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TITLE PAGE

 

BY

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--/H2013/01430
DEPARTMENT OF ----
SCHOOL OF ---
INSTITUTE OF ---

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APPROVAL PAGE

This is to certify that the research work, "medical surgical nursing" by ---, Reg. No. --/H2007/01430 submitted in partial fulfillment of the requirement award of a Higher National Diploma on --- has been approved.

By
---                                                     . ---
Supervisor                                                  Head of Department.
Signature……………….                           Signature……………….        

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External Invigilator

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DEDICATION
This project is dedicated to Almighty God for his protection, kindness, strength over my life throughout the period and also to my --- for his financial support and moral care towards me.Also to my mentor --- for her academic advice she often gives to me. May Almighty God shield them from the peril of this world and bless their entire endeavour Amen.

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ACKNOWLEDGEMENT

The successful completion of this project work could not have been a reality without the encouragement of my --- and other people. My immensely appreciation goes to my humble and able supervisor mr. --- for his kindness in supervising this project.
My warmest gratitude goes to my parents for their moral, spiritual and financial support throughout my study in this institution.
My appreciation goes to some of my lecturers among whom are Mr. ---, and Dr. ---. I also recognize the support of some of the staff of --- among whom are: The General Manager, Deputy General manager, the internal Auditor Mr. --- and the ---. Finally, my appreciation goes to my elder sister ---, my lovely friends mercy ---, ---, --- and many others who were quite helpful.

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PROJECT DESCRIPTION: This work "medical surgical nursing" research material is a complete and well researched project material strictly for academic purposes, which has been approved by different Lecturers from different higher institutions. We made Preliminary pages, Abstract and Chapter one of "medical surgical nursing" visible for everyone, then the complete material on "medical surgical nursing" is to be ordered for. Happy viewing!!!

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TABLE OF CONTENT
Title page …………………………………………………………………………               i
Certification ………………………………………………………………………               ii
Dedication …………………………………………………………………………             iii
Acknowledgement …………………………………………………………………             iv
Table of content ……………………………………………………………………             v         
CHAPTER ONE
INTRODUCTION
Background of the study …………………………………………………………….          1
Purpose of the study …………………………………………………………………          2
Significant of the study ……………………………………………………………             3
CHAPTER  TWO
LITERATURE REVIEW OF DIABETES MELLITUS FOOT ULCER
Definition of diabetic foot ulcer  ……………………………………………………           5
Causes of diabetes foot ulcer ……………………………………………………….            6
Risk factor for diabetes foot ulcer ……………………………………………………         6
Foot ulcer assessment and classification ……………………………………………            11
Pathophysiology of diabetes foot ulcer ………………………………………………         13
Clinical manifestation of diabetes foot ulcer …………………………………………         14
Complication of diabetes foot ulcer …………………………………………………          15
Wound healing ………………………………………………………………………           16
Factor influencing wound healing in diabetic patient ………………………………           18
How to improve diabetes foot ulcer healing ………………………………………              20
Management of patient with diabetes foot ulcer ………………………………..                 21
Prevention of diabetes mellitus foot ulcer ………………………………………                 25
Prognosis …………………………………………………………………………                26
CHAPTER THREE
Demographic data and history of the patient ……………………………………                .28
Source of data ……………………………………………………………………                29
Patient family and social history…...........................................................................              29
Past medical history …………………………………………………………………….      29
Present history of illness……………………………………………………………….        30
Clinical features presented by the patient ……………………………………………..        30
Nursing history/ assessment …………………………………………………………..         31
CHAPTER FOUR
MANAGEMENT OF THE PATIENT WITH DIABETES MELLITUS  FOOT ULCER
Physician systemic review ……………………………………………………………….    34
Physician diagnosis ………………………………………………………………………    36
Medical management of the patient with diabetic foot ulcer ……………………………    36
Pharmacology of drug used on the patient …………………………………………….       37
Daily nursing care and progress of the patient …………………………………………      42
Health education ………………………………………………………………………..      48
Rehabilitation …………………………………………………………………………..       49
Discharge ………………………………………………………………………………       50
Home visit ……………………………………………………………………………..        50
CHAPTER FIVE
Summary ………………………………………………………………………………        53
Conclusion …………………………………………………………………………….        53
Recommendation………………………………………………………………………        53
Reference ………………………………………………………………………………       54  

Drug	Indication	Mode of action	Dosage	Route	Side effect	Contra indication	Nursing Responsibility
Nifedipine	Angina pectoris, arterial hypertention myocardiopathy	It dilates the coronary arteries reducing the contration and oxygen demand of the myocardium	10-20mg 4hrly daily	Orally	Headache nausea Skin rash Dizziness	Pregnancy Lactation Hypersensitivity reaction	It should not be given to patient with pregnancy, hypertention and it should be taking with plenty of water
Capitopril	Hypertention, congestive cardiac failure Renal artery stenosis	It reduces cardiac overload and increase cardiac output	25mg twice daily	Orally	Hypotension Proteinuria Lost of taste Anaemia	Aortic stenosis Pregnancy Lactation	Care must be taken not to give the patient potassium supliment so as not to cause hyperkalaemia
Soluble insulin	Diabetes mellitus schizophrenia, anorexia in under nourish patient	It facilitate the transportation of glucose to the body tissue and also enhance proper ultilisation and oxidation of blood glucose by the body cell	0.5-5mls half hour before meal	Subcutenously,intramuscularly and intravenously	Hypoglyc emia systemic hypersensitivity cutenous reaction like lipodystrophy	Urticaria or hypotension hypersensitivity	Test the urine for glucose and acetone before each meal and to help determine dose of insulin to administer.
Glucophage	Non insulin dependent diabetes mellitus	It promote glucose uptake by body cell	Inicially 500mg bd then can be increase to	Orally	Nausea vomiting lactidosidosis	Diabetes coma ketoacidosis, renal insufficiency	Should not be given to patient with impaired renal or hepatic disfunction
Vitamin B	Beriberi Pellagra	The cyanocobalamin contain help in maturation of erythrocyte during erythropoises	One to two tablet three time daily before are after meal	Orally Intramuscullarly	No noticeable side effect	Incompactable with kenamicin injection	Serve the correct dose and avoid giving it kenemycin injection

CHAPTER ONE
1.0           INTRODUCTION
1.1       BACKGROUND OF THE STUDY
This case study was carried on Alhaja A.H, a 60years old trader who has right foot ulcer, patient was brought to accident and emergency unit on 30th march, 2017 with clinical diagnosis of right foot ulcer and later transfer to ward 2.
Approximately 15 to 20 percent of estimated 16million persons in the united state with diabetes mellitus will be hospitalized with a foot complication and also estimated in Nigeria (Harrison, 2012).
Mustapha (2010) define diabetes mellitus as an endocrine disorder in which there is deficiency or lack of insulin production leading to metabolic disorder of carbohydrate, fat and protein and characterized by hyperglycemia, dehydrative vascular changes and neuropathy.
Foot ulcers are significant complication of diabetes mellitus and after precede lower- extremity amputation.  The most frequent underlying etiologies are neuropathy, trauma, deformity, higher planter pressure and peripheral arterial disease.  Thorough systemic evaluation and categorization of foot ulcer help guild appropriate treatment (Fryberg, 2011)
Foot disorder such as ulceration, infection and gangrene are the leading causes of hospitalization in patient with diabetes mellitus. Unfortunately many of those patients will require amputation with the foot or above the ankle as a consequence of severe infection or peripheral ischemia (Mustapha, 2011).
Approximately 85 percent of the diabetes – related lower extremity amputation are preceded by foot ulcer.  Sharp debridement, management of underlying infection, and ischemia as well as relief of pressure using total contact cast, removable cast walker or half shoe are mainstay of initial treatment of diabetic foot ulcer.  The aim of therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed.  Multidisciplinary management programs that focus on prevention, education, regular foot examination, aggressive intervention and optimal use of significant reductions in the incidence of lower extremity amputation. (Fryberg,2011)     
PURPOSE OF THE STUDY

• To critically look at concept of diabetes complication i.e.  diabetes mellitus foot ulcer, causes, sign and symptoms, predisposing factor, prevention and management of the condition  
• To provide adequate care for diabetic mellitus foot ulcer patient and prevent further complication that can arise from diabetes foot ulcer such as amputation and even death
• To increase knowledge in medical field from latest discovery and management of diabetes foot ulcer.  Hence preventing or minimize the rate at which other complication arise
• To create awareness about the disease and health educate the people on how it can be detected and prevented
• To serves as an award of certificate in general nursing as required by the nursing and midwifery council of Nigeria

SIGNIFICANCE OF THE STUDY
The importance of this study cannot be overemphasized based on the following point
i.          This care study provide patient the opportunity to have close access to health practitioner and hence benefitting from therapeutic health education
ii.         It increase nurse-patient relationship by improving an individualized care for the patient
iii.        It will serve as base line for further studies about diabetes mellitus foot ulcer and it will help in the reduction of mortality rate in patient with diabetes mellitus foot ulcer, thereby improving economic standard of the patient
iv.        It provide information necessary to carryout research for junior nurse who might be faced with the challenge of care study in the course of his/her study
v.         It enhances the nurse ability to give an appropriate health education to the people as the nurse is better equip with updated knowledge.

CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
5.1       SUMMARY
This care study was carried out on a 65years old woman Alhaja A.H who was admitted on 28th march 2017 in to the female medical ward (ward2) of the Kwara state general hospital Ilorin, with diagnosis of right foot ulcer secondary to diabetes mellitus
Different literature was reviewed based on the patient condition under the following headings:- definition of the diabetes mellitus, causes, incidence, anatomy and physiology of the condition, clinical manifestation, complication, prognosis, brief discussion on diabetic foot ulcer and some effective management of this disease condition.  The patient data was collected and documented to assist in the diagnosis and ensure effective management, the patient was enlighten on the pre-disposing factor of the disease as well as the clinical manifestation and she was duely cared for.  Health education on the need for follow up care, subsequently.  Patient was discharges on 13/4/2017.  She is to visit the out patient department twice a week.  The patient home was visited and patient was advised on importance of environmental and personal hygiene   

5.2       CONCLUSION
Conclusively, it can be understood that diabetes mellitus foot ulcer does not just happen, it is a complication that arise from poorly managed diabetes mellitus which bring about inadequate blood flow to the peripheral tissue leading to necrosis hence diabetic foot ulcer .  it was also revealed that adequate management of diabetes mellitus can prevent the complication into diabetes foot ulcer

5.3       RECOMMENDATION
This write up contains useful information as regard to the cause, the symptoms and treatment of diabetes mellitus.

• The attention of the government should and other body concern and charged with health issue are adviced to developed qualitative health facility so as to solve the problems of inadequate access of health facility as this will provide adequate means of improving the health needs of the populace
• The government should increase the supply of essential drugs to the hospital in order to hasten the treatment of diabetes mellitus so has to prevent further complication such as diabetes foot ulcer
• The community member should be health educated on the importance of regular hospital visitation for check- up, this will help in early detection of any disorder of the body system
• Health education on the cause and treatment of this disease should be encouraged
• The would site should be dressed using bio- dress to enhance healing

Finally, the writer suggests that this care study should be kept in the school library for student nurse to assist

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CHAPTER TWO: The chapter one of this work has been displayed above. The complete chapter two of "medical surgical nursing" is also available. Order full work to download. Chapter two of "medical surgical nursing" consists of the literature review. In this chapter all the related work on "medical surgical nursing" was reviewed.

CHAPTER THREE: The complete chapter three of "medical surgical nursing" is available. Order full work to download. Chapter three of "medical surgical nursing" consists of the methodology. In this chapter all the method used in carrying out this work was discussed.

CHAPTER FOUR: The complete chapter four of "medical surgical nursing" is available. Order full work to download. Chapter four of "medical surgical nursing" consists of all the test conducted during the work and the result gotten after the whole work

CHAPTER FIVE: The complete chapter five of "medical surgical nursing" is available. Order full work to download. Chapter five of "medical surgical nursing" consist of conclusion, recommendation and references.

 

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