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l. Introduction

Diabetes mellitus, often simply referred to as diabetesis a condition in which a

person has high blood sugar, either because the body does not produce enough insulin,

or because cells do not respond to the insulin that is produced. This high blood sugar

produces the classical symptoms ofpolyuria (frequent urination), polydipsia (increased

thirst) and polyphagia (increased hunger).

The term diabetes, without qualification, usually refers to diabetes mellitus, which

roughly translates to excessive sweet urine (known as "glycosuria"). Several rare

conditions are also named diabetes. The most common of these is diabetes insipidus in

which large amounts of urine are produced (polyuria), which is not sweet (insipidus

meaning "without taste" in Latin).

The term "type 1 diabetes" has replaced several former terms, including

childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus

(IDDM). Likewise, the term "type 2 diabetes" has replaced several former terms,

including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent

diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standardnomenclature. Various sources have defined "type 3 diabetes" as: gestational diabetes,

[4] insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has

progressed to require injected insulin, and latent autoimmune diabetes of adults.

Type 2 diabetes mellitus is characterized by insulin resistance which may be

combined with relatively reduced insulin secretion. The defective responsiveness of

body tissues to insulin is believed to involve the insulin receptor. However, the specific

defects are not known. Diabetes mellitus due to a known defect are classified

separately. Type 2 diabetes is the most common type.

It is a chronic , progressive disease characterized by the bodys inability to

metabolize carbohydrate, fats, and proteins leading to hyperglycemia.Diabetes mellitus

is referred to us high sugars by both clients and health care providers. The notion of

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http://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Polyuriahttp://en.wikipedia.org/wiki/Polydipsiahttp://en.wikipedia.org/wiki/Polyphagiahttp://en.wikipedia.org/wiki/Glycosuriahttp://en.wikipedia.org/wiki/Diabetes_insipidushttp://en.wikipedia.org/wiki/Polyuriahttp://en.wikipedia.org/wiki/Gestational_diabeteshttp://en.wikipedia.org/wiki/Diabetes_mellitus#cite_note-3http://en.wikipedia.org/wiki/Latent_autoimmune_diabeteshttp://en.wikipedia.org/wiki/Insulin_resistancehttp://en.wikipedia.org/wiki/Insulin_receptorhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Polyuriahttp://en.wikipedia.org/wiki/Polydipsiahttp://en.wikipedia.org/wiki/Polyphagiahttp://en.wikipedia.org/wiki/Glycosuriahttp://en.wikipedia.org/wiki/Diabetes_insipidushttp://en.wikipedia.org/wiki/Polyuriahttp://en.wikipedia.org/wiki/Gestational_diabeteshttp://en.wikipedia.org/wiki/Diabetes_mellitus#cite_note-3http://en.wikipedia.org/wiki/Latent_autoimmune_diabeteshttp://en.wikipedia.org/wiki/Insulin_resistancehttp://en.wikipedia.org/wiki/Insulin_receptor


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associating sugar with diabetes mellitus is appropriate because the passage of large

amounts of sugar laden urine is characteristic of poorly controlled diabetes mellitus.

Other pathologic process and risk factors are just as important and sometimes

independent factors but people with diabetes mellitus can take preventive measures to

reduce the likelihood of such occurrences.

In the early stage of type 2 diabetes, the predominant abnormality is reduced

insulin sensitivity. At this stage hyperglycemia can be reversed by a variety of measures

and medications that improve insulin sensitivity or reduce glucose production by the

liver. As the disease progresses, the impairment of insulin secretion occurs, and

therapeutic replacement of insulin may sometimes become necessary in certain

patients.

For legal purposes and to protect the right of the patient, the researchers used

the name B.E. These data gathered would only be used for this care study and will hold

confidential.

At the end of the care study, the group will be able to assess the client; discuss

the pathophysiology of the clients condition; identity the different factors that aggravate

the condition of the client; plan the nursing independent action basing on the identifiedproblem; implement nursing intervention of each problem; evaluate the effectiveness of

the independent/dependent management to the client.

Objectives of the Study

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1. To be able to describe etiologic factors associated with diabetes

2. Relate the clinical manifestations of diabetes mellitus type ll to the associated

pathophysiologic alterations

3. Identify the diagnostic and clinical significance of blood glucose test.

4. Describe the relationship between diet, exercise, and medication for persons with

diabetes

5. Describe management strategies for a person with diabetes to use during sick

days

6. Use the nursing process as a framework for care of the patient with diabetes.

Scope and Delimitation

The study is limited only to the case of B.E. All the information about the client

was obtained from the Camiguin General Hospital and from actual interview and

assessment with the client, clients family and significant others.

The researchers will only focus on the clients disease, which is Diabetes Mellitus

Type II insulin requiring.

The researchers will try to formulate nursing diagnosis fit for this case in order to

have an effective nursing care plan during the caring process.

II. Demographic Data

Patient BE is a 21 year old woman presently residing at Compol, Catarman,

Camiguin Province. She is a fiancee of Mr.A. She was blessed with 1 child. Although

they are not yet bound by marriage due to financial reasons, Ms.BE and Mr. A is having

their own family whom they called their own and is presently living in the house of her

husbands parents.

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Her husband is a 24 year old jobless undergraduate. He wasnt able to finish

highschool due to lack of financial source. He supports his family by helping his father

and mother in their small farm which is their only means of living. Sometimes, he goes

with his neighbors when they went out for fishing and was able to get some share of

their catch to bring for his family. They own a small farm of which they plant some

vegetables and crops for their viand. According to the client, if they dont have this small

farm of theirs, they have no other source of food to get in since they are both jobless.

In terms of health facility, the patients residence is just a kilometer away from

Barangay Health Center, so whenever they have a problem, they directly addressed

their needs to the near Health Center for health security. But not at all times, because

according to her, she is having a difficulty visiting the health center because nobody will

look after her child because her partner is in the farm the wholeday. So with regards to

feeling ill, most of the time she ignores it and just take some rest or supplement her

body with herbal plants to feel better.

The house of the patient is made entirely of wood and is about 20 sq. meters.

Their roof is made of nipa and and the flooring is made of bamboo sticks put together.

The clients water source is from the barangay line and they pays about P30.00

monthly. They also have electricity and use it as source for their light at night. They

have one small television and an old style radio that they use to entertain them. Theirhouse is an all- in-one style wherein youll see the kitchen, bedroom and living room all

in one place. They have neighbors as well but their houses are quite distant from one

another.

Brgy. Compol is about 42 km from CPSC to the patients house. You can get

there by riding a jeep or a motorcycle going to Catarman with an estimated fare of

P30.00.

The source of income in their barangay is mostly from farming and fishing. The

barangay is near a small public market and has some few small shops as well. The

barangay has its own health center with a visiting physician and 3 Barangay Health

Workers and 1 midwife on duty. Their barangay hall is also active in maintaining the

peace and order in their area. With regards to the clients sanitation, they throw their

garbage in a small compost pit and sometimes they burn it when there is too much

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plastic in it. Their family is fond of using herbal plants when sick because they dont

have money to buy medicine at the pharmacy.

III. Developmental Data

Sigmund Freuds Psychosexual Development

According to Sigmund Freud, there are 5 stages of psychosexual development, the

oral stage, the anal stage, the phallic stage, the latent stage and the genital stage. As to

the client, she is now on the Genital Stage. It is the final stage of psychosexual

development. It begins at the start of puberty when sexual urges are once again

awakened. Through the lessons learned during the previous stages, adolescents directtheir sexual urges onto opposite sex peers; with the primary focus of pleasure are the

genitals. She has already resolved this stage because she already had a satisfactory

sexual relationship with the opposite sex- her husband

Erik Eriksons theory of psychosocial development

Erik Eriksons theory of psychosocial development is one of the best-known theories

of personality in psychology. Erikson believed that personality develops in a series of

stages. Eriksons theory describes the impact of social experience across the whole

lifespan. In each stage, Erikson believed people experience a conflict that serves as a

turning point in development. In Eriksons view, these conflicts are centered on either

developing a psychological quality or failing to develop that quality. During these times,

the potential for personal growth is high, but so is the potential for failure. These are the

stages of the development according to Erikson.

Trust vs. Mistrust

Autonomy vs. Shame or Doubt

Initiative vs. Guilt

Industry vs. Inferiority

Identity vs. role confusion

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Intimacy vs. Isolation

Generativity vs. Stagnation

Ego-Integrity vs. Despair

Ms. BE is 21 year old, so she belong to INTIMACY VS. ISOLATION stage. This

stage covers the period of early adulthood when people are exploring personal

relationships.

Erikson believed it was vital that people develop close, committed relationships

with other people. Those who are successful at this step will develop relationships that

are committed and secure.

Remember that each step builds on skills learned in previous steps. Erikson

believed that a strong sense of personal identity was important to developing intimate

relationships. Studies have demonstrated that those with a poor sense of self tend to

have less committed relationships and are more likely to suffer emotional isolation,

loneliness, and depression. Thus, Ms.BE build a strong relationship with his husband to

be. They are commited with each other. And found out to be secured with each other.

Sullivans Stages of Healthy Interpersonal Development

Ms. BE belongs to Late Adolescence Stage ( 14-21 y/o). The task for these Stage. It

focus on achievement of independence within the society and the formation of a lasting,

intimate relationship with a selected member of the opposite sex. Masters expression of

sexual impulses. Forms satisfying and responsible associations. Uses communication

skills to protect self from conflicts with others. Relating to Ms. BE. She was able to

achieved the task for these stage, evidenced by having friends and selected member of

the society that care for her. She was able to communicate with other people around

them

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IV. Nursing Assessment

First Assessment

July 4, 2010, 12:30 pm

Patient was awake lying on bed with an ongoing IVF of PNSS 1 L @ 350 cc level;

regulated at 40 gtts/min infusing well at the left arm.. Researchers introduced

thereselves and explained the purpose of the visit as well as the procedures the

researchers would performed. Researchers made an interview with Ms.B.E and asked

questions that was answered by the patient. Through the researchers interview with

Ms.B.E, the researchers was able to obtain the following data;

vital signs:

Temperature : 36.30C

RR : 18 cpm

PR : 90 bpm

BP : 120/80 mmHg

The patient has a family history of Diabetes Mellitus. The patient doesnt have

known allergies to food and drugs. During the researchers assessment, patient

complained about numbness of both lower extremities and verbalizes hawoy keu ako

ani mga tiel ug kamot as verbalized by the patient. During the asssessment, the patient

felt body malaise and experienced blurred vision. According to the patient, the doctor

said she was diabetic. During the assessment, the researchers imparted health

teachings, with emphasis on proper diet and increase fluid intake.

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1st Assessment

NURSING SYSTEM REVIEW CHART

Name: E.B Date: July 4, 2010Vital Signs:

Pulse: 90 bpm Temp: 36.3C RR: 18cpm Weight:32kgs Height:158cm

EENT: impaired vision blind _____________________ pain reddened drainage _____________________ gums hard of hearing deaf _____________________

burning edema lesion teeth _________ ____________Asses eyes, ears, nose _____________________

throat for abnormality no problem_____________________

RESP: _____________________

asymmetric tachypnea _____________________

apnea rales cough barrel chest _____________________ bradypnea shallow rhonci _____________________ sputum diminished dyspnea _____________________ orthopnea labored wheezing _____________________

pain cyanotic _____________________ Asses resp, rate, rhythm, depth, pattern, _____________________ breath sounds, comfort no problem

_____________________CARDIO VASCULAR _____________________

arrhythmia tachycardia numbness _____________________ diminished pulses edema fatigue _____________________ irregular bradycardia murmur _____________________

tingling absent pulses pain _____________________ Asses heart sounds, rate rhythm, pulse, blood _____________________ pressure, clrc., fluid retention, comfort _____________________

no problem

_____________________GASTRO INTESTINAL TRACT _____________________

obese distention mass _____________________

dysphagia rigidly pain _____________________ Asses abdomen, bowel habits, swallowing, _____________________ bowel sounds, comfort no problem

_____________________GENITO-URINARY and GYNE _____________________

pain urine color vaginal bleeding _____________________ hermaturia discharge noctoria _____________________

Asses urine freq., color, control, odor, comfort/ _____________________ Gyn-bleeding, discharge no problem

NEURO

paralysis stuporous unsteady seizures lethartic comatose vertigo tremors confused vision gripAsses motor function, sensation, LOC, strength,

Grip, galt, coordination, orientation, speech, no problem

MUSCULOSKELETAL and SKIN

appliance stiffness itching petechiae hot drainage prosthesis swelling

lesion poor turgor cool deformity wound rash skin color flushed

8

Impaired

vision

Numbness felt on

both hands

Numbness felt on

both feet

Body malaise


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Second Assesment

July 5, 2010

3:00 pm

The researchers had their second assessment to Ms. B.E, the researchers was

able to obtained the following data.

Temperature : 36.80C

RR : 18 cpm

PR : 72 bpm

BP : 110/70 mmHg

The patient has an increased Capillary Blood Glucose level of 388mg/dl. The

researchers referred it to Dr. Ma. Tecelyn Castilla and ordered for Humulin R 70/30 12

u SQ and repeat CBG monitoring after 1 hour. Capillary Blood Glucose level

rechecked 366mg/dl. During assessment, the researchers had observed poor skin

turgor and swelling on both feet of the patient. The researchers weigh the patient and

found out, Ms. B.E had increased weight into 39.6kg. Dr. Gerry Cabalang ordered to

increased dosage of Humulin R 70/30 to 25 u SQ 6am and 15 u SQ 6pm. The

researchers had explain the importance of exercise in maintaining weight and proper

diet.

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2nd Assessment


Name: Ms. B.E Date: July 5, 2010Vital Signs:

Pulse: 72 bpm Temp: 36.8C RR: 18cpm Weight:39.6kgs Height:158 cmEENT:

impaired vision blind _____________________ pain reddened drainage _____________________

gums hard of hearing deaf _____________________ burning edema lesion teeth _________ ____________

Asses eyes, ears, nose _____________________ throat for abnormality no problem

_____________________RESP: _____________________

asymmetric tachypnea _____________________ apnea rales cough barrel chest _____________________ bradypnea shallow rhonci _____________________ sputum diminished dyspnea _____________________

orthopnea labored wheezing _____________________


_____________________CARDIO VASCULAR _____________________

arrhythmia tachycardia numbness _____________________ diminished pulses edema fatigue _____________________

irregular bradycardia murmur _____________________ tingling absent pulses pain _____________________

Asses heart sounds, rate rhythm, pulse, blood _____________________ pressure, clrc., fluid retention, comfort _____________________

no problem_____________________

GASTRO INTESTINAL TRACT _____________________


dysphagia rigidly pain _____________________ Asses abdomen, bowel habits, swallowing, _____________________

bowel sounds, comfort no problem_____________________

GENITO-URINARY and GYNE _____________________

pain urine color vaginal bleeding _____________________

hermaturia discharge noctoria _____________________ Asses urine freq., color, control, odor, comfort/ _____________________ Gyn-bleeding, discharge no problem

NEURO

paralysis stuporous unsteady seizures lethartic comatose vertigo tremors confused vision grip

Asses motor function, sensation, LOC, strength,



appliance stiffness itching petechiae

hot drainage prosthesis swelling lesion poor turgor cool deformity wound rash skin color flushed

atrophy pain ecchymosis

diaphoretic moistAsses mobility, motion. Galt, alignment, joint function/skin color, texture, turgor, integrity no problem

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Bipedal edemaObserved (-1cm)

Body

malaise

Poor skin

turgor


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Third Assessment

July 6, 2010

3:00 pm

The researchers had their third assessment. The patient was awake lying on bed

with an ongoing IVF of PNSS newly hooked, regulated at 40gtts/minute infusing well at

left arm. During this time, the researchers obtained the following data:

Temperature : 36.7

0

C

RR : 19 cpm

PR : 95 bpm

BP : 110/80 mmHg

The patient still have increased Capillary Blood Glucose Level of 270mg/dl. The

researchers administered Humulin R 70/30 10 u SQ as prescribed. The patient still

complained on her swelling feet, experienced blurred vision and verbalizes nganu

nanghubag ni ako teel? Tungod ni sa tambal na ge-inject sah ako?. The researchers

provide health teaching with emphasis on explaining thoroughly the procedure for

insulin self-injection and its adverse effect. Help patient to achieve mastery of technique

by taking step by step approach.

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3rd Assessment


Name: Ms. B.E Date: July 6, 2010Vital Signs:

Pulse: 95 bpm Temp: 36.7C RR: 19cpm Weight:39.6kgs Height:158 cm




RESP: _____________________




_____________________CARDIO VASCULAR _____________________



no problem







NEURO






atrophy pain ecchymosis diaphoretic moist

Asses mobility, motion. Galt, alignment, joint function/skin color, texture, turgor, integrity no problem

12

Impaired

vision

Bipedal edemaobserved (-1cm)

Polyuria


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Fourth Assessment

July 7, 2010

3:00 pm

The researchers performed her fourth assessment; the author received her

patient awake sitting on bed without IVF. The author was able to obtained the following

vital signs;

Temperature : 36.0

0

C

RR : 18 cpm

PR : 94 bpm

BP : 110/80 mmHg

The researchers

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4th Assessment


Name: Mrs. E Date: December 29, 2009Vital Signs:

Pulse: 61 bpm Temp: 36C RR: 11 Weight:41kgs Height:152 cm




RESP: _____________________




_____________________CARDIO VASCULAR _____________________



no problem







NEURO







diaphoretic moistAsses mobility, motion. Galt, alignment, joint function

/skin color, texture, turgor, integrity no problem

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dyspnea

Diaphoretic

WeaknessFatigue

Cyanosis


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Fifth Assessment

January 17, 2010

10:00 am

The author had her first assessment to the patient at their residence in Soro-Soro,

Mabajao Camiguin. When the author arrived at their house the patient is doing light household

chores. The patients then stope what shes doing and accommodates the author. The patient then

verbalize Day unza diay nang hypertension, nganong daghan man bawal na sa akung pagkaon

ug uban pa? then the author explained independent nursing interventions, after 45 minutes the

patient understand something about disease process and treatment.

Health teaching imparted were the following;

- Low sodium diet

- Low fat diet

- exercise everyday (like walking every morning)

- avoid stressful activities

The author then take the patients vital signs:

Temperature: 37 0C

RR : 20 cpm

PR : 70 bpm

BP : 130/80 mmHg

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5th Assessment


Name: Mrs. E Date: January 17, 2010Vital Signs:

Pulse: 70 bpm Temp: 37C RR: 20 Weight:41kgs Height:152 cm




RESP: _____________________




_____________________CARDIO VASCULAR _____________________


tingling absent pulses pain _____________________ Asses heart sounds, rate rhythm, pulse, blood _____________________ pressure, clrc., fluid retention, comfort ____________________

no problem







NEURO







diaphoretic mois

Asses mobility, motion. Galt, alignment, joint function/skin color, texture, turgor, integrity no problem

16

Request for

information

Apathetic behavior

Inaccurate follow

through ofinstruction

Misinterpretation

of information


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V. History of Past Illness:

The patient has a family history of Diabetes Melllitus. They have no other knownhereditary diseases such as Cancer and Hypertension. According to the patient, she had

undergone a minor surgery which was removal of her cataract at the right eye last May 2009 and

in her left eye last December 2009.

Present Illness:

The patient felt numbness of both upper and lower extremities, excessive thirst, excessive

hunger, excessive urination, body malaise and fatigue for six months. The patient went to the OutPatient Department of Camiguin General Hospital for check-up. The doctor then prescribed the

patient to take multivitamins. The patient failed to take the multivitamins because of some

financial problem. The following day, July 2, 2010, the patient came back to the Out Patient

Department for check-up. The doctor then advised the patient for admission based on the data

seen.

Patient has a family history of Diabetes Mellitus.

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Medical Management

Date Time Physician Doctors Order Rationale of Doctors Order

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7-2-10

7-4-10

7-5-10

11:30am

12:30PM

11:24pm

Dr.Castilla

Dr.Castilla

Dr.Castilla

Please admit under medicalService

Secure consent to care

Monitor V/S every hour

Diabetic diet

Start venoclysis with PNSS1L

IVTF: PNSSlllL @ 60 gtts/min

Labs:

CBC with platelet

UA Sodium, Potassium

determination

Hb

Creatinine

For KUB UTZ

CBG now then q hour

Meds.

Give insulin 20 u: IV now

then start insulin drip 100ccPNSS + 100 u regularinsulin @ 10 gtts/min, thenhold if CBG


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NAME OFDRUG(GENERICAND BRANDNAME)

DATEORDERED

DRUGCLASSIFICATION

DOSE/FREQUENCY

MECHANISM OFACTION

SPECIFICINDICATION

CONTRAINDICATION and CAUTION

SIDE E FFECTS NURSINGPRECAUTION

Cefuroxime(Ceftin)

7-2-10 AntibioticCephalosporin(2nd

Generation)

750 mg q 8hr,IVTT

Bactericidal:Inhibitssynthesis ofbactreial cellwall, causingcell death

Lowerrespiratoryinfectionscaused by S.pneuminia

Contraindicatedwith allergy tocephalosporins orpenicillins.

Use cautiouslywith renal failure,lactation,pregnancy.

CNS:-headache-dizziness-lethargy

GI:-nausea-vomiting-diarrhea-anorexia-abdominalpain-liver toxicity

GU:-nephrotoxicity

Hypertensitivity:-rash to fever-serumsicknessreaction

Local:-pain-abcess atinjection site-phlebitis

1.Cultureinfection, andarrange forsensitivity testsbefore and duringtherapy ifexpectedresponse is notseen.

2.Have vitamin Kavailable in casehypoprothrombinemia occurs.

3.Discontinue ifhypersensitivityoccurs.

4.Report severediarrhea, difficultybreathing,unusual tirednessor fatigue, pain atinjection site.


DATEORDERED

DRUGCLASSIFICATION

DOSE/FREQUENCY

MECHANISM OFACTION

SPECIFICINDICATION



Humulin R70/30

7-3-10 AntidiabeticHormone

25 u 6AM15 u 6PM

Insulin is ahormonesecreted by betacells of thepancreas that, byreceptor-mediated effects,promotes thestorage of thebodys fuels,facilitating thetransport of themetabolites andions (potassium)through cellmembranes andstimulating thesynthesis ofglycogen fromglucose, of fatsfrom lipids, andproteins fromamino acids.

Treatment oftype 2 (non-insulin-dependent)diabetesmellitus thatcannot becontrolled bydiet or oraldrugs.

Contraindicatedwith allergy to porkproducts; history ofsmoking or lungdisease.

Use cautiously withpregnancy;lactation (monitormother carefully;insulinrequirements maydecrease duringlactation).

Hypertensitivity:-rash-angioedema

Local:-allergy-redness-itching-pruritis-lipodystropy

Metabolic:-hypoglycemia-ketoacidosis

Respiratory:-decline inpulmonaryfunction

1.Givemaintenancedosessubcutaneously, rotatinginjection sitesregularly todecreaseincidence oflipodystrophy.

2.Store insulinin a coolplace awayfrom directsunlight.

3.Monitorserumglucose levelfrequently todetermineeffectivenessof drug anddosage.

4.Reportfever, sorethroat,vomiting,hypoglycemicorhyperglycemic reactions,rash.


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DATEORDERED

DRUGCLASSIFICATION

DOSE/FREQUENCY

MECHANISM OFACTION

SPECIFICINDICATION


SIDE EFFECTS NURSINGPRECAUTION

Pregabalin 7-5-10 Calcium channelmodulatorAnalgesicAntiepileptic

50 mg 1tabletODHS

Binds to alpha2-delta sites on thenerves in theCNS, whichreduces thecalcium influxinto the cell anddecreases therelease ofneurotransmitters into thesynaptic cleft,resulting in lessstimulation of thenerves; in labstudies, it alsoincreases thetrasnport anddensity of GABA,which is knownto suppressnerve activity.

Managementof acute painassociatedwith diabeticperipheralneuropathy

Contraindicationwith knownhypersensitivity topregabalin or anycomponent of thedrug, lactation.

Use cautiously withdiabetes, CHF,pregnancy.

CNS:-dizziness-somnolence-ataxia-vertigo-confusion-tremors

GI:-dry mouth-constipation-flatulence

Other:-peripheraledema-weight gain-back pain-chest pain

1.Do notadministerdrug after afatty or largemeal,absorptioncan beaffected.

2.Monitorweight gainand fluidretention;adjusttreatment fordiabetes.

3.Providesafetymeasures ifdizziness,somnolence,changes inthinkingoccurs.

4.Report rash,changes invision,increasedbleeding,suddenmuscle pain,or weakness.


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NAME OFDRUG(GENERICAND BRAND

NAME)

DATEORDERED

DRUGCLASSIFICATION

DOSE/FREQUENCY

MECHANISM OFACTION

SPECIFICINDICATION



Pioglitazone 7-5-10 AntidiabeticThiazolidinedione

30 mg 1tabletOD afterbreakfast

Resensitizetissues toinsulin;stimulatesinsulinreceptors sitesto lower bloodglucose andimprove theaction ofinsulin;decreaseshepaticgluconeogenesis andincreases

insulin-dependentmuscle glucoseuptake.

Monotherapyas anadjunct todiet andexercise toimproveglucosecontrol inpatients withtype 2 (non-insulindependent)diabetes.

Contraindicationwith allergy to anythiazolidinedione;type 1 (insulin-dependent)diabetes,ketoacidosis,lactation.

Use cautiouslywith advancedheart disease,liver failure,pregnancy.

CNS:-headache-myalgia

CV:-fluid retention

Endocrine:-hypoglycemia-hyperglycemia

GI:-diarrhea

-liver injury

Respiratory:-sinusitis-URI-rhinitis

Other:-infection-fatigue-toothdisorders

1.Monitorurine andbloodglucoselevelsfrequently todeterminetheeffectiveness of the drugand dosagebeing used.

2.Administerdrug withoutregard to

meals.

3.Reportfever, sorethroat,unusualbleeding orbruising,rash, darkurine, andlight-coloredstools.


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Date Ordered/Date Performed

DiagnosticExam

Result Normal Values Interpretationof result

07-02-10 Urinalysis

Color Yellow Yellow Normal

Character Hazy Hazy Normal

Specific Gravity 1.010 1.010- 1.025 NormalpH 6.5 4.6- 8.0 Normal

Protein Negative Negative Normal

Glucose Positive Negative Possiblediabetic

Bilirubin Negative Negative Normal

Urobilinegen Negative Negative Normal

Nitrates Negative Negative Normal

Blood Negative Negative Normal

Leukocytes Negative Negative Normal

Ketones Negative Negative Normal

Epithelial cells Few Few NormalWBC 0-2/HPF 0-1/HPF Normal

BloodChemistry

FBS(Fasting

Blood Sugar)

338.2 60-110mg/dL Possiblediabetic

07-02-10 Special testreport:Hb A1c

GlycosylatedHgb

12.1 4.5-6.3 % Possiblediabetic

07-03-10 Urinalysis

Color Yellow Yellow Normal

Character Hazy Hazy Normal

Specific Gravity 1.010 1.010- 1.025 Normal

pH 6.5 4.6- 8.0 Normal

Protein Negative Negative Normal

Glucose Positive Negative Normal

Bilirubin Negative Negative NormalUrobilinegen Negative Negative Normal

Nitrates Negative Negative Normal

Blood Negative Negative Normal

Leukocytes Negative Negative Normal

Ketones Negative Negative Normal

Epithelial cells Few Few Normal

WBC 0-1/ HPF 0-1/HPF Normal


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Date Ordered/Date Performed

DiagnosticExam

Result Normal Values Interpretationof result

07-06-10 Serum

ElectrolytePotassium 3.49mmol/c 3.5- 5.0 mg/dL Normal

BloodChemistry

FBS(Fastingblood sugar)

177.3 mg/ dL 60-110mg/dL Possiblediabetic

CBG 388.0mg/dL 60-110mg/dL Possiblediabetic

CBG 286mg/dL 60-110mg/dL Possiblediabetic

Normal anatomy

PATHOPHYSIOLOGY

Precipitating Factors: Predisposing Factors:


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Diet age

SedentaryLifestyle heredity


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Nursing Care PlanCues

(S= Subjective;O= Objective)

NursingDiagnosis

Objectives Interventions Rationale Evaluation

Sub:Usahaymakahuna-hunako nga dili

magkaun para dilimagtaas akosugar asverbalized by thepatient

Obj:-

ImbalancedNutrition; lessthan bodyrequirements

related to utilizenutrients to meetmetabolic needs.

Short-term goal:At the end of 3days duty, the

patient will able todemonstratebehaviors, lifestylechanges tomaintain or regainappropriateweight.

Long-term goal: At the end of 1week, the patientdemonstrate

progressiveweight gain

Ascertainunderstanding ofindividualnutritional needs.

Discuss eatinghabits, includingfood preferences,intolerance oraversion.

Note total dailyintake. Maintaindairy of calorieintake, patternsand times ofeating.

Develop regular

exercise.

Weight weeklyand documentresult.

Collaboration:Take

To determinewhat informationto provide client

To appeal toclients like

To revealchanges thatshould be made inclients dietaryintake

To promote

wellness

To monitoreffectiveness ofdietary plan

To keepnourished.

At the end of 3days, the patientwas able todemonstrate

behaviors.Lifestyle changesto regain/ maintainappropriate weightas evidenced byincreased weight=39kg.


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multivitamins asprescribed

Cues(S= Subjective;O= Objective)

NursingDiagnosis


S= sukad pagkaadmit naku, mgalima na siguro nika adlaw ki ninggitupokan para sadextrose, asverbalized by thepatient

OBJ:-decreasedWBC=0-2/HPF-decreased bodyweight=32.2kls

Risk for Infectionrelated todecreasedleukocyte function

Long-term goal: At the end of 1week, the patientwill able todemonstratetechniques,lifestyle changesto promote safeenvironmentShort-term goal:At the end of 3days duty, thepatient will identifyinterventions to

prevent/ reducerisk for infection.

.

Observe forlocalized signs ofinfection atinsertion site ofinvasive line

. Monitor visitorsor caregivers

Maintainadequatehydration, stand/sit to void

Provide regular

perineal care

Instruct client intechniques toprotect theintegrity of theskin

Collaboration: Administer

To assesscausative orcontributingfactors

To preventexposure of client

To avoidbladder distention

Reduces risk ofascending UTI

To promotewellness

To reduce/correct existingrisk factors

Goals were met.At the end of 3days duty, thepatient identifiedinterventions toprevent risk forinfection. Thepatientdemonstratedlifestyle changesto promote safeenvironment.


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prophylacticantibiotics asindicated

Cues(S= Subjective;O= Objective)

NursingDiagnosis


S= Nganonaghubag ni akotiil?tungod ni satambal nga gi-inject sa ako?, asverbalized by thepatient

OBJ:

Knowledge Deficitrelated tocognitive limitation

Long-term goal: At the end of 8hours, the patientwill verbalizeunderstanding ofdisease processand treatment

Short-term goal:At the end of 1-2hours duty, thepatient will exhibitincreased interestfor own learningand begin to lookfor informationand asksquestions

.

Determineclients ability tolearn

.Provide anenvironment thatis conducive forlearning

Determineclients method ofaccessinginformation tofacilitate learning

Begin withinformation theclient alreadyknows and moveto what the client

To assessreadiness to learn

To facilitatelearning

Limits sense ofbeingoverwhelmed

Provides rolemodel and sharingof information

Goals were met.At the end of 2hours duty, thepatient exhibitedincreased interestfor own learningand began to lookfor informationand askedquestions aboutthe disease. Sheverbalizedunderstanding ofdisease processand treatment.


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does not know

Involve otherswith who have thesame problem

Provide activerole for client inlearning process

Promotes senseof control oversituation

Actual Nursing ManagementReadiness for enhanced self-care related to desire to learn about diabetes mellitus and management options, physical activity for

diabetes mellitus management, and dietary management of diabetes mellitus.

S

O

P

I

E


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XIII. Prognosis

CRITERIA RESULT GOOD POOR

A. ONSET OFILLNESS

The onset of illness started 6

months prior to patients

admission

B. DURATIONOF ILLNESS

The span of the duration ofthe illness is long-term

C. PRECIPITATING FACTOR/PREDISPOSINGFACTOR

The precipitating factor and

predisposing factor wereidentified.

D. ATTITUDEANDWILLINGNESS TOTAKE MEDICATIONTREATMENT

The patient was very muchwilling to follow every

medication and instruction ofthe doctor.

E. FAMILLYSUPPORT

The husband of the patient is

always present at her side andis providing both physical

and emotional support.


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Prognosis:

Patient B.E had shown progress from the time that the patient was admitted to Camiguin

General Hospital. The clients prognosis will largely depend on her willingness to follow her

treatment regimen religiously. The patient was taught of health maintenance by providing

strategies to decrease complications of diabetes mellitus, preventing hypoglycemia or

hyperglycemia by taking early action, she was also taught meal planning and physical activity

programs, follow-up visits to assess for complications of diabetes mellitus

DISCHARGE PLAN AND RECOMMENDATION

Preparation of the patient treatment plan is the best approach as a collaborative

effort of the medical team, which includes the family and or significant others, as the

patient embarks into the world outside the facility. The prognosis is somehow good . An

adequate discharge program aims to make the patient less dependent; and eventually

foster socials skills, work or job skills, and involvement in the community. Initial

discharge plan is as follows:

Medications:

Humulin 70/30 25 u SQ 6 am,15 u SQ 6 pm, this would decrease blood glucose inthe body.

Pioglitazone 30 mg 1 tab after

Exercise:


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Schedule routine activities such as walking, jogging and participation of activities, etc,

which should also correspond to the activities as scheduled in the facility.

Treatment:

Encouraged patient to participate in therapy sessions and other activities

conducted as scheduled in the facility and allow client to interact with other residents

during the evaluation process of every therapy session.

Health teachings on hygiene:

Allow self-care activities like bathing, grooming, and toileting with or without

assistance as minimal as possible; make it a routine activity to promote practice and

encourage less dependence. These activities will become a habit and eventually, the

patient will be able to follow through.

Outpatient:

If scheduled for discharge, explain the instructions to the patient or significant

others to adhere to medical check-ups one week after discharge and At least once or

twice a month, as well as compliance to medication regimen. Encouraged the significant

others or family to situate the patient to an enhanced vicinity than on where he is

currently living now.


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Diet:

There are specific diet restrictions just like foods that have high sugar content.

Recommendations:

Patient B.Es family was encouraged to support her and to be an alley for

patients recovery. Diabetes management is the responsibility of the clients and her

family. The pt should be empowered to accept self-management and become the focus

of the team approach to treatment. They should also be required to have a consistent

follow-up, updating, and reinforcement.

Health TeachingsM Medication The pt was given take home medications which includes

Humulin 70/30 25 u SQ 6 am,15 u SQ 6 pm,Pioglitazone 30 mg 1 tab after ,the pt was encouraged to report anyadverse effects just like dizziness,nausea, vomiting,diarrhea and the like

Take medications with meals to prevent GI upset

Do not overdose drug

Take medication at right time


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E Exercise Walk at least 30 minutes per day

Encouraged to ambulate, flex arm and legs

T Treatment Follow drug regimen as prescribed to prevent reoccurrence of

symptoms

Do not stop taking insulin, even if you are vomiting and unable to eat.

Encouraged to self monitor blood glucose.

Notify your doctor when you have any of the ff. problems.

- Severe abdominal pain

- Temperature greater than 100 F

- Persistent diarrhea

- Vomiting with inability to consume fluids for more then 4 hours

H Home Care Observe proper hygiene;

Take a bath regularly wash hands before and after eating

Proper wound care must observe to prevent infection

Encouraged to have adequate fluid intake every 15 to 30 minutes to

prevent dehydration

O Out-Patient

Department

Come back for follow-up check-up on July 19,2010

D Diet Eat lot of fruits and vegetables.

Instructed to eat foods rich in carbohydrates, eating 10 to 15g of

carbohydrate every 1 to 2 hours. Avoid foods high on sugar like chocolate

Drink plenty of water at least 8 glass of water a day.

DISCHARGE PLAN AND RECOMMENDATION

Preparation of the patient treatment plan is the best approach as a collaborative

effort of the medical team, which includes the family and or significant others, as the

patient embarks into the world outside the facility. The prognosis is somehow good . An

adequate discharge program aims to make the patient less dependent; and eventually


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foster socials skills, work or job skills, and involvement in the community. Initial

discharge plan is as follows:

Medications:

Humulin 70/30 25 u SQ 6 am,15 u SQ 6 pm, this would decrease blood glucose inthe body.

Pioglitazone 30 mg 1 tab after

Exercise:

Schedule routine activities such as walking, jogging and participation of activities, etc,

which should also correspond to the activities as scheduled in the facility.

Treatment:

Encouraged patient to participate in therapy sessions and other activities

conducted as scheduled in the facility and allow client to interact with other residents

during the evaluation process of every therapy session.

Health teachings on hygiene:

Allow self-care activities like bathing, grooming, and toileting with or without

assistance as minimal as possible; make it a routine activity to promote practice and

encourage less dependence. These activities will become a habit and eventually, the

patient will be able to follow through.


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Outpatient:

If scheduled for discharge, explain the instructions to the patient or significant

others to adhere to medical check-ups one week after discharge and At least once or

twice a month, as well as compliance to medication regimen. Encouraged the significant

others or family to situate the patient to an enhanced vicinity than on where he is

currently living now.

Diet:

There are specific diet restrictions just like foods that have high sugar content.

Recommendations:

Patient B.Es family was encouraged to support her and to be an alley for

patients recovery. Diabetes management is the responsibility of the clients and her

family. The pt should be empowered to accept self-management and become the focus

of the team approach to treatment. They should also be required to have a consistent

follow-up, updating, and reinforcement.

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