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Group-1-Diabetic-Foot-Ulcer (2)

The case presentation discusses a 63-year-old male with a severe, non-healing diabetic foot ulcer due to uncontrolled diabetes. The patient has a history of poor medication adherence and lifestyle factors contributing to his condition, leading to a treatment plan that includes insulin and antibiotics while addressing drug therapy problems. Goals of therapy focus on achieving optimal blood glucose control, preventing infection, promoting wound healing, and enhancing the patient's quality of life through education and lifestyle modifications.

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Precious Obiamalu
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10 views18 pages

Group-1-Diabetic-Foot-Ulcer (2)

The case presentation discusses a 63-year-old male with a severe, non-healing diabetic foot ulcer due to uncontrolled diabetes. The patient has a history of poor medication adherence and lifestyle factors contributing to his condition, leading to a treatment plan that includes insulin and antibiotics while addressing drug therapy problems. Goals of therapy focus on achieving optimal blood glucose control, preventing infection, promoting wound healing, and enhancing the patient's quality of life through education and lifestyle modifications.

Uploaded by

Precious Obiamalu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Case Presentation:

Diabetic Foot Ulcer by


Group 1
This presentation outlines the case of a 63-year-old male patient
presenting with a severe, non-healing diabetic foot ulcer, complicated
by uncontrolled diabetes.
GROUP MEMBERS
• Evbuomwan Ann Itohan - • Imoukhuede Courage - • Ikem Ugochukwu Samuel -
PHA1810555 - 181. PHA1808389 - 111. PHA1808383 - 109
• Jesurobo Bernard Jesurobo - • Ehiosun Osahon Nathaniel - • Precious Obiamalu - PHA1810461
PHA1605109 - 4. PHA1808362 - 93. - 180
• Egbere Joshua Oghonna - • Ekaka Grace - PHA1808363 - 94. • Clara Ikeboh - PHA1808382 - 108.
PHA1808361 - 92. • Okonjo Akuchukwu Favour - • Peace Oduobuk Edward
• Owokolo Joy Oghosa - PHA1601983 - 4. PHA1808360 - 91.
PHA1810381 - 179
• Akinbobola Abimbola -
PHA1601606 -
OUTLINE
• Title • Evaluation of therapy
• Demographics • Drug therapy problem, if any
• Chief complaint • Goals of therapy & pharmacist care plan
• History of illness • Outcome/follow up
• Social and other histories • Documentation
• Laboratory investigation
• diagnosis
Patient Demographics and History
Patient Profile Vital Signs
Patient J.D. is a 63-year-old male who works as a driver •Heart Rate (HR): 95 bpm
and resides in Benin City, Edo State, with his wife and
four children. He weighs 72 kg, stands 168 cm tall, and is •Blood Pressure (BP): 127/82 mmHg
a Christian, belonging to the Bini tribe.
•Fasting Blood Sugar (FBS): 300 mg/dL
•Temperature (Temp): 38.5°C
Clinical Presentation
Chief Complaint: Severe pain, swelling, and discharge from a non-
healing ulcer on the left foot, worsening over the last month.

History of Present Illness: The patient, a known diabetic for 15


years, sustained a minor injury while trimming his toenails two
months ago. Despite local care at home, the wound progressively
worsened with increasing pain, swelling, discharge, and a foul odor.
Social History and Lifestyle
1 Lifestyle 2 Dietary Habits
Patient leads a sedentary High-carbohydrate diet
lifestyle. with minimal vegetables

3 Alcohol and 4 Medication


Smoking History Adherence
Occasional alcohol The patient has irregular
consumption, non-smoker adherence to prescribed
diabetes medications.
Past Medication History

DRUG DOSAGE PURPOSE SOURCE OUTCOME

Metformin 500 mg BD management of hospital/ reduction of blood


diabetes community glucose levels but
pharmacy rises due to it being
taken irregularly

Glimepiride 5mg daily management of hospital/ reduction of blood


diabetes community glucose levels but
pharmacy rises due to it being
taken irregularly

OTC wound dressing maintaining and community wound covered and


protecting diabetic pharmacy kept clean
sores
Laboratory
Investigations and
Diagnosis
Blood Glucose Elevated at 300 mg/dL normal range
(Fasting) (70-100 mg/dl)

Complete Elevated white blood normal range


Blood Count cell count of 20,000 (4,500-11,000
(CBC) cells/μL, indicating cells/μL)
infection
Diagnosis
Diagnosis

Diabetic ulcer secondary to uncontrolled diabetes.


Present Medication and Evaluation of Therapy
Inj Insulin Tab Clindamycin 300 mg IV Metronidazole 400
QDS mg TDS
For blood glucose control.
Antibiotic targeting both aerobic Antibiotic targeting anaerobic
and anaerobic bacterial infections. bacterial infections.

IV Levofloxacin 250 mg BD
Antibiotic targeting of aerobic bacterial infections.
Evaluation of Therapy
DRUG NAME DOSE INDICATION EVALUATION

INJ insulin 0.5 For blood glucose control. appropriate


units/kg/day
(basal-bolus
regimen)

TAB clindamycin 300 mg QDS Antibiotic targeting anaerobic appropriate


bacterial infections.

IV metronidazole 500 mg TID Antibiotic targeting anaerobic appropriate


bacterial infections.

IV levofloxacin 250 mg BD Antibiotic targeting of aerobic not appropriate due to its risk of
bacterial infections. exacerbating neuropathy in a
diabetic patient.
Drug Therapy Problems

Nonadherence
Poor glycemic control due to inconsistent use of oral antidiabetic agents and lack of
lifestyle modifications.

Adverse drug reaction


Use of levofloxacin may exacerbate existing peripheral neuropathy, complicating
the management of diabetic foot ulcers.

Need for additional therapy


The addition of vitamin C 1000 mg and also IM diclofenac 75 mg to manage pain
and improve healing
Goals of Therapy

Achieve Optimal Blood Glucose Control


1 Target fasting blood glucose <130 mg/dl.

Prevent Further Infection Spread


2
Eradicate causative organisms and prevent septicemia.

Promote Wound Healing and Limb Salvage


3
Facilitate wound closure and avoid amputation.

Enhance Patient's Quality of Life


4 Educate the patient on self-care and ensure adherence to
treatment.
Pharmaceutical care
plan
Drug-Focused Interventions

• The correct drugs and dosage were accurately


provided and dispensed to the patient.
• Discontinue levofloxacin due to the risk of
exacerbating peripheral neuropathy.
• The prescriber was contacted, and ceftriaxone was
recommended to replace the levofloxacin.
• The prescriber was contacted to initiate the addition of
vitamin C 1000 mg daily and IM diclofenac 75 mg to
manage the pain and improve healing.
Pharmaceutical care plan
Patient-Focused Interventions

• Educate the patient on the importance of blood glucose


monitoring, proper foot care, and managing diabetes to prevent
• complications.
Advise dietary changes, focusing on reducing high-carbohydrate
intake, increasing fiber, and choosing diabetic-friendly foods.
• Emphasize the importance of consistent medication use to prevent
future complications.
• Educate on wound hygiene, including regular dressing changes
and signs of infection that warrant medical attention.
Expected Outcomes and Next Steps

1 Improved control with regular insulin use; target fasting blood glucose levels of 123 mg/dl was attained at 4 days.

Infection Management
2 Reduction in wound discharge and pain. Reduction of infection markers (WBC) by the
end of antibiotic therapy.

Wound Healing
3
Decrease in ulcer size and signs of granulation tissue formation observed.

Patient Satisfaction and Adherence


4 Increased patient engagement with improved adherence to
insulin.
Documentation

All pharmaceutical care plans, interventions, and patient


progress are documented in the patient’s medical record
for continuity of care and reference during follow-up
visits.
lTHANK YOU FOR
LISTENING. ANY
QUESTIONS?

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