Group 9B 1. Zulherman 2. Ulfia Rahmanita 3. Aulia Rahmi 4. Hidayaturrahmi F 5. Nova Suryati 6. Rahmi Fitri 7. Denada Florencia Leona 8.

Kurnia Fitra Hasana 9. Feby Rahma Astri

Mrs. Sela 45 years old, come to the clinic because of the wound on his leg that do not heal. From the anamnesis doctor get information that 10 days ago Mrs. Sela stepped on broken glass and treated with the midwife. Previously unknown diabetes but lately Mrs. Sela often feel tired and her youngest son was 3 years old, has birth weight 4.5 kg. From the examination the doctor get at right pedis region there is ulcer, surrounding redness and other signs of inflammation. From laboratory tests was obtained 14000/mm3 of leukocytes and blood sugar at time 450 mg / dl. Doctor give antibiotics and insulin and referring Mrs. Sela to the hospital. At hospital Mrs. Sela was treated and examined include culture and sensitivity test of pus, the doctor said to Mrs. Sela that she suffered from diabetes, and explain everything about diabetes.

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5. 6. 7. 8.

Ulcers : extensive tissue death and accompanied by invasive bacteria Insulin : hormone secreted in pancreatic beta cells that serve to take and carry glucose into the cells to produce energy Blood sugar at time : Blood sugar measurement results at any time without fasting (N: <200) Diabetes mellitus: metabolic disease characterized by increased blood sugar due to impaired insulin secretion or impaired insulin action, or both. Region pedis dextra: Right foot area Test cultures: induced breeding of microorganisms or living tissue in a medium conducive to growth. Test sensitivity: tests performed to test the sensitivity of antibiotics against bacteria Pus: fluid as results of an inflammatory process, consisting of leukocytes and aqueous fluids known as liquor puris

1. Why Mrs.Sela (45 years) was suffered injuries in his leg and do not heal? Overweight: skin,s tissue in obese people have a lot of adipose tissue with little vascularization. Drugs that slow wound healing, such as steroids. Psychological conditions: stress, depression. Low Immunity : easily cause infections so wound healing requires a longer time. Wound healing is also affected by the intake : good nutrition to meet the substances needed for wound healing and prevent someone from decreased immune response. Acommon glukotoksisitas and blockage of blood vessels in people with diabetes will interfere with the blood supply and disrupt the process of wound healing. In epidemiology, more women suffer from diabetes mellitus than men. Mrs. Selas age (45 years) demonstrated risk factor for diabetes mellitus. 2. Why Mrs. Selas wound at foot does not go away even after seeing a midwife? Midwives provide care injuries such as wound in general. While in patients with diabetes mellitus, need more specialized wound care accompanied by treatment of disturbed blood sugar.

3. Why previously doesnt have known the diabetes of Mrs. Sela? Because diabetes mellitus have a chronic course of the disease, at which time Mrs.Sela did not have any complaints, she was still able to compensate the blood sugar disorders (prediabetes period). 4. Why lately Ny. Sela often feel tired? cause tired: Lack of vitamin B12 intake that needed in the formation of red blood cells. Red blood cells are needed in the supply of oxygen to be used in the produce energy. The state of depression Lack of fluid The state of diabetes mellitus: glucose metabolism (which is necessary for produce energy) is interrupted 5. Why Mrs. Selas youngest child has birth weight 4.5 kg? Mrs. Selas youngest child has excessive birth weight (macrosomia) because the mother had diabetes during pregnancy so that the supply of glucose to the fetus from the mother is also increasing. Mothers who given birth a child with birth wiegt > 4 kg increase the risk of diabetes mellitus.

6. Why doctor obtained ulcers at right pedis region and signs of inflammation? In patients with diabetes mellitus, the blood sugar is too high may decrease the sensitivity of the nerves and causes insensitive to the injury. This situation was followed with constriction of blood vessel that cause impaired blood flow and causing ischemia. Besides, sugar is a good medium for bacterial growth so the injuries will worsen on the people with diabetes mellitus. Signs of inflammation arises because of the body's response to infection and the state of obesity. In obese people, an increase of fat deposits will trigger the increasing of TNF (inflammation factor). 7. How are interpretation of Mrs. Selas laboratory tests? 14000/mm3 of leukocytes showed leukocytosis state as the body's response to infection. The blood sugar of 450 mg/dl indicates that high blood sugar levels (diabetes mellitus) due to a disturbance of the function of insulin. 8. Why does doctor give antibiotics and insulin and referring Mrs. Sela to the hospital? Are there other therapeutic measures? Given antibiotics to treat the infection. Antibiotic is a broad spectrum because the wounds in people with diabetes mellitus are polymicrobial. Insulin is given to improve the state of blood sugar to the normal state. There is 3 kinds of insulin: short-acting, intermediate acting, and long-acting. Mrs. Sela was referred to the hospital because her blood sugar levels are too high and the presence of complications such as foot ulcers. Other therapeutic : diet management and sports.

9. Why do culture and sensitivity test of pus? Culture to know the types of microorganisms on ulcers and sensitivity test to determine the type of antibiotics for treatment. 10. How does doctors diagnose that Mrs.Sela had diabetes mellitus? Based on the risk factors (age, children are born with excess weight), complaints of foot ulcers, high blood sugar. 11. What are the risk factors of diabetes mellitus? Risk factors that can be changed: lifestyle, obesity, smoking, stress, hypertension. Risk factors that can not be changed: age 45 years, family history, race, history of gestational diabetes mellitus, history of have big babies.

SCHEME
Women 45 years old

Childbearing 4.5 kg

Wounds dont heal

Tired

Signs of inflammation

Ulcers

Physical Examination

Type1
Type2 Another Type Preventive and Promotive Diabetes Mellitus Laboratory

Therapeutic

Complication

Reffering to the Hospital

Prognosis