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Case Study - Case DFU (Question)

Mr. A is a 45-year-old man newly diagnosed with type 2 diabetes who was admitted to the hospital for an infected right diabetic foot ulcer. He has a BMI of 31.2 kg/m2 and biochemical tests show poor glycemic control with HbA1c of 13.1%. His current diet consists mostly of rice, noodles and fried foods with low intake of fruits and vegetables. He is unaware of proper diabetes management. The main nutrition problem is uncontrolled diabetes due to inappropriate dietary intake. The nutrition diagnosis is ineffective diabetes self-management related to lack of diabetes knowledge. The intervention plan includes diabetes nutrition education and counseling to improve glycemic control and promote wound healing through a balanced diet.

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Kazmanie Kamaruzaman
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86 views6 pages

Case Study - Case DFU (Question)

Mr. A is a 45-year-old man newly diagnosed with type 2 diabetes who was admitted to the hospital for an infected right diabetic foot ulcer. He has a BMI of 31.2 kg/m2 and biochemical tests show poor glycemic control with HbA1c of 13.1%. His current diet consists mostly of rice, noodles and fried foods with low intake of fruits and vegetables. He is unaware of proper diabetes management. The main nutrition problem is uncontrolled diabetes due to inappropriate dietary intake. The nutrition diagnosis is ineffective diabetes self-management related to lack of diabetes knowledge. The intervention plan includes diabetes nutrition education and counseling to improve glycemic control and promote wound healing through a balanced diet.

Uploaded by

Kazmanie Kamaruzaman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Case Study : T2DM with Diabetic Foot Ulcer Question

CASE STUDY: Type 2 DM: Right Diabetic Foot Ulcer (DFU)

Case Description:
Mr A is a 45yrs Chinese man who works as a teacher in a school. He has been newly diagnosed with DM
after admitted to ward with diagnosis Infected Right Diabetic Foot Ulcer (DFU). Currently during an
encounter with Dietitian, post op 18 hrs for Wound Debridement of right foot. Pre and post operative
diagnosis are Infected right DFU. A grade III ulcer developed as a result of the increased pressure sub-4th
metatarsal head.
Currently he is given SC Actrapid 6U TDS and SC Insulatard 20U OD, IV Unasyn 1.5g TDS – D2, IV
Tramal 50 TDS and T PCM 1g QID.

Anthropometric Data:
Current Weight Height BMI
85kg 165cm 31.2 kgm2
Client history:
Family history –Father had HPT
Stay with wife (house wife), and 10 year old son
Smoker: social smoker (10 sticks daily)
Physical activity: bed-rest due to DFU

1 Medical Nutrition Therapy for Advanced Diabetes Management


Case Study : T2DM with Diabetic Foot Ulcer Question

Biochemical Data:
22.3.23
Indicators Result Reference Range
T.Chol 5.4 <5.2mmol/L
LDL 2.8 <2.6mmol/L
HDL 0.63 >1.7mmol/L
TG 1.9 <1.7mmol/L
HbA1c 13.1 <6.5%
Alb 30 34 to 54 g/L
Urea 4.7 1.80-7.20mmol/L
Na 137 136-146 mmol/L
K 4.8 3.5-5.1mmol/L
Cl 100 96-106 mmol/L

Time 6.00 8.00 10.30 12.00 12.15 2.30 6.30 7.00 9.30 10 11
am am am pm pm pm pm pm pm pm pm
Insulin 6u 6u 6u 20 u

2 Medical Nutrition Therapy for Advanced Diabetes Management


Case Study : T2DM with Diabetic Foot Ulcer Question

BSP 7.9 12.1 10.3 11.7 13.2 10.2 8.9

Clinical
Parameters Value
BP 120/78
Polyurea, polydipsia, polyphagia /
Symptoms of hypo X
FBS 12.3
Numbness x
Eye sight problem X

Dietary history:

Diet intake at ward


Tolerate diabetic diet portion but refuse to eat eggs and chicken as worried chicken causes itchiness to
wound and eggs will cause pus.

3 Medical Nutrition Therapy for Advanced Diabetes Management


Case Study : T2DM with Diabetic Foot Ulcer Question

BF: fried rice noodle 1 medium bowl (3ex CHO) + skim milk 1 cup (1ex CHO)+coffee
Lunch: Rice 1 medium bowl (3ex CHO)+ sambal (bring from home) + apple 1 (1ex CHO)
AT: curry puff 1pc (1ex CHO) + skim milk 1 cup (1exCHO)+coffee
Dinner: Rice 1 medium bowl (3ex CHO)+ steam fish 1pc + orange 1 (1ex CHO)
Take ikan haruan essence 1 bottle per day

Diet intake at home:

Time Food Portion


BF (9am) Fried economic rice noodle(3 exc CHO,1ex Protein, 1ex fat)
Drink : teh tarik (3exc CHO)
LN (11am) Rice (6 exc CHO)
Eat at Chicken masak curry/sambal 2 pc (4ex Protein, 2ex fat)
home Extra gravy (2ex fat)
before go Not taking vege sometimes
to work No buy fruits
Depends on availability – normally eat cucumber and baby kalian only
Drink : teh tarik (3exc CHO)

4 Medical Nutrition Therapy for Advanced Diabetes Management


Case Study : T2DM with Diabetic Foot Ulcer Question

Or will skip meal 3 times per week as still full after eat breakfast
9pm Ala carte from restaurant
Dinner Fried Mee/ Fried rice (6 exc CHO, 2ex protein, 3ex fat)
Tea O iced (2exc CHO)
Check list Drink 3 in 1 coffee (2exc CHO)- during work – during work 1time per day as is
free and is available at pantry
Does not like to eat fruits

Awareness, knowledge and perception:

Mr A does not have knowledge on diabetic management as he is newly diagnosed with DM type 2.
However, He shows readiness to change his lifestyle wherever possible as he hopes his wound can heal
faster and he is worried about leg amputation due to diabetic.

Question:
1. Based on Mr A diet history please calculate patient energy, protein, carbohydrate and fat intake and
please give comments on his diet practice.

5 Medical Nutrition Therapy for Advanced Diabetes Management


Case Study : T2DM with Diabetic Foot Ulcer Question

2. After doing a nutrition assessment, what is Mr A's main problem? What is the Nutrition Diagnosis for
this case? Discuss your intervention plan.

3. Are there any special nutrients needed for wound healing for Mr A?

4. How do you monitor your intervention plan?

5. Do we need to calculate ICR and ISF for this patient?

6 Medical Nutrition Therapy for Advanced Diabetes Management

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