DM Type 2 Case Pres

8/4/2019 DM Type 2 Case Pres

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Diabetes Mellitus

Type 2

TABLE OF CONTENTS

I. Introduction

II. Patient¶s Profile

III. Past history

IV. Present history

V. Family history

VI. Social history

VII. Theoretical framework

VIII. Activities of daily living

IX. Physical assessment

X. Laboratories

XI.

Anatomy and physiology XII. Pathophysiology

XIII. Nursing care plan

XIV. Drug studies



I. INTRODUCTION

Description

Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels

that result from defects in insulin secretion, or action, or both. In patients with diabetes, the absence or

insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that

although it can be controlled, it lasts a lifetime.

Diabetes mellitus type 2 or type 2 diabetes (formerly called non-insulin-dependent diabetes mellitus

(NIDDM), or adult-onset diabetes) is a disorder that is characterized by high blood glucose in the context of

insulin resistance and relative insulin deficiency.

Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage

are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important

factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes,

coronary heart disease, and other large blood vessel diseases.

There are an estimated 23.6 million people in the U.S. (7.8% of the population) with diabetes with

17.9 million being diagnosed, 90% of whom are type 2. With prevalence rates doubling between 1990 and

2005, CDC has characterized the increase as an epidemic.

Philippines is still low on this score compared with other countries, especially Scandinavian nations

like Finland, Sweden, and Norway, but we are also seeing an increase every year. Moreover, mathematical

modeling on projection yields that 380 million people are expected to develop diabetes by 2025 based on

International Diabetes Federation/World Health Organization data, a good percentage will be coming from

Southeast Asian countries, including the Philippines. This finding is no longer astonishing considering the

latest statistics on Filipinos afflicted with diabetes and hypertension which continues to increase on the scale

of medical records. This goes to show that statistics on Diabetes Mellitus in the Philippines continues to be

unfavorable to the general population because of the continuous rise in the number of Filipinos developing

diabetes every year which adds to the number of people who cannot enjoy life and are becoming less

productive due to this disease.



By 2025, most people with diabetes will be in aged 65 years or more, while in developing countries

most will be in the aged 45 to 65 years range and it's affected in their most productive years", WHO deplores.

In Southern Asia, diabetes is considered as one of the top 10 causes of death. In the Philippines, diabetes

claims at least 5,000 lives each year. The Department of Health (DOH) reports that diabetes mortality rate in

the total population has increased by 92% over 10-year period.

Unknowingly, many Filipinos who are afflicted with diabetes do not know the early signs of the disease and

even don't know if they have the disease already . "Many of the patients die because it is already too late to

remedy the situations, " many doctor says. "A doctor cannot tell that to complain and usually that is already

late as far as complications are concerned. This disease has no cure. What doctors can do is just onset a little

later because the disease is more manageable among older people.



II. Patient¶s Profile

Patients name: Mrs. AV

Age: 56 yrs old

Sex: Female

Marital Status: Married

Occupation: Buy and sell of vinegar

Address: Gabon Abucay Bataan

Birthday: June 23, 1955

Birthplace: Paompong, Bulacan

Nationality: Filipino

Religion: Roman Catholic

Name of father: Mr. FV

Name of mother: MrsBV

Admission date: July 18, 2011

Time of admission: 12:20 AM

Attending physician: Dr. Mallari

Chief Complaint: DOB

Admitting diagnosis: Pulmonary Congestion, DM type 2, Nephropathy, HPN



III. Past History

Mrs. A.V. was born on June 23, 1955 via normal spontaneous home delivery assisted by a ³hilot´. The patient

claimed that she had completed all immunizations in her childhood, those immunization were administered by

their health center personnel. The Health center is their family¶s main health care service when she was

growing up She also stated that she has a history of measles and mumps she also had fever , colds, diarrhea

during childhood. She had taken OTC drug in order to relieve her diseases. Mrs. A.V. is a multipara, having

four children, all born alive and well via normal spontaneous delivery at Bataan Doctors Hospital. The patient

was diagnosed of (Type II) DM last 2001. Before her DM diagnosis, Mrs A.V described her symptoms as

being hungry a lot of times, always thirsty. This made her gain weight. She was also waking up at night to

urinate and this sometimes disrupts her sleep . What she did was she stopped drinking a lot of fluid few hours

before she sleeps so she can avoid waking up. She has been admitted in the hospital several times because of

loss of consciousness. She stated that ever since she was diagnosed of DM she was going back and forth in thehospital. She described it as sometimes weekly at the worst and sometimes once a month. This was from

2001 to 2009. From 2010 and till 2011, this was her 1st

visit to the hospital. The patient underwent an

operation last 2007 due to her ingrown oh her left foot at Bataan Doctors Hospital on with her surgeon, Dr.

Sampang. Besides her ingrown incidence, she didn¶t have anymore operations. She has no known allergies.

Mrs. A.V doesn¶t eat seafood but not because she is allergic but she doesn¶t like the taste of it. She has a

maintenance drug Glibenclamide but she doesn¶t take it because she thinks that if she doesn¶t have the

symptoms she don¶t need the medication. Patient didn¶t have any injuries growing up. Patient used to drink

when she was single but stopped when she got married. The patient used to smoke for ten years after her

youngest was born. She says that it relaxes her. Mrs A.V used to work in the morning as an exercise, she say

that they would go by the seas side and walk as early as in the morning. But this stopped because of her illness. Now she considers cleaning the house as an exercise.

IV. Present History

Three days to admission, the patient experienced difficulty of breathing, hyperventilation, and chest

pain. This prompted her to seek medical assistance. Prior to consultation, she has self-administered

Salbutamol nebulization but then, symptoms persist. Mrs. A.V. was rushed in the emergency room on July 20,

2011 at 12:20 AM. During the initial assessment, her first vital signs were the following: BP190/100mmHg,

T- 34.60C, PR 112-bpm, RR 35-bpm. She has an admitting diagnosis of Pulmonary Congestion, Diabetes

Mellitus, nephropathy and Hypertension and her admitting physician was Dr. Malixi. Upon admission, several

laboratory tests were requested to help diagnose the patient such as BUN, creatinine, cholesterol,

triglycerides, HDL, LDL, and CBC.



V. Family History

Grandfather

36 y/o,dead

(Diabetes)

Grandfather

Dead,

(CVA)

Father

Dead

HPN

CVA,

dead

A & W A & WA & W

Grandmother

Dead,

Breast

Grandmother

Dead

HPN

Mother

83 y/o

Diabete

s A & W

Diabete

s

Patien

A.VDiabe

tes

Dia

bet

Female

Male



VI. Personal-Social History

Mrs. A.V. is a 56 years old, working as a businesswoman. She buys and sells vinegar from Bulacan. Prior to

this business, she used to work in Abu Dhabi as a cook from 1992 to 1996. She also used to buy and sell fruits

before working in Abu Dhabi.

In her business, the patient travel back and forth from Bataan to Bulacan. For leisure, the patient plays

bingo with her neighbors.

Mrs. A.V.¶s husband died last July 2, 2011 so she is still depressed about it. Her husband died with

CVA. She talk to her children regarding his feelings, also one of her children is now living with her with the

company of her children¶s family. Patient has 4 grandchildren. The patient has no pet. She used to have 2

dogs but she sold them because of foul smell. Mrs. A.V. finished high school and then started a business.

Currently, the patient is receiving money from her children, one from abroad and one from the Philippines.

She stated that the money that she is receiving is enough for her daily expenses including medication. Mrs

A.V also talks to her brothers and sisters ad they help her do things in the house. She also accompanies her to

wherever she goes. The patient states that her friends are also her neighbors. The patient considers her self as

an average level of economic status. She states that her earning are fairly enough for her.

Mrs. A. V considers herself to be religious but stated that couldn¶t go to church every sunday due to

her business. The patient can do fairly everything for herself. She cooks, cleans and washes her clothes. But

due to her physical condition right now, the patients couldn¶t do all those. Now, her daughter in law helps her

to do the basic chores in the house.



VII. Theoretical Framework

Self-Care Deficit Theory of Nursing

By: Dorothea Orem

Self-care is an activity that promotes a person¶s well-being. It is performed by persons who are aware

of the time frames on behalf of maintaining life, continuing personal development and a healthy functionalliving.

Self-care requisites are insights of actions or requirements that a person must be able to meet and

perform in order to achieve well-being. These are reasons for any actions of self-care that must be undertaken.The two elements of self-care requisites are: The factor to be controlled or managed to keep as aspect(s) of

human functioning and development within the norms compatible with life, health, and personal well-beingand the nature of the required action.

These are universally set goals that must be undertaken in order for an individual to function. In scopeof a healthy living. The eight self-care requisites common in men, women, and children are as follows:

Maintenance of a sufficient intake of air, maintenance of a sufficient intake of food, maintenance of a

sufficient intake of water, provision of care associated with elimination, maintenance of balance between

activity and rest, maintenance of balance between solitude and social interaction, prevention of hazards to

human life, human functioning and human well-being, and promotion of human functioning and development.

Self care deficit of Orem is specifies when nursing is needed. Nursing is required when an adult (or in the case

of a dependent, the parent) is incapable or limited in the provision of continuous effective self care. Orem

identifies 5 methods of helping: Acting for and doing for others, guiding others, supporting another, providing

an environment promoting personal development in relation to meet future demands, teaching another

In relation to our client¶s case, our client needs a lot of care, since we know that she is suffering in her

problem which is nephropathy secondary to diabetes mellitus. Before hospitalization she was able to carry out

activities of daily living but during hospitalization she became dependent to nurse and to her daughter in law

in able to meet her needs. She doesn¶t take it because she thinks that if she doesn¶t have the symptoms she

doesn¶t need the medication. Being a health care provider to our client we must guide, support, provide and

teach her to achieve well-being. We help our client to establish or identify the ways to perform self-care

activities. She also needs to have good elimination and urination. Maintenance of balance between activities

and rest and avoid hazards to human life, human functioning, and human well-being.



VIII. Activities of Daily living

Before Hospitalization During Hospitalization (day1)

Nutrition The patient eats 3 times a day. Sheusually eats 1-2 cups of rice and redmeat. She likes soft drinks too. The

patient doesn¶t like eating fish. Sheusually prepares her food by herself.

Don¶t like snacks and vegetables.

The patient doesn¶t eat much. Thismorning she have half cup of riceand some viand. At lunch she had ½

of siopao. She had biscuits for snacks. Her daughter in law assisted

her in preparing her foods.

Elimination The patient has normal bowel

movement without changes inconsistency and shape. She also had

good urine output of 4 to 5 times aday.

The patient has an IFC. The color of

her urine is amber and odor isammonia like.Her output is350cc for

5hours.

Hygiene The patient takes a bath 2 times aday. She takes a bath in the afternoon

after cleaning her house and an hour before sleeping. The patient practices

good hygiene.

The patient hasn¶t take a bath yet.She only washed her face this

morning with the help of her daughter in law.

Rest and sleep

a) Routine

b.)Sleeping

pattern

The patient goes to bed around 9 pm

and wake up around 4 am.Sometimes she wakes in the middle

of the night having DOB. She takessome naps in the afternoon for at

least 2 hours.

The patient has an altered sleep

pattern. She doesnt sleep well due

to the noise inside the hospital. Also

She wakes up in the middle of the

night due to DOB . She takes naps

once in a while during the day.



IX. Assessment

PHYSICAL ASSESSMENT

Findings Analysis

Initial V/S are as follows :

BP- 190/100

Temp- 34.6

PR- 112

RR- 35

Hypertensive

Afebrile

Tachycardic , full and bounding pulse

Tachypneic

General Status : conscious , coherent

SHEENT : (-) pallor , pale conjunctiva

Chest : (+) retractions

Abdomen : (-) tenderness on all quadrants

Extremities : (-) gross deformities



July 18, 2011 Monday 5:00 PM

BODY PART EXAMINED TECHNIQUE USED ACTUAL FINDINGS INTERPRETATION

/ANALYSIS

SKIN

Color

Lesions

Moisture

Edema

Skin turgur

HAIR

Quality

Texture and oiliness

Prescense of parasites

SCALP

NAIL

Fingernail and toenail

bed color

Capillary refill

HEAD

Skull and face

Inspection

Inspection

Palpation

Palpation

Inspection

Palpation

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Inspection

Palpation

Inspection

Evenly colored skin tones

without unusual or

prominent discolorations

Birth marks are flat and soft

Moisture in skin folds and

axillae

Skin rebounds and does not

remain inderted when

pressure is released

When pinched ,skin springsback to previous state

Thick , evenly distributed

Silky resistant hair

None

Smooth and firm without

lesion and redness

The nail bed is pink in color

and clean

Pink tone returns

immediately to blanched

nailbeds when pressure is

released

Rounded smooth skull

contour with symmetric

facial features and

movement

Bipedal , non-pitting

edema



EYES

Pupil

Eyelids

EARS

Auricle

NOSE

LIPS

GUMS

TONGUE

NECK

CHEST

ABDOMEN

LUNGS

Inspection

Inspection

Inspection

Palpation

Inspection

Inspection

Inspection

Inspection

Inspection

Palpation

Inspection

Palpation

Inspection

Palpation

Auscultation

PERRLA

Skin intact no discharge and

discoloration

Color same as facial skin ,

symmetrical , firm ,and not

tender

Symmetrical and no lesion

Firm and moist no ulceration

Pink gums , no bleeding

Normally , midline

Symmetrical , lymph nodes

are not palpable

Symmetrical , chest

expansion as observed

No tenderness

Crackles in both lungss



X. Laboratory

DIAGNOSTIC

PROCEDURE

DATE

ORDERED/DATE

RELEASED

TESTS RESULTS NORMAL

VALUES

ANALYSIS AND

INTERPRETATIONS

Complete

blood count

July 18, 2011 Hemoglobin 99.0 g/l 120-150

g/l

EPO production

decreases because

the kidney is

malfunctioning. As aresult, R BC count

decreases, as does

hemoglobin.Hematocrit 0.30 0.37 - 0.47 Decreased

production of

erythropoeitin or

your bone marrow

does not work

properly

WBC count 8.8 x 10 g/l 5.0 x 10

g/l

This can result from

bacterial infections,

Lymphocytes 0.59 0.25 0.35

It might signify

infection the

patient currently

having

HBA1C JULY 18, 2011 Glucosynate

hemoglobin

8.9% 4.2 6.2% A high HbA1c

represents poor

glucose control.

Blood

chemistry

July 18, 2011 FBS 8.6 mmol/l 4.6 6.1

mmol/l

Positive for increase

glucose in the body

BUN 12.0 mmol/l 2.5 7.6

mmol/l

It is characterized

by decreased

effective circulating

blood volume withdecreased renal

perfusion, in

postrenal

obstruction of urine

flow, and in high

protein intake

states.

Creatinine 472.7 umol/l 62 120

umol/l

Increase in serum

creatinine is seen a

renal functional

impairment.

Because of its

insensitivity indetecting early renal

failure

Cholesterol 7.5 mmol/l < 6.5

mmol/l

When there is too

much cholesterol

(a fat-like

substance) in your

blood, it builds up

in the walls of your

arteries and blood



flow to the heart is

slowed down or

blocked.

Triglycerides 1.0 mmol/l 0.46 0.90

mmol/l

Risk for developing

heart disease

HDL 0.74 0.9 1.7 It removes the

waste or the

cholesterol build

up in the arteries

LDL 6.5 2.0 4.4 High LDLcholesterol leads to a

cholesterol

Build-up in the

arteries.

x- ray July 18, 2011 Chest PA Cardimegaly with

pulmonary

edema/congestion

R/O pneumonia

negative Patients have a

enlarged

heart,and

accumulation of

fluids in the lungs



XI. ANATOMY AND PHYSIOLOGY

Every cell in the human body needs energy in order to function. The body¶s primary energy source is

glucose, a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches).

Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it.

Insulin is a hormone or chemical produced by cells in the pancreas, an organ located behind the stomach.

Insulin bonds to a receptor site on the outside of cell and acts like a key to open a doorway into the cell

through which glucose can enter. Some of the glucose can be converted to concentrated energy sources like

glycogen or fatty acids and saved for later use. When there is not enough insulin produced or when the

doorway no longer recognizes the insulin key, glucose stays in the blood rather entering the cells.

Anatomy of the pancreas:

The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach. The

right side of the organ (called the head) is the widest part of the organ and lies in the curve of the duodenum

(the first section of the small intestine). The tapered left side extends slightly upward (called the body of the

pancreas) and ends near the spleen (called the tail).

The pancreas is made up of two types of tissue:



1. Exocrine tissue

The exocrine tissue secretes digestive enzymes. These enzymes are secreted into a network of ducts that join

the main pancreatic duct, which runs the length of the pancreas.

2. Endocrine tissue

The endocrine tissue, which consists of the islets of Langerhans, secretes hormones into the bloodstream.

Functions of the pancreas:

The pancreas has digestive and hormonal functions:

The enzymes secreted by the exocrine tissue in the pancreas help break down carbohydrates, fats, proteins,

and acids in the duodenum. These enzymes travel down the pancreatic duct into the bile duct in an inactive

form. When they enter the duodenum, they are activated. The exocrine tissue also secretes a bicarbonate to

neutralize stomach acid in the duodenum.

The hormones secreted by the endocrine tissue in the pancreas are insulin and glucagon (which regulate the

level of glucose in the blood), and somatostatin (which prevents the release of the other two hormones.

Anatomy of kidney

The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste

products, but also by balancing levels of electrolytes in the body, controlling blood pressure, and stimulating the

production of red blood cells.

The kidneys are located in the abdomen toward the back, normally one of each side of the spine. They get

their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the

renal veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)

The kidneys have the ability to monitor the amount of body fluid, the concentrations of electrolytes like

sodium and potassium, and the acid-base balance of the body. They filter waste products of body metabolism,

like urea from protein metabolism and uric acid from DNA breakdown. Two waste products in the blood can

be measured: blood urea nitrogen (BUN) and creatinine (Cr).

Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make

red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall,

erythropoietin levels rise and the body starts to manufacture more red blood cells.



XII. Pathophysiology

Family Hx Asian Age 56yrs Diet

Chance to have response to carbohydrate intake

Defective pancreas Insulin increases glucose in

the bloodstream

Destruction of B-cells

In pancreas

glucose level in blood

Insulin Production

Insufficient intracellurlar glucose *8.6mm/dl Increased LDL 6.5mm/dl

Polyphagia Hyperglycemia

Glycosuria Chronic increased Ldl

Polyuria Sluggish Circulation Atherosclorosis

Dehydration of cell Insufficient renal tissue perfusion chronic BP increased

Thirst Nephropathy Cardiomegaly

Polydipsia

GFR Hgb HCT

Fluid in ECF BUN Creatinine DOB Pale conjunctiva12.0 mm/dl 472.7 mm/dl

RR CR

Fluid volume excess *35bpm * 112PR

Hydrostatic pressure

Fluid shift to interstitial

Compartment

Periphery Increase BP Lungs

* 190/100 *Xray result with pulmonary/edema congestion

Bipedal Edema Pulmonary congestion

Crackles



XIII. Nursing care plan

Assessment Diagnosis Planning Intervention Rationale Evaluation

S>"Nahihirapan akohuminga"as claimed

O> RR of 30bpm>C O2 inhalation of

4-5 lpm>C crackles upon

auscultation>C facial

grimace;noted>use of accessory

muscles for respiration>CXR revealed

pulmonary edema

Impaired gasexchange r/taccumulation of

fluid in both lungfields as

evidenced bycrackles upon

auscultation

After 1 day of nursingintervention, the

pt. will have a better gas

exchange asevidenced by

RR of 30 to thenormal range of

12-20bpm,abscense

of pulmonaryedema and

crackles .

INDEPENDENT>Place pt. onhigh fowler's

position>Teach the pt.

appropriate deep breathing

technique

>kept rested

DEPENDENT

>Administer O2inhalation as

ordered

>Furosemide asordered

>To promote proper lungexpansion

>Promoteoptimal

chestexpansion

and tofacilitate

adequate air >To promote

relaxation of the body

thereforedecreases O2

demand>To have an

adequatesupply of O2

in the body>Furosemide

is a Diuretics

w/c makes patienturinate

thereforedecreased

fluid vol.and relieve

pulmonaryedema

Goal partimet

>RR decreased

from 30 to22bpm

>crackleswere just

slightlyheard upo

auscultatio> C mild

pulmonaryedema



Assessment Diagnosis Planning Intervention Rationale Evaluati

S>" Hirap akomakahinga" as

claimedO>RR of 30bpm

>O2 inhalation of 4-5 lpm

>use of accessorymuscles for

respiration>CXR revealed

pulmonary edema>crackles upon

auscultation

Fluid volumeexcess r/t

accumulation of fluid in the lungs

as evidenced by pulmonary

edema uponCXR

After 1 day of nursing

intervention, the pt.will be able to have

stabilized fluidvolume as

evidenced byabsence of edema

>Place pt. on highfowler's position

>Teach pt.


technique

>kept rested

DEPENDENT


ordered

>To promote proper lung

expansion>To promote

chestexpansion and

to facilitate air better

>To promoterelaxation of

the bodytherefore

decreases O2demand

>To haveadequate

supply of O2to the body

Goal partially

met>CXR

revealedmild

pulmonaedema



Assessment Diagnosis Planning Intervention Rationale Evaluatio

S>Hindi akomasyado makatulog

dahil hirap akomakahinga" as

claimedO> RR of 30bpm

>C O2 inhalationof 4-5 lpm

>weak inappearance

>C episodes of yawning

>Irritability>fatigue

Sleep patterndisturbance r/t

DOB secondaryto pulmonary

congestion asevidenced by

episodes of yawning

After 6 hours of nursing

intervention, the pt.can able to increase

the sleeping hoursfrom 4 to 8 hours S

interruption of DOB

INDEPENDENT>Place pt. on high

fowler's position

>Teach clientappropriate deep

breathingtechnique

>Kept rested

>Limit fluidintake before

bedtime

DEPENDENT


ordered

>To promote proper lung

expansion>To promote

chestexpansion and

to facilitateair better

>To promoterelaxation of

the bodytherefore

decreases O2demand

>To preventurinary

bladder retention

causingdribbling of

urine

>To haveadequate

supply of O2to the body

Goal met

>Pt.sleeping

patternincreased

from 4 tohours S

complainof DOB



Assessment Diagnosis Planning Intervention Rationale Evaluation

S>Hindi ako masyado

makatulog dahil hirapako makahinga" as

claimedO> RR of 30bpm

>C O2 inhalation of 4-5 lpm

>weak in appearance>C episodes of

yawning>Irritability

>fatigue

Sleep pattern

disturbancer/t DOB

secondary to pulmonary

congestion asevidenced by

episodes of yawning

After 6 hours of

nursingintervention, the pt.

can able to increasethe sleeping hours

from 4 to 8 hours Sinterruption of

DOB

INDEPENDENT

>Place pt. on highfowler's position

>Teach client


technique

>Kept rested

>Limit fluid

intake before bedtime

DEPENDENT>Administer O2

inhalation asordered

>To

promote proper lung

expansion>To

promotechest

expansionand to

facilitate air better

>To promote

relaxation of the body

thereforedecreases

O2 demand>To prevent

urinary bladder

retentioncausing

dribbling of urine

>To have

adequatesupply of

O2 to the body

Goal met

>Pt.

sleeping pattern

increasedfrom 4 to 8

hours Scomplainin

of DOB



XIV. Drug Study

July 18, 2011

DRUGS ACTION INDICATION CONTRAIN

DICATION

SIDE EFFECT NURSING

CONSIDERATION

CLONIDINE

Brand Name:

DURACLON

CLASSIFICATI

ON:

Antihypertensiv

e

Dosage/Route:15mcg tab OD

Inhibits

sympathetic

vasomotor

center inCNS, which

reduces

impulses in

sympathetic

nervous

system;

blood pressure,

pulse rate,

cardiac

outputdecrease,

prevents

pain signal

transmission

in CNS by

a-adrenergic

receptor

stimulation

of the spinalcord.

Mild to

moderate

hypertension

, used aloneor in

combination

Hypersens

itivity,

bleeding

disorders

CNS: Drowsiness,

Sedation, headache,

fatigue, nightmares,

insomnia, mentalchanges, anxiety,

depression,

hallucinations, delirium

CV:Palpitations, ECG

abnormalities

GI: Nausea, Vomiting,

malaise, constipation,

dry mouth

ASSESS: Blood studies:

neutrophils, decreased

platelets.Renal studies: protein,

BUN, creatinine,

increased levels may

indicate nephritic

syndrome.

BP, pulse if used for

hypertension, reportsignificant changes.

Edema in feet legs

daily; monitor I&O;

check for falling outpu

Teach patient: Not to discontinu

drug abruptly o

withdrawal

symptoms ma

occur; increase

BP, pulse. Not to use OT

(cough, cold oallergy) produc

unless directed b

prescriber.



DRUGS ATION INDICATION CONTRAINDICATION

SIDE EFFECT NURSINGCONSIDERATION

LOSARTAN

+

HYDROCHL

OROTHIAZI

DE

Brand Name:

COZAAR

UROZIDE

CLASSIFICA

TION:

Antihypertens

ive

Dosage/Route

:50mg/12.5mg

tab OD

PO (1-0-0)

Blocks the

vasoconstrictor

and aldosterone-

secreting effects

of angiotensin II;

selectively blocks

the binding of

angiotensin II tothe AT1 receptor

found in tissues.

Acts on distal

tubule and

ascending limb of

loop of Henle by

increasing

exretions of

water, sodium,chloride,

potassium.

Hypertensio

n, alone or

in

combination

,nephropathy

in type 2

diabetes,hypertension

with left

ventricular

hypertrophy.

Edema,

hypertension

dieresis,

CHF,idiopathic

lower

axtremityedema

therapy.

Pregnancy 2nd

/3rd

trimesters,

hypersensitivity

Hypersensitivity

to thiazide or

sulfonamides,

anuria, renaldecompensatio.

CNS: Dizziness,insomnia, anxiety,

confusion,abnormal dreams,

migraine, tremor,

vertigo, headache.

CV: angina pectoris, 2nd

degree AV block

cerebrovascular

accident,hypotension,myocardial

infarction,dysrhythmias.

GI: Diarrhea,

dyspepsia,

anorexia,

constipation, drymouth, flatulence,

gastritis,

vomiting.

GU: impotence,nocturia, urinary

frequency, UTI,

renal failure.

HEMA: Anemia

ASSESS: BP with positio

changes, pulsenote rate, rhyth

quality

Electrolytes: K

Na,Cl

Skin turgor,dryness of muc

membrane for

hydration statu

Teach patient: To comply wit

dosage schedueven if feeling

better. To notify

prescriber of m

sores fever,

swelling of hanor feet, irregula

heartbeat, ches

pain. The drug may

cause dizzinessfainting; light-

headedness ma

occur.



Drug studyJuly 18, 2011

DRUGS ACTION INDICATION CONTRA-

INDICATION

ADVERSE

EFFECT

NURSING

CONSIDERATION

Furo-

semide

Brand

name: lasix

Classific

ation:

Loop

Diuretic

Dosage/Route:

40 mg IV

OD

Inhibits

reabsorptionof sodium

and chlorideat proximal

and distaltubule and I

the loop of Henle

Pulmonary

edema; edemain CHF,

hepaticdisease,

nephroticsyndrome,

ascites,hypertension

Hypercalcemi

a in malignancy,hypertensive

emergency/urgency

CNS:

Headache,fatigue, weakness

CV:Orthostatic

hypotension,chest pain,

circulatorycollapse

ENDO:Hyperglycemia

GU:

Renal failure, polyuriaHEMA:

Thrombocyto- penia,

leucopenia,anemia

Monitor blood

pressure lying,standing; postural

hypotension mayoccur

Assess signs of metabolic alkalosis:

drowsiness, restlessnessMonitor weight,

intake and output daily todetermine fluid loss,

Assess rate, depth

rhythm of respiration,effect of exertion, lungsounds

Monitor serumelectrolytes; Ca, Na



Drug study

July 18, 2011


INDICATION

ADVERSE

EFFECT

NURSING

CONSIDERATION

Amlodipine

Brand name: Norvasc

Classification:

AntianginalAnti

hypertensiveCalcium

channel blocker

Dosage/Route:

10g tab OD

decrease

cardiaccontractility

and the work

load of theheart thusdecreasing

the need for oxygen

Chronic

stable angina pectoris,

hypertension,

variant angina

Hypertension

(pediatric clients)

CNS:

Headache,fatigue,

dizziness,

depressionCV:Dysrythmia,

peripheraledema

GI: Nausea,

vomiting,diarrhea,

gastric upsetGU:

Nocturia, polyuria

Assess cardiac

status; B/P, pulse,respiration

Monitor I & O

and weight dailyAdminister without regard to

mealsAdvice to take

hazardous activitiesuntil stabilize on

product, dizziness isno longer problem



Drug study

July 18, 2011

DRUGS ACTION INDICATIO

N

CONTRA-

INDICATION

ADVERSE

EFFECT

NURSING

CONSIDERATIO

Simvastatin

Brand name:

Zocor

Classification

:

Antilipedemic

Dosage/Route

:

20g tab OD

Inhibits

HMG-CoAreductace, the

enzyme that

catalyzes thefirst step in thecholesterol

synthesis pathway,

resulting in adecrease serum

cholesterol,serum LDL¶s

and either anincrease in

serum HDL¶s

As an

adjunct in primary hiper

cholesterolem

ia,type IIIhyperlipoproteinemia

Pregnancy

(x),breastfeeding,

hypersensitivit

y, activehepatic disease

CNS:

headacheGI:

nausea,

constipation, liver dysfunction

RESP:upper respiratory

tract infection

INTEG:rash, pruritus,

photosensitivity

Assess 12-hour

fasting lipid profile:LDL, HDL

Advice to eat lo

cholesterol diet andexercise programAssess renal

studies in patients wcompromised renal

system: BUN, I & Oratio, creatinine



Drug studyJuly 18, 2011


INDICATION

ADVERSE

EFFECT

NURSING

CONSIDERATIO

N

Salbutamol

Classificatio

n:

Anti

asthmaticBeta2

selectiveadrenergic

agonist

Dosage/Rout

e:

Nebule 6o

Longacting agonist

that binds toBeta2 receptors

in the lungscausing

bronchodilation; also inhibits

release of inflammatory

mediators inthe lung,

blockingswelling and

inflammation

Maintenance therapy for

asthma and prevention of

bronchospasmin patients with

reversibleobstructive

airway diseaseincluding

nocturnalasthma. Long

termmaintenance

treatment of bronchospasm

related toCOPD.

Prevention of exercise

induced bronchospasm.

Contraindicated with

hypersensitivity tosalbutamol, acute

asthma attack,worsening or

deterioratingasthma (life

threatening) acuteairway

obstruction.

CNS:headache,

tremor,dizziness

CV:tachycardia,

palpitations,hypertension

Respirator y: worsening

of asthma,difficulty of

breathing, bronchospasm,

asthma relateddeaths( risk

higher in black than white

patients)Other:

pain

Documentindications for

therapy, onset,other agents use

and anticipatedtreatment period.

Should beused with caution

in patient withHPN and narrow ±

angle glaucomaContraindicate

d hyperthyroidismand uncontrolled

seizureMonitor BP



DRUGS ACTION INDICATION CONTRAINDICATION SIDE EFFECT NURSING

CONSEDIRATION

RAPID ACTING

INSULIN

Dosage/Route:

RAI 8units SC

now

Rapid-acting

insulin begins

working very

quickly inside

the body -

usually within 5

and 10 minutes.This type of

insulin should

be taken just

before or just

after eating. It

operates at

maximum

strength for

one to two

hours and

duration is

typically up to

four hours..Extra fast-

acting insulins

are very

convenient

because they

allow diabetic

patients to

inject

themselves just

when they eat.

Treatment

of Aspart

Insulins

Repaglinide is

contraindicated in

patients with a

known

hypersensitivity to

repaglinide, in

patients with type1 diabetes mellitus

(since repaglinide

is not effective in

the absence of

functioning beta-

cells) and in

diabetic

ketoacidosis as it

requires treatment

with insulin.

Repaglinide should

be used cautiously

in patients withimpaired hepatic

function.

Sinusitis, rhinitis,

bronchitis,

headache,

nausea, diarrhea,

constipation,

vomiting and

dyspepsia.Musculoskeletal

disorder back

pain may occur in

some patient.

Patients on

repaglinide

therapy can mis

or postpone a m

without increas

risk of

hypoglycemia ocompromising

glycogenic cont

Repaglinide whe

combined with

metformin has

shown better

glycogenic cont

in patients with

type 2 diabetes

mellitus.

DM Type 2 Case Pres

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