As Filipino citizens, this is significant data, especially when you consider that the Philippines is only a developing country. Worsened by the fact that diabetes is a chronic disease, the Philippine healthcare system will have to shoulder the task Of helping the Filipino people prevent and manage the disease. In addition, the Philippine economy Will suffer because our working-age citizens, instead of performing their jobs and functions as often and as best they could, may have to divide their time for the workplace to receive diabetic management and treatments.
As student ruses, this is also significant. When we were 2nd years, we were regularly assigned to the Outpatient Department (Dispensary) of the Mary Johnston Hospital. Every Wednesday, the hospital’s Diabetes Club would gather and get their regular check-up, including the taking of their blood pressures, blood sugar and cholesterol. And now as 3rd years, we are regularly assigned to the Medicine and Surgery wards of the same hospital, and unfortunately see a few of the club members there due to complications brought on by diabetes.
That is why we – Pearlier Okay and Bianca – decided to focus our case study on foot abscess. If this case study can at least make the three of us better teachers to our patients, then this would assist in our goal of helping the Filipino people be more aware of Diabetes, and hopefully, prevent further occurrences of the disease in the Philippines. II. Demographics Name: D. I. D. G. Age: 64 years old Gender: Male Marital Status: Married Religion: Roman Catholic Address: Tendon, Manila Occupation: Unemployed/Retired Educational Attainment: 2nd year of high school Date of Admission: January 17, 201 5 (10:45 AM) Ill.
Nursing History Present Health History Three days prior to admission, the patient felt sharp pain on his right foot. Because he did not want to miss the party at his house, he did not seek any consultation. A few hours prior to admission, the patient felt the pain on his right foot increase in severity until he could no longer tolerate the pain. He was then rushed to the ERE Department and then admitted. Past Health History Allergy: (-) Asthma; (-) Food allergies; (-) Drugs and blood transfusion; (-) Allergies of unknown cause; (-) Family history.
Immunization: Incompletely vaccinated or cannot remember what he received; received Tetanus Toxic shot in the ERE Department (January 17, 201 5) Childhood Illnesses: All before gig school (+) Chickenpox; (+) German Measles; (+) Measles; (+) Mumps Surgery: Incision & Drainage of right foot (January 1 8, 2015) Family History: (+) Hypertension on both sides of family Current Illnesses: (+) Type-2 diabetes (since 2000 and poorly controlled); (+) Hypertension (since 2000) Medication: Calico, Meteoroid; Inalienable Vices: (+) Occasional alcoholic beverages; (-) Smoker; (+) Fatty foods IV.
Cordon’s Functional Health Pattern Health Perception & Health Management “Hindi an aka healthy kaki Madame an nag skit kook,” as stated. “Gung may dead an, Hindi an manuals o mammals,” as stated. Has regular check-ups with Dry. Alex Tan in his clinic in Memories. Complies with anti-hypertensive medications. Manages his Type-2 diabetes poorly. Nutrition & Metabolism Before: Prefers fatty, fried foods. Usually eats all types of meats. Can eat 2-3 cups of rice per meal. Should be on a low-salt, low-fat, diabetic diet. Drinks 2-3 glasses of water a day. Has a cup of coffee a day.
Enjoys soft drinks at least twice a day. Now: Is on a strict low-salt, low-fat, diabetic diet. Ate a bread roll with 1 cup of coffee for breakfast. Ate 1/4 piece of a hamburger, rice porridge and a small banana for lunch. Ate 1 cup Of rice and soup for dinner. Drinks 1 to 1. 5 liters of water a day. Elimination Usually urinates 2-3 times a day; urine is usually dark yellow. Usually defecates every 2 days; stool is usually hard and brown. Strains when defecating. No pain. No abnormal discharges. Sweats profusely throughout the day. Alginates 3-4 times a day; urine is dark yellow.
Defecates every other day; stool is hard and brown. Strains when defecating. Sweats moderately due to air conditioning. Activity & Exercise Helps around the house whenever there is nobody to do household chores; otherwise, usually sedentary. Spends most of his time watching television or alkali to family and friends. Does not actively exercise. Is bedridden due to inability to use right foot. Usually asleep or watching television. Can perform oral hygiene by himself; otherwise, relies on family to do Adds for him. Cognition & Perception Oriented to person, time and place.
Answers questions accordingly. Can understand Toga fluently and some English phrases. Is slightly disheveled-looking, but clean. Has no problems with hearing. Sleep & Rest Sleeps usually between 10 PM to 12 AM and wakes up between 7 AM to 8 AM. Sleep in interrupted by late night bathroom breaks (1 to 2 times). Feels refreshed upon waking. Takes a nap after lunch. No nightmares, but can sometimes remember dreams. Snores loudly. Sleeps usually between 9 PM to 10 PM and wakes up at 7 AM. Sleep is interrupted by pain every 5 to 30 minutes.
Wakes up early due to nursing activities. Sometimes feels refreshed. Takes naps throughout the day (2 to 3 times). No nightmares and dreams. Self-perception & Self-Concept Used to be impatient and prone to yelling. Gets irritated easily. Does not get violent, but shouts only. Happiest when family behaves and gets along. Sad when family leaves him out of outings. Angry when children are disrespectful or does not take school seriously. Now: Tries to be patient and understanding. Does not yell as much. Happy when children and grandchildren visits him.
Sad when house is quiet and is by himself. Angry when he does not agree with family decisions, politics and rude behavior. Roles & Relationships House is noisy, well-lit and well-ventilated. Used to work regularly to support family; breadwinner. Held different jobs. Was the disciplinarian in the family. Lived with wife and 6 children. House is usually peaceful, well-lit and well-ventilated. Is retired. Spoils grandchildren by giving them what they want. Lives with wife usually, but sometimes children and grandchildren spend the weekend with them.
Sexuality & Reproduction Has male genitalia and is attracted to women. Usually intimate with wife 3 times a week. Has 6 children with wife. Does not use family planning. Usually has no energy or strength to be intimate with wife. Coping & Stress Tolerance Stresses about finances and children. Felt burdened with supporting family. Preferred to be alone when stressed. When overwhelmed, goes to sleep or usually drinks with friends. Now: Stresses about his health, finances and grandchildren. Asks for assistance when overwhelmed. Prefers company or at least wife’s company.
Can delegate problems to children now that they are grown. Values & Beliefs Is Roman Catholic. Follows Filipino traditions and customs. Rarely goes to church. Worried about children’s education. Wanted to make it rich. Is more spiritual. Goes to church at least 2-3 times a month. Prays before meals and sleep V. Physical Assessment Vital Signs Temperature: 38. 3 ‘C Pulse Rate: 119 BPML Respiratory Rate: 20 CPM Blood Pressure: 120/70 meg Skin Brownish skin color Warm to touch; febrile With good skin terror 1 second) With scars, scabs and bruises all over body
No presence of rashes No skin allergies Moist skin; sweaty Edema (+2) in right foot Hair Greasy; short hair Salt and pepper in color No infestations Nails Pinkish Round in shape With good capillary refill (1-2 seconds) Head proportional Can flex and extend No bumps or masses Neck Us apple Moves from side to side; can rotate freely No palpable cervical lymph nodes With small pimples on the forehead No lesions With minimal acne at the cheeks Has a “four o’clock” shadow; unshaven Eyes Can rotate Symmetrical Mesenteric Sclera Pink palpable conjunctiva Pupils equally rounded and reactive to light Ears No odor
No auditory discharges Can hear whispers Positive for watch-tick test Nose No nasal discharge No nasal flaring Moist lips and abacas mucosa Teeth and Mouth With dental caries No toothaches No mouth ulcers Appropriate number of dentition for age group With dentures Lungs Symmetrical chest expansion Equal breath sounds Clear lung fields Heart With regular heart tone Tachycardia No palpitations felt Abdomen Flabby and distended No masses or tenderness Normative bowel sounds Extremities No cyanogens Pulses full and equal Can move freely VI. Anatomy and Physiology of the Affected System/Organ INTEGUMENT SYSTEM.
Epidermis The epidermis is the most superficial layer of the skin that covers almost the entire body surface. The epidermis rests upon and protects the deeper and thicker dermis layer of the skin. Structurally, the epidermis is only about a tenth of a millimeter thick but is made of 40 to 50 rows of stacked exogamous epithelial cells. The epidermis is an vascular region of the body, meaning that it does not contain any blood or blood vessels. The cells of the epidermis receive all of their nutrients via diffusion of fluids from the dermis. The epidermis is made Of several specialized types of cells.
Almost 90% Of the epidermis is made of cells known as keratinous. Keratinous develop from stem cells at the base of the epidermis and begin to produce and store the protein keratin. Keratin makes the keratinous very tough, scaly and water-resistant. At about 8% of epidermal cells, melancholy’s form the second most numerous cell type in the epidermis. Melancholy’s produce the pigment melanin to protect the skin from ultraviolet radiation and sunburn. Lanterns cells are the third most common cells in the epidermis and make up just over 1% of all epidermal cells.
Lanterns cells’ role is to detect and eight pathogens that attempt to enter the body through the skin. Finally, Marker cells make up less than 1% of all epidermal cells but have the important function of sensing touch. Marker cells form a disk along the deepest edge of the epidermis where they connect to nerve endings in the dermis to sense light touch. The epidermis in most of the body is arranged into 4 distinct layers. In the palmary surface of the hands and plantar surface of the feet, the skin is thicker than in the rest of the body and there is a fifth layer of epidermis.
The deepest region of the epidermis is the stratum Basel, which contains the stem cells that reproduce to form all of the other cells of the epidermis. The cells of the stratum Basel include cuboids keratinous, melancholy’s, and Marker cells. Superficial to stratum Basel is the stratum spumoni layer where Lanterns cells are found along with many rows of spiny keratinous. The spines found here are cellular projections called decomposes that form between keratinous to hold them together and resist friction.
Just superficial to the stratum spumoni is the stratum granules, where keratinous begin to produce waxy lamellar granules to teraflop the skin. The keratinous in the stratum granules are so far removed from the dermis that they begin to die from lack of nutrients. In the thick skin of the hands and feet, there is a layer of skin superficial to the stratum granules known as the stratum lucid. The stratum lucid is made of several rows of clear, dead keratinous that protect the underlying layers. The outermost layer of skin is the stratum corners.
The stratum corners is made of many rows of flattened, dead keratinous that protect the underlying layers. Dead keratinous are constantly being shed from the reface of the stratum corners and being replaced by cells arriving from the deeper layers. Dermis The dermis is the deep layer of the skin found under the epidermis. The dermis is mostly made of dense irregular connective tissue along with nervous tissue, blood, and blood vessels. The dermis is much thicker than the epidermis and gives the skin its strength and elasticity.
Within the dermis there are two distinct regions: the papillary layer and the reticular layer. The papillary layer is the superficial layer of the dermis that borders on the epidermis. The papillary layer contains many finger-like extensions called rearm papillae that protrude superficially towards the epidermis. The dermal papillae increase the surface area of the dermis and contain many nerves and blood vessels that are projected toward the surface of the skin. Blood flowing through the dermal papillae provide nutrients and oxygen for the cells of the epidermis.
The nerves of the dermal papillae are used to feel touch, pain, and temperature through the cells of the epidermis. The deeper layer of the dermis, the reticular layer, is the thicker and tougher part of the dermis. The reticular layer is made of dense irregular connective tissue that contains any tough collagen and stretchy elastic fibers running in all directions to provide strength and elasticity to the skin. The reticular layer also contains blood vessels to support the skin cells and nerve tissue to sense pressure and pain in the skin.
Hypodermic Deep to the dermis is a layer of loose connective tissues known as the hypodermic, cubists, or subcutaneous tissue. The hypodermic serves as the flexible connection between the skin and the underlying muscles and bones as well as a fat storage area. Areola connective tissue in the hypodermic contains elastic and collagen fibers loosely arranged to allow the skin to trench and move independently of its underlying structures. Fatty adipose tissue in the hypodermic stores energy in the form of triglycerides.
Adipose also helps to insulate the body by trapping body heat produced by the underlying muscles. Hair is an accessory organ of the skin made of columns of tightly packed dead keratinous found in most regions of the body. The few hairless parts of the body include the palmary surface Of the hands, plantar surface Of the feet, lips, labia minor, and glass penis. Hair helps to protect the body from UP radiation by preventing sunlight from striking the skin. Hair also insulates he body by trapping warm air around the skin.
The structure of hair can be broken down into 3 major parts: the follicle, root, and shaft. The hair follicle is a depression of epidermal cells deep into the dermis. Stem cells in the follicle reproduce to form the keratinous that eventually form the hair while melancholy’s produce pigment that gives the hair its color. Within the follicle is the hair root, the portion of the hair below the skin’s surface. As the follicle produces new hair, the cells in the root push up to the surface until they exit the skin. The hair shaft consists of the part of the hair that is found outside of he skin.
The hair shaft and root are made of 3 distinct layers of cells: the cuticle, cortex, and medulla. The cuticle is the outermost layer made of keratinous. The keratinous of the cuticle are stacked on top of each other like shingles so that the outer tip of each cell points away from the body. Under the cuticle are the cells of the cortex that form the majority of the hair’s width. The spindle-shaped and tightly packed cortex cells contain pigments that give the hair its color. The innermost layer of the hair, the medulla, is not present in all hairs.
When present, the medulla usually notation highly pigmented cells full of keratin. When the medulla is absent, the cortex continues through the middle of the hair. Nails Nails are accessory organs of the skin made of sheets of hardened keratinous and found on the distal ends of the fingers and toes. Fingernails and toenails reinforce and protect the end of the digits and are used for scraping and manipulating small objects. There are 3 main parts of a nail: the root, body, and free edge. The nail root is the portion of the nail found under the surface of the skin.
The nail body is the visible external portion of the nail. The free edge is the distal end portion of the nail that has grown beyond the end of the finger or toe. Nails grow from a deep layer of epidermal tissue known as the nail matrix, which surrounds the nail root. The stem cells of the nail matrix reproduce to form keratinous, which in turn produce keratin protein and pack into tough sheets of hardened cells. The sheets of keratinous form the hard nail root that slowly grows out of the skin and forms the nail body as it reaches the skin’s surface.
The cells of the nail root and nail body are pushed toward the distal end of the finger or toe y new cells being formed in the nail matrix. Under the nail body is a layer of epidermis and dermis known as the nail bed. The nail bed is pink in color due to the presence of capillaries that support the cells of the nail body. The proximal end of the nail near the root forms a whitish crescent shape known as the lunar where a small amount of nail matrix is visible through the nail body.
Around the proximal and lateral edges of the nail is debouching, a layer of epithelium that overlaps and covers the edge of the nail body. The eponymous helps to seal the edges of the nail to prevent infection of the underlying tissues. Codifier’s Glands Codifier’s glands are exocrine glands found in the dermis of the skin and commonly known as sweat glands. There are 2 major types of codifier’s glands: exocrine sweat glands and apposing sweat glands. Exocrine sweat glands are found in almost every region of the skin and produce a secretion of water and sodium chloride.
Exocrine sweat is delivered via a duct to the surface of the skin and is used to lower the body temperature through evaporative cooling. Apposing sweat glands are found in mainly in the auxiliary and pubic regions of the body. The ducts of apposing sweat glands extend onto the follicles of hairs so that the sweat produced by these glands exits the body along the surface of the hair shaft. Apposing sweat glands are inactive until puberty, at which point they produce a thick, oily liquid that is consumed by bacteria living on the skin. The digestion of apposing sweat by bacteria produces body odor.
Sebaceous Glands Sebaceous glands are exocrine glands found in the dermis of the skin that produce an oily secretion known as sebum. Sebaceous glands are found in every part of the skin except for the thick skin of the palms of the hands and soles of the feet. Sebum is produced in the sebaceous glands and carried wrought ducts to the surface of the skin or to hair follicles. Sebum acts to waterproof and increase the elasticity of the skin. Sebum also lubricates and protects the cuticles of hairs as they pass through the follicles to the exterior of the body.
Ceremonious Glands Ceremonious glands are special exocrine glands found only in the dermis of the ear canals. Ceremonious glands produce a waxy secretion known as cerement to protect the ear canals and lubricate the eardrum. Cerement protects the ears by trapping foreign material such as dust and airborne pathogens that enter the ear canal. Cerement is made continuously and slowly shushes older cerement outward toward the exterior of the ear canal where it falls out of the ear or is manually removed.