and no edema foot -due to the presence of
and edema     wound on the left foot
Palpation The skin is moist, smooth  
Moisture and texture and soft Wrinkle and dry skin - Due to old age
5.Eye/ Vision Inspection      
          
a. Eyeball  Protrusion No protrusion, scant amount No protrusion has scant Normal
    of secretion amount of secretion.  
       
         
b. Conjunctiva Color appearance Palpebral conjunctiva Glossy and pink Normal
    normally appears glossy and    
    pink, the bulbar conjunctiva is    
    present.    
     
     
c. Sclera Color appearance White, clear White clear Normal
         
       
       
d. Iris Color appearance Black, round Black, round Normal
         
       
   
e. Cornea Color, shape Clear, visible, flat, round Black in color, equal in size Normal
         
   
  3-7 mm in diameter, perrla  
f. Pupils Color 3-7mm in diameter, perrla constricts and dilates when Normal
    constricts as light is pointed to the light is pointed and  
    the eyes and when object is removed.  
    moved closer to the eyes and    
    dilates when light is removed  
  and when objects moved  
away.
           
g. Eyebrows and Color, asymmetry,  Symmetrical, thick hair Thick hair evenly distributed,  Normal
eyelashes quantity of hair, evenly distributed, raises and raises and lowers  
  placement lowers symmetrically, parallel asymmetrically, parallel to  
    to each other. each other.  
         
          
h. Eye movement in Color, appearance Can move in all direction Both eyes have movement Normal
all direction     coordination  
         
         
i. Eyelids Characteristics position Skin intact, no discharges, no Skin intact, no discharges, no Normal
  in relation to cornea discoloration, lids close discoloration, lids close  
  ability to blink asymmetrically asymmetrically  
       
       
   No edema and tenderness
j. Lacrimal Glands Inspection and No edema and tenderness seen and palpated Normal
palpation
6. Ears/ Hearing Inspection Parallel, symmetrical Color same as facial skin, Normal
  Parallelism, symmetry, proportion to the size of the symmetric position, in line  
  size, shape, appearance, head, bean- shape, skin is the with the outer canthus of the  
  placement same to the surrounding area, in eyes, proportion to the size of  
    the line with the outer canthus the head  
    of the eyes    
       
         
  Palpation Firm cartilage, non- tender, Firm recoils after it is folded,  
a. Pinna Firmness of the cartilage recoils after it folded non- tender Normal
  and tenderness      
         
         
  Inspection Pinkish, clean with scant    
  Color, appearance, any amount of cerumen Brown colored with scant  
b. External Canal discharge   amount of cerumen Normal
       
         
         
     
     
   
       
(whisper from client’s ear   Able to repeat the phrase
at a distance at two feet Able to repeat the phrase spoken “I am a nurse”  
C. Hearing Acuity away from client's back) spoken “I am a nurse” at a Normal
medium pitch
7. Nose Inspection Nasal system are intact and Nasal system are intact and Normal
Placement, discharges symmetrical, no discharges, symmetrical at the midline  
and patency, redness and patent, no flaring and pink with no discharge and flaring  
swelling mucosa of nostrils.  
       
Palpation  
Tenderness and masses No tenderness, no lesion and no No tenderness, no lesion and Normal
displacement of bone cartilage no displacement of bone
cartilage
8. Mouth/ Lips Inspection Pinkish, smooth, moist, Grayish, slightly dry, Abnormal
  Color, shape, moisture, asymmetrical symmetrical Due to smoking
  symmetry, appearance      
         
         
Color, appearance      
a. Gums   Pinkish, smooth, no discharge, Slightly dark in appearance, Normal
    no retraction no swelling, no discharge, no  
      retraction  
         
   
Color, arrangement,   Complete set of teeth,  
b. Teeth general condition, Hare teeth yellowish with dental carries Abnormal
  moisture, movement     Poor hygiene
        And smoking
      Central position, large, slight  
  Color, texture elicits gag   pink, rough on top, moist and  
c. Tongue reflex Central position, large, medium, freely movable, no lesion Normal
  red or pink, slightly rough on
top, smooth along the lateral
margin, moist, shiny and freely
movable, no lesion
9. Cheeks Inspection Pinkish, smooth Brown, smooth Normal
Color, appearance      
       
Palpation      
Check for tenderness No tenderness and masses No tenderness and Normal
and masses masses

10. Neck Inspection Proportional to the size of Proportional to the size Normal
Symmetry, position body head, symmetrical of body head,  
  and straight, able to move symmetrical and straight,  
  No lumps, no masses, no able to move  
  tenderness No lumps, no masses, no  
Palpation tenderness  
Lumps, nodes, Normal
tenderness
11. Chest Inspection No heaves or abnormal No heaves or abnormal Normal
Lifts, heaves pulsation pulsations pulsations

12.Abdomen Inspection Symmetrical, same color as Symmetrical, same color as Normal

Color, contour, the rest of the body, good skin the rest of the body, no scars  
symmetry, skin integrity, turgor, no scares and skin and skin turgor skin  
scars, and size turgor    
       
       
Auscultation   Audible bowel sound and no  
Bowel sound and Audible bowel sound and no arterial bruit, no friction rub Normal
peritoneal friction rub arterial bruit, no friction rub    
       
       
Percussion   Tympany over the stomach  
Determine the presence Tympany over the stomach and gas filled bowel dullness  
of tympany and dullness and gas filled bowel dullness   Normal
       
       
Palpation      
Deep palpation over all   Tenderness may be present  
4 quadrants Tenderness may be present near the xiphoid process  
near the xiphoid process when palpated  
Normal
13. Upper INSPECTION, Symmetrical equal in length, Symmetrical equal in length, Normal
Extremities symmetry, size length, no lesions, no deformities able no lesions, no deformities  
  deformities, skin, to do flexion, extension and able to do flexion, extension  
  lesions, scars, ROM ROM and ROM. Thin extremities.  
  movement      
       
    5 fingers, pinkish nail beds, 5 fingers, pale nail beds, not  
a. Hand Size no.of finger per well-trimmed nails, clean can well trimmed nails, can do Normal
hand, color of nails. do ROM ROM
Hygiene movement

14. Genitals INSPECTION Pubic hair and skin No inflammation, swelling Normal
  Skin of pubic area of   and lesions  
  parasites inflammation      
  swelling and lesions.      
         
       
         
  INSPECTION      
  Penis and scrotum size      
a. Penis and Scrotum and lesions Size of genitalia is relative to Size of genitalia is relative to Normal
the body and childhood, no the body and childhood, no
inflammation and discharges inflammation and discharges
15. Inguinal PALPATION
Inguinal lymph nodes
16.Lower Extremities INSPECTION
  Symmetry, length,
  deformities, scars, hair and
  movement
   
   
  PALPATION
  Presence of tenderness and
  pain, edema and loss of
  function
   
 
  INSPECTION
a. Feet Symmetry, length, size,
  deformities, hair
  distributions , scars and
  lesions, movement
  (flexion, extension, and
  rotation)
   
  PALPATION
  Presence of tenderness in
  the area, edema and loss of
  functions
 
No enlargement or tenderness
Equal on length symmetrical,
with no deformity, no scars,
minimal or moderate hair
distributions, able to do ROM
Absence of tenderness, edema,
swollen areas, and pain
 
 
Equal in size, no scars, no
lesions, no deformities, with 5
toes each foot, able to move
freely and do ROM
 
 
 
 
Absence of tenderness edema,
swollen areas and pain
No enlargement or tenderness Normal
Has a wound at the left foot; Abnormal
with minimal ROM inability to  
stand and walk -due to the wound at left foot
 
 
  Abnormal
with tenderness, pain and  
swelling    
   
 
Abnormal
 Unequal in size with 5 toes  
each. There’s a wound located -there’s a wound that is
at left foot that has a diameter infected
of 3 inches with swelling,  
redness, and purulent drainage.  
   
   
Swollen and tender, localized Abnormal
heat  
-due to swelling areas and pain
because of the wound
Anatomy &
Physiology
Pathophysiology
DIAGNOSTIC
TEST
 DIAGNOSTIC TEST NORMAL VALUES RESULT CLINICAL SIGNIFICANCE
  Red blood cell count    
  Male: 4.35-5.65 trillion    
COMPLETE BLOOD cells/L* elevated white - signifies infection
COUNT (CBC) Female: 3.92-5.13 trillion blood cell  
cells/L   -A high white blood cell count is not
    always infectious, though this is the most
White blood cell count   common reason. Stress reaction can
4,500 to 11,000 WBCs per 14,000 per cause a high count, and certain drugs,
microliter microliter especially steroids, can lead to a higher
number.

       
    210mg/dl - high level of rbs
RANDOM BLOOD SUGAR Below 11.1 mmol/l Below   -A level of 200 mg/dl or higher is an
(RBS) 200 mg/dl indication of diabetes mellitus.
  Less than 100 mg/dL =    
  normal.    
      -high level of fbs
  Between 110–125 mg/dL    
FASTING BLOOD SUGAR = impaired fasting glucose 150 mg/dl - These points to either insulin resistance
(FBS) (prediabetes)   or inadequate insulin production and, in
  some cases, both.
Greater than 126 mg/dL on
two or more samples =
diabetes
       
  A normal A1C level is below    
  5.7%   -High level
HEMOGLOBIN A1C TEST      
a level of 5.7% to 6.4% greater than 7 - The higher A1C level is the poorer your blood
indicates prediabetes sugar control and the higher your risk of
  diabetes complications.
a level of 6.5% or more
indicates diabetes

  If the one foot has a hallux    

  valgus angle that is “normal” No fractures seen  
  while the contralateral foot has    
XRAY a hallux valgus angle that is
“abnormal.”
MEDICAL
MANAGEMENT
 Drug Name Mechanism of Indication Contraindication Side Effects Nursing Responsibility
Action
Generic name: It works by stopping Used to relieve •Hypersensitivity to • Nausea, • Assess patients who develop severe
Mefenamic acid the body’s mild to moderate drug vomiting, abdominal diarrhea and vomiting for dehydration and
  production of a pain cramps electrolyte imbalance
Brand name: substance that •Give with meals, food, or milk to
Ponstan causes pain, fever, minimize GI adverse effects
  and inflammation.  
Dose: • Drowsiness • Raise side rails
500mg • Do not drive or engage in potentially
  hazardous activities until response to drug
Route: is known. It may cause dizziness and
P.O. drowsiness.
   
Frequency:  
TID • Sore throat discontinue if adverse effect was shown
  • Headache  
• Rash  
 
 
 
 Drug Name Mechanism of Indication Contraindication Side Effects Nursing Responsibility
Action
Generic name: It works by Used to treat • sensitivity to • rash • Before administering the drug, perform
Cloxacillin stopping the bacterial infection penicillin • itching skin test
  growth of bacteria   • chills • Instruct the patient to report rash, itching,
Brand name: It exerts     and chills or other signs or symptoms of
Cloxapen bactericidal     hypersensitivity reaction as with other
  activity via   penicillins.
Dose: inhibition of    
1g bacterial cell wall •Wheezing • Monitor signs of allergic reactions and
  synthesis by   anaphylaxis, including pulmonary
Route: binding one or   symptoms (tightness in the throat and
IV more of the   chest, wheezing, cough dyspnea) or skin
  penicillin binding   reaction
Frequency: proteins (PBPs).    
q6 •Hematologic: • Lab tests: Periodic assessments of renal,
  Eosinophilia, hepatic, and hematopoietic function are
leukopenia, advised in patients on long-term therapy
agranulocytosis
 Drug Name Mechanism of Action Indication Contraindication Side Effects Nursing Responsibility

Generic name: - works the same way treatment for •hypoglycemic •Hypoglycemia • Monitor for S&S of hypoglycemia
Insulin Glargine as natural human adults and children patient   • Monitor Blood Glucose Level
  insulin, but it's action with type 1 •Hypersensitivity to   • Ingest some form of sugar (e.g., orange
Brand name: lasts longer. It helps diabetes drug   juice, dissolved table sugar, honey) if
Lantus diabetic patients   symptoms of hypoglycemia develop; and
  regulate glucose or   seek medical assistance.
Dose: sugar in the body.  
6units Insulin glargine works •Instruct the patient to report any signs of
  by promoting • Rash, itching hypersensitivity to drug
Route: movement of sugar  
Subq from blood into body • Notify the physician of any of the
  tissues and also stops • Fever following: fever, infection, trauma,
Frequency: sugar production in •Diarrhea diarrhea, nausea, or vomiting. Dosage
AC liver. • Nausea or adjustment may be needed.
  vomiting  
  • Avoid injection of cold insulin; it can lead
• Skin thickening or to lipodystrophy, reduced rate of
pits at the injection absorption, and local reactions
site • Rotate injection sites
 Drug Name Mechanism of Indication Contraindication Side Effects Nursing Responsibility
Action
Generic name: It lowers blood Humulin R U-100 •hypersensitivity to • Low Blood • Monitor for hypoglycemia at time of
Insulin regular glucose levels by is indicated as an drug Sugar peak action of insulin.
human increasing peripheral adjunct to diet     • Check blood sugar before injecting
  glucose uptake, and exercise to • During episodes   humulin R
Brand name: especially by skeletal improve glycemic of hypoglycemia   • Carry some form of fast-acting
Humulin R muscle and fat tissue, control in adults   carbohydrate at all times to treat
  and by inhibiting the and children with   hypoglycemia
Availability: liver from changing type 1 and type 2    
100U/mL glycogen to glucose. diabetes mellitus. • Skin thickening • Avoid injection of cold insulin; it can
  or pits at the lead to lipodystrophy, reduced rate of
Dose: 5–10 Units injection site absorption, and local reactions.
    • Learn correct injection technique
Route: SQ   • Rotate injection sites
  • Allergic  
Classifications: reactions • Instruct the patient to notify physician of
HORMONE AND ( Itching and local reactions at injection site.
SYNTHETIC rash)
SUBSTITUTE;  
ANTIDIABETIC  
AGENT; INSULIN  
   
   
 
 Drug Name Mechanism of Indication Contraindication Side Effects Nursing Responsibility
Action
Generic name: Vitamin C is an Used to prevent • Thalassemia •Nausea • Assess patients who develop severe
Ascorbic Acid antioxidant which is or treat low • G6PD deficiency •vomiting diarrhea and vomiting for dehydration
  thought to have a levels of vitamin • sickle cell disease,   and electrolyte imbalance
Brand name: protective role in C in people who and   • Give with meals and food to minimize
Cecon diabetes by reducing do not get •hemochromatosis   GI adverse effect
  the damage caused enough of the    
Classification: by free radicals vitamin from   • Raise side rails
Vitamin their diets. Most •Headache  
  people who eat a   • Monitor for S&S of acute hemolytic
  normal diet do •Fatigue anemia, sickle cell crisis.
Dose: not need extra
500mg ascorbic acid
   
Route:
P.O
 
Frequency:
0D
 
 Drug Name Mechanism of Indication Contraindication Side Effects Nursing Responsibility
Action
Generic name: As the building Vitamin B Hypersensitivity to •Headache due to • Assess patient for signs of vitamin
Vitamin B complex blocks of a healthy complex may drug excess intake of deficiency before and periodically during
  body, B vitamins have have a strong role Vitamin B therapy. •Assess nutritional status through
Brand name: a direct impact on to play when complex 24-hr diet recall.
Nephro-vite your energy levels, treating diabetic   • Raise side rails
  brain function, and neuropathy. The    
Classification: cell metabolism. presence of    
Vitamin Vitamin B complex vitamin complex •Itching or rash • Take a careful history of sensitivities to
  helps prevent is necessary for   drug.
Dose: 25mcg infections and helps the correct    
  support or promote: functioning of •nausea  
Route: P.O cell health. nerve cells, and •vomiting • Assess patients who develops vomiting for
  therefore taking it dehydration and electrolyte imbalance
Frequency: OD as a supplement  
  may help to •Give with meals, food, or milk to minimize
reduce nerve GI adverse effects
damage.  
•Encourage patient to comply with diet
recommendations of health care
professional. Explain that the best source of
vitamins is a well-balanced diet with foods
from the four basic food groups.
 SURGICAL
MANAGEMENT
 Surgical Description Indication Complication
Treatment
Wound Debridement is a procedure for  presence of ● Pain
Debridement treating a wound in the skin. It necrotic, senescent ● Bleeding
  involves thoroughly cleaning the tissue or biofilm ● Infection
wound and removing all  when there is ● Delayed healing
hyperkeratotic (thickened skin or excessive fibrotic ● Loss of healthy tissue
callus), infected, and nonviable tissue  
(necrotic or dead) tissue, foreign  
debris, and residual material from
dressings. Debridement can be
accomplished either surgically or
through alternate methods such as
use of special dressings and gels.
PRE-OERATIVE POST-OPERATIVE
NURSING CARE NURSING CARE
 Pre-Operative Nursing Care

-Perform a physical examination before the operation.

-Perform and maintain wound care.

-The patient should be in supine position.

-The nurse should immobilize the wounded part of the foot.

-Measure the size of the wound in the affected part.

PRE-OERATIVE POST-OPERATIVE
NURSING CARE NURSING CARE
 Post-Operative Nursing Care
-Use an aseptic, non-touch technique for changing or removing dressings.
-Aim to leave the wound untouched for up to 48 h after surgery, using sterile saline
for wound cleansing during this period only if necessary
-Advise patients that they may shower safely 48 h after surgery.
-Use tap water for wound cleansing after 48 h if the wound has separated or has
been surgically opened to drain pus.
-Use an interactive dressing for surgical wounds that are healing by secondary
healing.
 NURSING
CARE PLAN
 ASSESSMENT BACKGROUND DIAGNOSIS PLANNING NURSING RATIONALE EVALUATION
KNOWLEDGE INTERVENTION
Subjective: As part of immune Elevated body After 4 hours of Independent:   After 4 hours of
“Dalawang araw na response of the body, temperature nursing  Monitor vital signs  Vital signs provide nursing intervention the
akong nilalagnat ” elevated temperature related to left foot intervention the   more accurate patient’s temperature
as verbalize by the is usually caused by infection as patient’s   indication of core was decreased from
patient infection of injury in evidenced by temperature will   temperature 38.9°C to 37.2°C
  the left foot. As warm skin and decrease from    To lessen the body
Objective: inoculation occurs, temperature of 38.9°C to 37.2°C  Provide tepid temp in process of Goal was met.
  proliferation of 38.9°C sponge bath conduction and
 Facial bacteria follows and   evaporation
grimace multiplication occurs.    These decrease
 Irritable Once that bacteria   warmth and
 Flushed skin starts to grow in   increase evaporative
 Warm to number, it will soon  Remove excess cooling
touch reach it pathogenic clothing covers  To promote clear
 Wound on level that will result   flow of air in the
left foot into pyrexia or fever   patient’s area. One
  as defense mechanism  Promote a well way of promoting
Vital signs taken as of the body. ventilated area to heat loss.
follows: patient
   
T – 38.9°C  
P – 100 bpm  
R – 28 bpm  
BP -130/80 mmHg  
 
   Advise patient • Additional fluids
to increase fluid help prevent
intake elevated temperature
  associated with
  dehydration
   To reduce
 Maintain bed metabolic
rest demands/ oxygen
  consumption
   Gives cooling
  sensation
 Place a cool  
cloth on the  
forehead  
   
Collaborative:  
   
 Administer  to reduce the
medication as progress of
prescribed by infection and
the physician fever
 ASSESSMENT BACKGROUND DIAGNOSIS PLANNING NURSING RATIONALE EVALUATION
KNOWLEDGE INTERVENTIONS
Subjective Data: Neuropathy is both a Impaired physical After 24 hours of  Assess the overall  Assessment of the After 24 hours of
major cause of injury mobility related to nursing condition of the condition of the skin nursing intervention,
“Hindi ko maigalaw in individuals with wound infection intervention, the skin and ROM. provides baseline the patient was able to
ang kaliwang paa ko, diabetes, and also a as manifested by patient will be data. maintained or increased
namamanhid, at ilang reason for limited range of able to maintain strength and function of
araw na rin na sariwa complications in motion. or increase affected and
ang sugat ko.” As diabetes wound strength and compensatory body
verbalized by the healing. When high   function of part.
patient. blood sugar destroys affected and
   
  nerves, they do not compensatory  Evaluate the
regenerate; thus body part. patient’s strength Goal met.
Objective Data: many patients with to move (e.g.,  Serves as baseline
diabetes are   shift weight while data.
-Redness around increasingly less sitting, turn over
wound  sensitive to pain in in bed, move from
their limbs. bed to chair).
-Foul smelling
wound
 Assisted/have
-Darkening skin at client reposition
the edges self on a regular
schedule from
  side to side.
 To decrease
numbness and pain
in the affected area.
- tenderness at With this loss of •Used side rails •To prevent the
the affected sensation, of bed. patient from
extremity patients don't feel possible fall or
- localized heat developing accident that
- feeling of blisters, might happen.
numbness on the infections, or
affected part existing wound
changes. That •To help ease the
means that •Encouraged pain and
wound healing is patient to move numbness of said
complicated not the affected part part.
only by the fact from time to
that patients don't time.
feel wounds as
they occur, but •Assess the •Patients who
they also have no surface that the spend the
pain to alert them patient consumes majority of time
that a wound is most of his time on one surface
getting worse or on (e.g., mattress require a pressure
infected. for bedridden reduction or
patient, cushion pressure relief
for people in device to
wheelchairs). distribute
pressure more
evenly and
reduce the risk
for breakdown.
For many with •Encourage the •The aims of
diabetes, injuries patient to change repositioning are
are only noticed position every 15 to reduce or
with careful daily minutes and relieve the
skin checking. change chair- pressure on the
However, limited bound positions area at risk,
mobility can make every hour. maintain muscle
it difficult for mass and general
some individuals tissue integrity and
to check the most ensure adequate
vulnerable areas, blood supply to the
such as the bottom at risk area.
of their feet.

•Encourage •Ambulation
ambulation if the reduces pressure
patient is able. on the skin from
immobility thus
lessening the
factors that may
result in impaired
skin integrity.
•Reinforce the •These will
importance of enhance their
turning, mobility, sense of efficacy
and ambulation and can improve
compliance with
the prescribed
interventions.

•Educating
•Educate patients patients and
and caregivers caregivers
about proper methods to
wound & skin maintain skin
care. integrity enhances
their sense of self-
efficacy and
prevents skin
breakdown.

•The incidence
•Reassess the skin and onset of skin
regularly and breakdown is
whenever the directly related to
patient’s condition the number of risk
or treatment plan factors present.
results in an
increased number
of risk factors.
THANK YOU