1. The document presents a case of diabetic foot in a 47-year old male with type 2 diabetes and a history of alcohol and tobacco use. He presented with pain and discharge in his left great toe.
2. On examination, he had signs of infection in the left foot. He was treated with antibiotics, wound debridement, and amputation of the left great toe.
3. After treatment, his symptoms improved and he was discharged with medications and lifestyle recommendations to prevent recurrence of diabetic foot complications.
a case presentation on diabetic foot/ case study on diabetic foot.martinshaji
This is a detailed study on diabetic foot a condition usually seen on patients with diabetics. this may become complicated according to the severity of the condition and diabetes , ideal management is needed with drugs sometimes surgical methods. this case study will give a detailed study about diabetic foot ............... the treatment, diagnosis , management, patient counselling, pharmacist intervention, pathophysiology etc
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a case presentation on diabetic foot/ case study on diabetic foot.martinshaji
This is a detailed study on diabetic foot a condition usually seen on patients with diabetics. this may become complicated according to the severity of the condition and diabetes , ideal management is needed with drugs sometimes surgical methods. this case study will give a detailed study about diabetic foot ............... the treatment, diagnosis , management, patient counselling, pharmacist intervention, pathophysiology etc
Please leave a comment if you visited this
thank u
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
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Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
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Stroke is the 2nd leading death associated disorder. It is also known as cerebrovascular disorder mainly caused by high blood cholesterol levels or rupture of cerebral arteries.
A case study on appendicitis / a case presentation on appendicitismartinshaji
A condition in which the appendix becomes inflamed and filled with pus, causing pain.
The appendix is a pouch-like structure attached at the start of the large intestine that has no known purpose.
Appendicitis begins with fever and pain near the belly button and then moves toward the lower-right side of the abdomen. This is often accompanied by nausea, vomiting, loss of appetite, fever and chills.
Appendicitis is usually treated with antibiotics and surgery is required within 24 hours of its diagnosis. If untreated, the appendix can rupture and cause an abscess or systemic infection (sepsis).
i have already done a detailed study on appendicitis , and giving the link below
https://www.slideshare.net/martinshaji/appendix-appendicitis-medical-information
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14. a case study on diabetes mellitus type 1 with diabetic ketoacidosis cp in...Dr. Ajita Sadhukhan
A 26 year old male patient was admitted to the male medicine ward with complaints of nausea, vomiting, generalised weakness, anxiety, decreased appetite, headache since noon.
A case study on Pangastritis with pancreatitis martinshaji
this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case .
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martinsuja369@gmail.com
PHARM-D INTERNSHIP ANNUAL REPORT PRESENTATION UNDER THE GUIDENCE OF DR.R.GO...DR. METI.BHARATH KUMAR
PHARM-D final Internship Report Presentation Under the Guidance of DR.R.Goutham Chakra
If Anyone need this they can contact me via
dr.m.bharathkumar@gmail.com
this case study describes about maxillofacial trauma , which details about the treatment, management , diagnosis, surgical options, patient counselling, pharmacist interventions & discussions are followed in this case .
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martinsuja369@gmail.com
Case Presentation on Diabetes Mellitus complicationsShivankAgrawal5
This case study on Diabetes Complications presented by Shivank Agrawal (Doctor of Pharmacy ) will help understand about the critical insights regarding treatment of Diabetes, its complications and its management.
Title: Case Study: Management of Diabetic Cellulitis
Introduction:
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia, leading to various complications including skin infections such as cellulitis. Cellulitis is a bacterial infection affecting the skin and underlying tissues, often exacerbated in diabetic patients due to impaired immune function and compromised blood circulation. This case study focuses on the management of diabetic cellulitis in a patient presenting with typical symptoms.
Treatment Plan:
Antibiotic Therapy: Initiation of empiric antibiotic therapy with oral cephalexin to cover common pathogens such as Staphylococcus aureus and Streptococcus species. The choice of antibiotics was based on local antibiogram data and the patient's clinical response.
Glycemic Control: Optimization of blood glucose levels through insulin therapy to enhance immune function and promote wound healing. Regular monitoring of blood glucose levels was implemented to adjust insulin doses accordingly.
Wound Care: Daily wound cleansing with saline followed by application of topical antimicrobial agents and sterile dressings to prevent secondary infection and promote granulation tissue formation.
Patient Education: Comprehensive education regarding diabetic foot care, including the importance of daily foot inspections, proper footwear, and prompt management of any foot injuries to prevent future complications.
Conclusion:
This case highlights the importance of prompt diagnosis and appropriate management of diabetic cellulitis to prevent complications and improve patient outcomes. A collaborative approach involving pharmacists, physicians, and other healthcare professionals is essential for the comprehensive care of diabetic patients with skin infections. Emphasis on glycemic control and wound care plays a crucial role in preventing recurrent infections and promoting overall health in diabetic individuals.
Role of Clinical Pharmacist in Management of Diabetes Complications.
Pharmacists play a crucial role in the management of diabetes cellulitis, contributing significantly to patient care through their expertise in medication therapy management, patient education, and collaborative healthcare. Their involvement spans various aspects of the management process:
Medication Management:
Antibiotic Selection: Pharmacists assist in choosing appropriate antibiotics based on the patient's clinical presentation, comorbidities, and potential drug interactions.
Dosing and Administration: They ensure proper dosing regimens, considering factors such as renal function and drug allergies, to optimize therapeutic efficacy and minimize adverse effects.
Monitoring: Pharmacists monitor the patient's response to antibiotic therapy, inc
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2. INTRODUCTION-
DEFINITION
Diabetic foot is one of the most significant and devastating complications of diabetes, and is defined as a foot
affected by ulceration that is associated with neuropathy and/or peripheral arterial disease of the lower limb in a
patient with diabetes.
TYPES
Diabetic foot is classified into two major types.
• The Neuropathic Foot where neuropathy dominates
• The Neuroischemic Foot, where occlusive vascular disease is the main factor, although neuropathy is present.
3. Wound classification system-
Stages Description
Stage A No infection or ischemia
Stage B Infection present
Stage C Ischemia present
Stage D Infection and ischemia present
Grading
Grade 0 Epithelialized wound
Grade 1 Superficial wound
Grade 2 Wound penetrates to tendon or capsule
Grade 3 Wound penetrates to bone or joint
4. RISK FACTORS
• Age ≥ 45 years
• Male gender
• Charcot joint
• Peripheral vascular disease
• Peripheral neuropathy
• DM Duration ≥10 years
• Insulin use
• Retinopathy
• Nephropathy
• Poor glycemic control
• Cerebral vascular disease
• Coronary heart disease
• Hypertension
• Smoking
6. TREATMENT GOALS
1. Eradication of clinical evidence of infection.
2. Avoidance of soft tissue loss and amputations.
3. Leg Conservation.
4. Rehabilitation of Patients.
5. Treatment and healing of DIABETIC FOOT.
6. Prevention of recurrence of DIABETIC FOOT and wounds.
7. Reduction of morbidity and mortality due to LEG.
8. SIGNS AND SYMPTOMS
• Pain, erythema, and edema may be absent due to neuropathy
• Pus
• Delayed healing
• Increased lesion size
• Malodor
• Changes in skin color
• Changes in skin temperature
• Swelling in the foot or ankle
• Open sores on the feet that are slow to heal or are draining
• Ingrown toenails or toenails infected with fungus
• Corns or calluses
• Dry cracks in the skin, especially around the heel
• Foot odor that is unusual or won't go away
10. NON- PHARMACOTHERAPY
• Debridement of necrotic tissues
• Wound drainage and amputation as required
• Frequent dressing changes
• Maximize glycemic control to aid in would healing
• Elevation to decrease swelling
12. SOAPANALYSIS
• Patient Details-
➢Patient Name- ABC
➢IPN NO- IPD-1-220xxxx
➢Ward- General Surgery Male 410
➢Date of Admission- 08-08-2022
➢Date of Discharge- 20-08-2022
➢Age- 47 years old
➢Gender- Male
➢Height- 170 CMS
➢Weight- 59 kg
➢BMI- 20.4 kg/m2 (Normal 18.5- 25)
13. SUBJECTIVE DATA
• Chief Complaints-
➢Pain in the left great toe since 5-6 years and it is extending till ankle
• Personal History-
➢Consumption of alcohol since 20 years, stopped consuming from last 3 years.
➢Chronic tobacco chewing since 25 years.
• Medical History- Diabetes Mellitus type II
• Medicine History- T. METFORMIN 2-0-1
• Diet-MIXED
14. OBJECTIVE DATA
H/O-
➢Sudden onset non progressive
➢ Trauma
➢Purulent discharge
➢Fever and chills
➢Swelling in left Inguinal region
➢Local rise of temperature
➢Tenderness
➢Discoloration of toe since yesterday (i.e.- day before admission)
O/E-
➢Conscious, Oriented, Afebrile
15. • Left lower limb DVT screening results-
Subcutaneous edema is noted in left lower limb extending from mid leg to dorsum of foot.
Lab reports-
BLOOD GROUP O (RH POSITIVE)
URINE ANALYSIS ABNORMAL VALUES NORMAL VALUES
PROTIENS 2+ Absent
SUGAR 2+ Absent
PUS (WBC CELLS) 8-10 HPF Absent
EPITHELIAL CELLS 7-8/HPF Absent
17. PRESCRIBED DRUGS DOSE ROUTE FREQUENCY DATE OF
ADMINISTRATION
INJ. TT 0.5ML IM STAT 8/8/22(1)
INJ.TAXIM 1 GM IV 8 HOURLY 8/8/22(1)
INJ. AUGMENTIN 1.2 GM IV 12 HOURLY 9/8/22-13/8/22 (2-6)
INJ. PAN 40 MG IV 24 HOURLY 9/8/22-12/8/22 (2-5)
INJ. DICLO 1 AMP IV 8 HOURLY 9/8/22-11/8/22(2-4)
INJ. HAI 40IU SC 8 HOURLY 11/8/22-20/8/22(4-13)
T. VITAMIN C 500MG ORAL 1-0-1 11/8/22- 20/8/22(4-13)
C. MVBC 1 capsule ORAL 0-1-0 11/8/22- 20/8/22(4-13)
T.PAN 40 MG ORAL 1-0-0 13/8/22- 20/8/22(6-13)
T. EMAZEN D 50:10 MG ORAL 1-0-1 13/8/22- 20/8/22(6-13)
Drug Chart-
(DAYS)
18. PRESCRIBED DRUGS DOSE ROUTE FREQUENCY DATE OF
ADMINISTRATION
INJ. LANTUS 10U SC 1-0-0 13/8/22-20/8/22(6-13)
INJ. PIPTAZ 4.5g IV 8 HOURLY 15/8/22-20/8/22(8-13)
T. TELMA 40 MG ORAL 1-0-0 14/8/22- 20/8/22(7-13)
Drug Chart-
19. ASSESSMENT
• Diagnosis- Diabetic foot (left).
• Etiology-
1. History of type II Diabetes Mellitus
2. Poor glycemic control
3. Improper foot care
4. Poor blood circulation
5. Dry skin
6. Impaired Immune response
Due to excessive alcohol consumption and tobacco consumption
which has lead to loss of essential nutrition from body.
20. • Progress chart-
8/8/022-
L/E- local site of temp +, tenderness +, discharge+
O/E- conscious, oriented, afebrile
Patient is comfortable
PR- 84/min, BP- 140/80mmHg
9/8/22-
L/E- local site of temp +, tenderness +, discharge+
O/E- conscious, oriented, afebrile
Patient is comfortable
PR- 87/min, BP- 160/80mmHg
10/8/022-
L/E- no soakage
O/C/O- amputation of left great toe SA.
O/E- conscious, oriented, afebrile
Patient is comfortable
PR- 76/min, BP- 100/70mmHg
11/8/22-
L/E- no soakage
O/E- conscious, oriented, afebrile
Patient is comfortable
PR- 72/min, BP- 100/80mmHg
23. • Progress chart-
20/8/22-
L/E- Wound Healthy
O/E- conscious, oriented, afebrile
Patient is comfortable
PR- 78/min, BP- 140/90mmHg
• Operation Notes-
Debridement SOS Amputation of left great toe SA.
• Follow up details-
➢Visit daily for dressing, review back on Monday (22-8-22) in OPD 9 General Surgery or if needed SOS.
24. • Discharge medications-
1. C. MVBC 0-1-0
2. INJ.HAI 8-8-8U S/C
3. INJ. LANTUS 10U S/C @10PM
4. T.TELMA 40 MG 1-0-0
5. T.VITAMIN C 500MG 1-0-1
6. T.SHELCAL 500MG 0-1-0 FOR 15 DAYS
7. UPRISE D3 1 CAPSULE ONCE A WEEK FOR 4 WEEKS.
8. T. CEFIXIME 200MG 1-0-1 FOR 5 DAYS.
9. T. PAN 40 MG 1-0-0 FOR 5 DAYS.
25. • Goals achieved-
1. Symptomatic Improvement is seen.
2. Patient was hemodynamically stable at the time of discharge.
3. Operation conducted shown desired results.
• Drugs to be avoided-
When culture/ susceptibility test was done Proteus Vulagris bacteria found in discharge and it
is resistant to drugs-
AMPICILLIN, CEFAZOLIN, CEFUROXIME, TIGECYCLINE, TETRACYCLINE,
NITROFURANTOIN, COLISTIN, POLYMYCIN B
• Patient Compliance-
➢Patient didn’t have any complaints to the therapy given.
• Response to therapy-
➢Patient responded well to therapy, symptoms were reduced.
26. INTERVENTION
• Drug Interactions found between INJ. DICLO AND T. TELMA
AII-RB may enhance toxic effect of NSAIDS, it can decrease GFR and renal function, severity is Moderate and
there is to monitor that.
• While prescribing drugs prescriber should mention drug generic name, instead of brand names.
27. MY PLAN-
• Monitoring Parameters-
1. Blood sugar level
2. Symptoms like fever, itching on site
3. Local rise in temperature.
• Drug Interactions-
INJ. DICLO AND T. TELMA
• Alternate therapy if any-
CCBs- AMLODIPINE 10 MG ONCE DAILY- ORAL
28. PATIENT COUNSELLING-
➢On drugs-
1. T. VITAMIN C- Store in cool, dry, away from sunlight place.
2. C. MVBC- Don’t consume more than prescribed amount.
3. T.PAN 40- Consume 1 hr. before the meal.
30. • Lifestyle Changes-
1. Stop alcohol and tobacco consumption.
2. Maintain regular schedule for eating and sleeping
3. Take medication on time, do not repeat dose if missed
4. Drink 7-8 glasses of water.
5. Avoid Junk food.
6. Consume protein rich foods- tofu, egg, chicken, seafood, lentils.
7. Consume whole grain and high fiber carbohydrates- beans, cereals, whole grain chapati
8. Consume non starchy vegetables- cauliflower, tomatoes, peppers, cabbage, French beans.
9. Consume 1:1 water and jamun and karela juice in the morning on an empty stomach.
31. BRAND NAMES
PRESCRIBED DRUGS BRAND NAME
1. INJ. TT
2. INJ.TAXIM
3. INJ. AUGMENTIN
4. INJ. PAN
5. INJ. DICLO
6. INJ. HAI
7. T. VITAMIN C
8. C. MVBC
9. T. EMAZEN D
10. INJ. LANTUS
11. INJ. PIPTAZ
12. T. TELMA
GENERIC NAME
1. TETANUS TOXOID
2. CEFOTAXIME
3. AMOXICILLIN/CLAVULANATE
POTASSIUM
4. PANTOPRAZOLE
5. DICLOFENAAC
6. HUMAN ACTRAPID INSULIN
7. ASCORBIC ACID
8. MULTIVITAMIN
9. DICLOFENAC AND
SERRATIOPEPTIDASE
10. INSULIN GLARGINE
11. PIPERACILLIN AND TAZOBACTAM
12. TELMISARTAN
32. REFERENCE
1. Diabetic foot treatment: Here's all you need to know about stem cell therapy. Hindustan Times. 2022
2. Pendsey SP. Understanding diabetic foot. International journal of diabetes in developing countries. Medknow
Publications; 2010.
3. Justin J. Sherman MCS. Diabetic foot ulcer assessment and treatment: A pharmacist's guide. U.S. Pharmacist–
The Leading Journal in Pharmacy. 2010.
4. Diabetic foot problems: Symptoms, treatment, and care. WebMD.
5. Oluwaranti Akiyode PD. Management of acute diabetic foot disease. U.S. Pharmacist–The Leading Journal in
Pharmacy.2014
6. Aims & primary goals. Diabetic Foot Clinic. 2020
7. Online. Lexicomp Online.
8. Hmpgloballearningnetwork.com.
9. Explore scientific, technical, and medical research on ScienceDirect. ScienceDirect.com | Science, health and
medical journals, full text articles and books.
