X.

ON-GOING APPRAISAL

September 2, 2009
The patient was admitted to the hospital for amputation of his 2 nd toe of his left foot.
Different diagnostic and laboratory tests were done to the patient like x-ray of the chest, left foot
and hand; chemical analysis of the serum; anti-bodies screening; CBG; coagulation and
hemostasis of the plasma.

September 3, 2009
By 400H, the patient had a temperature of 37.8 ºC and tepid sponge bath was done as a
nursing intervention. He is on a DM diet with no source of simple sugar on his food. Also pre-
operative preparation was done on him. And by 1130H, he is still febrile with a temperature of
38 ºC and positive of chills. Blankets were given to the patient to lower his temperature and a
paracetamol. Then he was transferred to the OR for amputation of his big toe on his left foot.
Anti-body screening of the serum; chemical analysis of the serum and CBG were repeated. Also,
a microbiology study of the wound and serum of the blood; and an ultrasound of the upper
abdomen were done. The medications ordered were Humulin 70/30, Hematinic, Dulcolax,
Clindamycin and paracetamol if his temperature is above 37.8˚C.

September 4, 2009
The patient’s left foot was amputated and was given a vaccine for tetanus toxoid.
Laboratory studies were also repeated like chemical analysis of the serum; CBG and a
microbiology study of the wound
.
September 7, 2009
CBG and chemical analysis of the serum were repeated. And the doctor ordered Unasyn
for the patient to take.

September 8, 2009
By 600H, the patient was on NPO after eating a light breakfast. His head was elevated at
15 to 30˚ since his BP was 140/80. At 1300H patient was transferred to OR for a repeat of toe
disarticulation. 1405H his diet was shift to DAT. The patient was given tramadol to relieve pain.
A microbiology study of serum and a hematology test of his right arm for a bacteria culture were
done.

September 9, 2009
The patient’s medication, metronidazole was discontinued. The result of the
histopathology of his left toe was verified.The patient was given metoclopramide.

September 10, 2009

The patient was scheduled for duplex scan of his both lower extremities. CBG was also
repeated.

September 11, 2009

500H Patient was on NPO after a light breakfast. At 1000H patient was transferred to the
OR. Microbiology study of serum was done. The patient was given Kalium durule.
 September 12, 2009
The patient was given a Celebrex and paracetamol was discontinued.

September 14, 2009

CBG was done. The doctor discontinued Dulcolax and switched his medication to
Duphalac. An additional medication was given, Tygacil
.
September 15, 2009
A microbiology study of the wound tissue was done.

September 16, 2009

A histopathology of his foot was done. The doctor ordered a medication for the
patient to take, Glucophage.

XI. DISCHARGE PLAN

Medication:
• Duphalac 300cc once a day at bedtime; hold if bowel movement > 2x/day
• Paracetamol 500mg 1 tab, every 4 hours
• Humulin 70/30 32 units/ml and 18 units/ml, subcutaneously
• Hematinic 500 mg 1 tab, once a day
• Glucophage 500 mg 1 tab, twice a day

Exercise:

-advise the relative of the patient to help the patient do some passive range of movements
as his everyday exercise to improve blood circulation in his body like chin-to-chest, head turns,
head tilts, shoulder rotation, wrist rotation, etc.

Treatment:
• Test your blood sugar at least twice a day, and preferably three or four times a day.
• Avoid intake of alcoholic beverages.
Health Educations:
• Take plenty of rest.
• Take prescribed pain relievers
• Keep wounds clean.
• Change the bandage regularly.
• Avoid smoking areas
• Avoid injuries.
• Wash and check the feet daily — Use lukewarm water and mild soap to clean the feet.
Gently pat your feet dry and apply a moisturizing cream or lotion.
 • Be sure to complete the antibiotic course that is prescribed.
• Limit activity as much as possible for a few days.
• Eat about the same amount of food each day.
• Eat at about the same times each day.
• Take your medicines at the same times each day.
• Exercise at the same times each day.
• Limit the amounts of fats and sweets you eat each day.

OPD Follow-up:
- Visit your doctor once a week to have a check-up and to update his doctor in his
condition.

Diet:
- Drink plenty of fluids with electrolytes.
- Reduce overall fat, especially trans- fat commonly found in fried food.
- Use oils or foods that are high in Omega-3 fatty acid, such as olive oil, rapeseeds oil,
flaxseed and flaxseed oil as they require lower insulin.
- Refined carbohydrates and sugar from your diet should be avoided
- Fruit should be the major source of sweetness in your diet, as they are low in calories,
high in fibers, and many other minerals and vitamins which are essential for keeping
the body healthy.
- Protein should be minimized. Instead, use meat substitute or non-animal protein foods
such as legumes, tofu.
- Red meats should be avoided. Increase fish in the diet.

Signs and Symptoms:

Consult a health-care provider immediately if the following signs develop:
• An area of the body turns blue or black.
• A wound does not heal in seven to14 days.
• Pain in a localized area is severe.
• Unexplained fever is persistent.
• Pus or blood drains from the wound.
• A foul-smelling odor discharges from the wound.
• Check the entire surface of both feet for skin breaks, blisters, swelling, or redness,
including between and underneath the toes where damage may be hidden.