NURSING PROCESS FORMAT

Introduction to diabetes

Diabetes is the inability of the body to control the blood sugar level. High blood
sugar levels are known as hyperglycemia this is
controlled by the hormone insulin. So having diabetes means there is interference
with the creation and secretion of insulin. There
three types of diabetes

Type 1 diabetes

This first type of diabetes is known as Type 1 diabetes, what it means is that the
person
with it is insulin dependent mellitus or has juvenile diabetes. It can be called
juvenile
because of the age it is often acquired. It is not common to get Type 1 diabetes
when
you have past your mid 20's.

This type of diabetes is also known as autoimmune disorder. That means the body
destroys cells that produce the insulin the reason for this is that it thinks that
it is
harmful to the body. The cells are called the beta cells that are found in the
islet cells
and are found in the pancreas. When the insulin producing cells get destroyed
blood
sugar levels are not able to be regulated by the body so insulin has to be
injected into
the body to perform this function.

Type 2 diabetes

The second type of diabetes or Type 2 diabetes, which is sometimes also known as
adult onset diabetes, this is because it was commonly found to occur in later
life. It is
caused by insulin resistance. Beta cells in the pancreas continue to produce
insulin but
the body needs more insulin than secreted to process the glucose or the insulin is
less
effective in converting glucose into glycogen and thus reducing the blood sugar
level.

is not completely verified why Type 2 diabetes happens, being overweight seems to
be
common condition of most people that have Type 2 diabetes. There is a theory that
a
lifestyle of eating unhealthy foods with out taking regular or adequate exercise
could
contribute to causing this disease. it is also believed that type 2 diabetes can
be hereditary, although the most documented advice on avoiding

type 2 diabetes is to lose weight, eat healthily and do more exercise.

It
a
Symptoms for diabetes Type 2

It is important to be aware that you could have diabetes and diabetes related
problems without symptoms.

Type 3 diabetes

Third type of diabetes is Gestational diabetes this is acquired during pregnancy

and is the product of hormonal changes in the body during the
pregnancy stage and also hereditary genes. this type 3 diabetes usually stops
after childbirth.

CONCLUSION

The most common type of diabetes is type 2 diabetes it is estimated that 90% of
diabetics suffer the type 2 diabetes ailment. There is also more
information on how to avoid and prevent type 2 diabetes than any of the others.
Exercising more regularly and eating a healthy, balanced diet can
help considerably reduce the chances of getting diabetes. And if you have
diabetes, exercise and healthy eating can make it less intrusive to your
lifestyle.
I. Biographic Data
Name: E.R.
Address: Tatalon, Quezon City
Gender: Male
Religious Affiliation: Roman Catholic
Marital Status: Married
Room and Bed #: 216A Occupation: none
Chief Complaint: Wound in the right foot
Provisional Diagnosis: Gangrene of the big toe and distal plantar area �
Attending Physician: Dr. Nelson Dy / Emil dela Rosa

II. Nursing History

A. Past Health History
1.
Childhood Illness � None
2.
Immunizations -None
3.
Allergies -None
4.
Accidents -None
5. Hospitalizations
6.
Medications used or currently taken
Motillium tablet TID 8-1-6
FeSO4 capsule TID 8-1-6
Cefuroxime 500 g / tab BID 8-6
Aminobrane 1 capsule BID 8-6
7. Foreign Travel ( when, length of stay) � None
B.
History of Present Illness
Patient is a diagnosed case of DM Type II (2003), with irregular follow-up. Two
weeks PTA, patient noted a
wound on the � big toe. It was associated with on-and-off fever. No consultation
done. One week PTA, the
signs and symptoms persisted. Few hours PTA, patient was brought to the attending
physician who advised
admission.
C. Family History
D. 1987
father
heart
attack
D. 1983
mother
old
age
D. 1997
eldest
brother
kidney failure
1937
ET
Diabetes
71
1940
sister
HTN/
alive
67
1944
sister
HTN/
alive
63
1947
brother
TB/
alive
60
1939
wife
HTN/
alive
68
eldest daugther son
son asthma/ well/
well/alive alive alive
III. Patterns of Functioning
A. Psychological Health
1. Coping PatternsInterpretation: �Para sa akin, ang buhay ng tao ay di maaring
mawalan ng problema sa mga bagay na tulad
niyan, nasusubukan kung paano ka lalaban sa hamon ng buhay kaya ako tanggap lang
ako ng tanggap. kasi alam
kong di ito ibibigay ni God kung di ko naman kakayanin..may dahilan lahat ng bagay
kung bakit tayo ganito..sa
kalagayan ko ngayon�di maiiwasang mag-alala ako dahil ayaw ko ding maging isang
alalahanin para sa pamilya
ko�kaya talagang nagpapagaling ako�madalas nagadadasal ako hinihingi ko guidance
ni God para sa akin at sa
pamilya ko�ang pamilya ko ang sandigan ko sa lahat ng oras�minsan naman pag di ko
na kaya umiiyak ako,
pagkatapos nun nawawala na ang bigat na nararamdaman ko, tapos saka ako nag-iisip
ng paraan para mawala
ang iniisip kong problema.�
Analysis: Coping means dealing with problems and situations, or contending with
them successfully. A coping
strategy is an innate or acquired way of responding to a changing environment or
specific problem or situation.
According to Folkman and Lazarus (1991), coping is �the cognitive and behavioral
effort to manage specific
external and/or internal demands that are appraised as taxing or exceeding the
resources of the person.� Kozier p.
1020

Although stress is part of daily life, it is also highly individual; a situation

that to one person is a major stressor may
not affect another. Some methods to help reduce stress will be effective for one
person; other methods will be
appropriate for a different person. Therefore a nurse must be sensitive to
client�s needs and reactions; the
effectiveness of individual coping depends on the number, duration, and intensity
of the stressors; past
experience, support systems available; and the personal qualities of the person.

2. Interaction Patterns
Interpretation: �Maayos ang pakikitungo ko sa asawa ko at sa dalawang anak ko�pero
dun sa asawa ng isang
anak ko, yung manugnag kong babae, di ko tlaga makasundo kasi may ugali, di man
lang ako ginagalang
samantalang sa baahy ko sila nakatira tapos yung isang nak kong babae naman ayun
at iniwan yung anak niya sa
akin matapos syang mabuntis at iwanan ng ama ng anak niya�
Analysis: Nurses should pay special attention to how the members listen to one
another and encourage the
participation of the others. With the situation of our patient, they seem to not
communicate effectively that at times
they tend to jeopardize their standing in the family. The family members do not
support one another and do not
have the ability to listen, empathize, and reach out to one another in times of
crisis. When the needs of the family
members are met, they are more able to reach out to meet the needs of others in
society. Kozier p. 193
3. Cognitive PatternsInterpretation: �High school lang ang aking natapos. Kaya nga
pinipilit kong matapos ng aking mga apo ang
kanilang pag-aaral. Mahirap kasi pag di ka nakatapos�

Analysis: Pertaining to the mental processes of knowing, perceiving, or being

aware; an expression of
intellectual capacity. In the case of our patient, she is educated and finished
college; he does not know all the
indications of the medicines that he is taking, since he is a retired pharmacist.
That means that he does not
have knowledge on his current health situation, in particular with his medicines.
A patient with enough
knowledge with her health situation is better than those who do not know.
Collaborating with the nurse on what
she prefers on her treatment will help a lot in his restoration of wellness.

4. Self-conceptInterpretation: �Magmula kasi nung nagkasakit na ako, di ko na

magawa lahat ng dapat kong gawin, gaya ng
magmaneho, kasi dahil sa paa ko�

Analysis: Self-concept is one�s mental image of oneself. For our patient, he is

having a negative point of view
in his life. A positive self-concept is essential to a person�s mental and
physical health. Individuals with a
positive self-concept are better able to develop and maintain interpersonal
relationships and resist
psychological illness. Nurses have a responsibility not only to identify with
negative self-concept, but also to
identify the possible causes in order to help people develop a more positive view
of them. When individuals are
able to conceptualize their self, they begin a lifelong process of deciding
whether and to what extent they are
valuable. Kozier p. 970

5. Emotional Patterns
Interpretation: �Pinapagalitan ko yang mga apo ko pag di tama at pasaway sila,
nalulungkot lang din ako kasi
din a ako pinapansin ng mga kamag-anak ko magmula ng magkaskit ako��

Analysis: Emotions are natural phenomena and they are present in every individual
but they vary person to
person. Some people become emotional for everything and matters, some are
emotional on different matters
while there is a class of people who can very well hide their emotions and don�t
let others know about their
feelings and thoughts for that particular time and period. Emotions are the flow
of our inside. It is about the
internal feelings of our self. Our self is something which has a way to express
itself by the help of emotions.
Emotions are also under hormonal control and at times, a person fails to have
full-fledged control of emotions.
Some people are more emotional than others because they have this thing in their
nature. Their nature is like
this because of their high hormonal secretion. Another thing that makes some
people more emotional than
others is their inherited nature. Thus, a person has the ability to adapt to its
environment with his/her true
emotions.

6. Family Coping Patterns

Interpretation: �Kami ng asawa ko ang nagtutulungan para sa kakaayusan ng pamilya
namain, kasi nga mga
pasaway mga anak ko at apo..pati manungang ko may ugali na di mo malaman kung
ano�hinihiling ko lang
na sana tumagal pa buhay ko para sa kanila�

Analysis: Family coping mechanisms are the behaviors families use to deal with
stress or changes imposed
within or without. Coping mechanisms can be viewed as an active method of problem
solving developed to
meet life�s challenges. The success of the family largely depends on how will
copes with the stresses it
experiences. Kozier p 1023

B. Socio-cultural Patterns
1. Cultural Patterns/ Significant Relationships
Interpretation: �Mas gusto ko yung sama-sama kami ng mga anak ko sa iisang bahay
at ng yung negosyo
naming e sila din ang makikinabang, mahirap na kasi yung watak watak kami �

Analysis: The family is the basic unit of society. Cultural values can determine
communication within the family
group. The nurse needs to identify who has the authority to make decisions in a
client�s family. Cultural family
values may also dictate the extent of the family�s involvement in the hospitalized
client�s care. Kozier p. 212

2. Recreation Patterns
Interpretation: �Natutulog ako sa hapon at maaga din ako matulog sa gabi, pag
gusto naming magbakasyon
mag-anak pumupunta kaming probinsya, pero mas gusto sa bahay lang ako, wala pang
gastos. Sa bahay
naman, din a ako masyadong nagkikilos o gumagawa kasi ngayung paa ko. Mas gusto ko
din ng sariwang
hangin kaya gusto yung naglalakad sa labas tuwing umaga. Nagbabasketball din ako,
kasi sa tapat lang ng
bahay naming ang court. Kaya lang e di ko na gaanu ginagawa dahil mabilis akong
mapagod.�

Analysis: Rest and sleep are essential for health. People who are ill frequently
require more rest and sleep
than usual. Often debilitated people expend excessive amounts of energy to regain
health or perform the
activities of daily living. Rest restores a person�s energy, allowing the
individual to resume optimal functioning.
Rest implies calmness, relaxation without emotional stress, and freedom from
anxiety. Therefore, rest does not
always imply inactivity: in fact, some people find certain activities such as
walking in fresh air restful. When rest
is prescribed for a client, both nurse and client must know whether that
inactivity involves the whole body or a
body part (e. g. an arm) Kozier, 1114

3. Environment
Interpretation: �Dito sa hospital ayos naman kasi tahimik at maayos ang
pakikitungo ng mag tao sa amin�

Analysis: Environment affects the individual�s health, so as nurse we need to

manipulate the environment for a
patient in a hospital, because they are not in their comfort zone (home), so there
is a tendency that patient
might be shy and will not feel comfortable, making the patient feel comfortable,
can help a lot in her health
condition.

4. Economic
Interpretation: �Sapat naman ang pinapadala sa akin ng aking anak sa abroad,
nakakkatulong na iyon sa aking
pamumuhay at sa bayad ko sa gamot at sa hospital at may pension din naman ako.�

Analysis: A patient who was hospitalized might be in an anxious state if their

financial capacity is inadequate to
help them restore their health.

C. Spiritual Patterns
1. Religious Beliefs and Practices/ Values and Valuing
Interpretation: �Ako e di palasimba, pwede naman akong magdasal kahit saan, e yung
mga lage nagsisismba,
pakitang tao lang yan, paglabas naman nila ng simbahan kung anu-ano masasama ang
sinasabi nila�

Analysis: In holistic nursing, the nurse provides care not only for the physical
body and mind but also for the
client�s spirit. Meeting the client�s spiritual needs can decrease suffering and
aid in physical and mental
healing. Because involvement in the meeting of spiritual needs is personal for
both the nurse and the client,
nurses need to communicate with sensitivity and empathy and to have a food
understanding of their own
values. A client�s experience of what is divine is complex and individual. Nursing
interventions that promote
spiritual well-being include offering one�s presence, supporting the client�s
religious practices and praying with
a client. Kozier 907-1000
IV. Activities of Daily Living
ADL Before Hospitalization During Hospitalization Interpretation and Analysis
1. Nutrition He is eating what he likes, like
fish, vegetables, sinigang na
baboy, drinking alcohol.
DAT as tolerated, but was
advised to eat 2 white eggs.
The body breaks down different
types of foods at different rates.
Carbohydrates (be it potato or
table sugar) typically take from five
minutes to three hours to digest,
whereas protein (like egg) takes
three to six hours and fat can take
eight or more hours. That's why
different foods have different
effects on blood sugar, such as
why ice cream (higher in fat)
raises blood sugar levels more
slowly than potatoes. But people
with diabetes don�t always have to
forgo desserts and sweets. They
just have to be sure not to eat
moderate amounts more than
once or twice a week. Reaching
and maintaining a healthy weight
is important for everyone with
diabetes. Weight control is
extremely important in treating
type 2 diabetes because extra
body fat makes it difficult for
people with type 2 diabetes to
make and use their own insulin.
2. Elimination Usual bowel time pattern is
every evening. The character of
stool is firm/brown without
bleeding. No urinary problem,
the character of urine is pale
yellow.
Because of intake and output
monitoring the patient�s intake
for an 8-hour shift is 750 t0 960
ml and his output is 240-350 ml.
The patient has no elimination
problem.
3. Exercise Likes walking every morning,
playing basketball.
Do not have time to do much,
because he is too tired most of
the time, feeling weak after each
Because of amputation of the
right great big toe, the patient
limited himself to his daily
exercise. routine.
4. Hygiene He is independent in all areas
and prefers to take a bath every
10 am.
Short cut hair, clean, shaven.
Hands are rough and dry, scalp
and eyebrows are with scaly
white patches, but his right foot,
the great big toe was amputated
and it was wrapped with a plastic
bag. He needs assistance for his
wound care
The patient can do self-care
activities alone. But now needs
assistance for his wound care.
5. Sleep and Rest He can sleep early and wake up
early.
Does not have any sleeping
disturbance pattern.
Do not have problems with his
sleeping pattern.

V. Physical Assessment
General Appearance Norms Actual Findings Interpretation and Analysis
1. Posture/Gait Relaxed, erect posture;
coordinated movement
Slouched, and in bent posture. Poor posture distorts the body�s
proper vertical alignment and the
back�s natural curves. If you have
poor posture, your bones are not
properly aligned, and your
muscles, joints, and ligaments
take more strain than nature
intended. Faulty posture may
cause you fatigue, muscular
strain, and, in later stages, pain.
Many individuals with chronic back
pain can trace their problems to
years of faulty postural habits. In
addition, poor posture can affect
the position and function of your
vital organs, particularly those in
the abdominal region.
2. Skin Color Healthy appearance Pallor and weak in appearance Due to patient�s
present health
condition he is experiencing
weakness and this is one of the
signs and symptoms of diabetes
3. Personal Hygiene/Grooming
Clean, neat

Unkempt

4. Nutritional Status
Proportionate, varies with lifestyle

Excessively thin

5. Age Appropriateness
Adult age 71 years old

6. Verbal Behavior
Understandable, moderate pace;

Understandable, exhibits thought

exhibits thought associations

associations

7. Non-verbal Behavior
Cooperative, no distress noted

Cooperative, no distress noted

mellitus II.

Personal grooming includes

activities such as showering,
dressing, toileting and attention to
personal presentation, such as
brushing hair, applying makeup
etc. due to his present condition
the patient is unable to undertake
personal grooming because of
underlying causes of diabetes, like
muscle weakness, easy
fatigability.

Due to his diabetes the patient

experiences polyphagia,
polydipsia, and polyuria, because
of this there is variation to his
nutritional status.

Genetic makeup influences

biologic characteristics, innate
temperament, activity level, and
intellectual potential. It has been
related to susceptibility to specific
disease, such as diabetes. The
distribution of disease. Certain
acquired and genetic diseases are
common in middle-aged males.
No abnormalities found

No abnormalities noted
Measurements
1. Temperature 36.5 � 37.5 37.1 C Normal
2. Pulse Rate 60 � 120 bpm 73 bpm Normal
3. Respiratory Rate 14 � 24 bpm 23 bpm Normal
4. Blood Pressure 120/70 mmHg 110/70 mmHg Normal
5. Weight 45 kg
6. Height 153 cm

Body Part Norms Actual Findings Interpretation and Analysis

Hair White, fine,
Face
Oval in shape, symmetrical, facial
expression is dependent on the
mood or true feelings, uneven with
wrinkles, no involuntary muscle
movements
Eyes Parallel and evenly placed,
symmetrical, non-protruding, with
scant amount of secretions, both
eyes black but patient does not
have clear vision, slowed blink
reflex
Eyebrows Black symmetrical, parallel to
each other
Eyelashes Black evenly distributed and
turned outward
Eyelids
Upper eyelids cover a small
portion of the iris and the cornea
and the sclera when the eyes are
open. When the eyes are closed,
the lids meet completely.
Symmetrical in color is the same
as the surrounding skin.
Looseness of the eyelids.
No palpable mass
Lid Margins
Clear without scalings, lacrimal
duct are evident at the nasal ends
of the upper and lower lids
Sclera White but not that clear
Iris Proportional to the size of the
eyes, round, black and
symmetrical
Eye Movement Not able to move eyes in full
range of motion and not able to
move in all directions
Ears
Parallel, symmetrical, proportional
to the size of the head, bean-
shaped, is in line with the outer
canthus of the eye, skin is same in
color as the surrounding area
Firm cartilage
Ear Canal Pinkish, with scant amount of
cerumen and few cilia
Hearing Acuity Not able to hear spoken words,
you need to louder you voice and
repeat it again
Nose Midline, symmetrical,
Mouth (lips) Pinkish, symmetrical, lip margin
well defined, uneven and dry
Gums Pinkish, smooth, moist no
swelling, no discharge
Teeth Has denture and 1 tooth
Tongue Medium, pink, slight rough on top,
smooth along lateral margins,
moist but not freely movable
Neck Proportional to the size of the
head, symmetrical
Presence of internal jugular
vascular access(temporarily used
for hemodialysis), presence of
blister
Neck (ROM) Not freely movable
Thorax and Lungs No lumps, masses, areas of
tenderness
Has difficulty in breathing
Heart The heart sounds are audible at
apical area, cardiac rate is 72
Abdomen
Blemished skin, flat, symmetrical
movements caused by respiration,
umbilicus is flat and positioned
midway between the xiphoid
process and the symphisis pubis,
color is the same as the
surrounding skin
Borborygmi sounds, �stomach
growling� heard
No tenderness, no lumps or
masses
Upper Extremities
Arms
Dark skin, symmetrical, fine hair
evenly distributed, presence of
visible veins, presence of vascular
access for hemodialysis on the
left arm.
Warm, dry, non-elastic, no areas
of tenderness, poor muscle tone
Palms and Dorsal Surfaces Non-elastic, dry and saggy
Nails Five fingers in each hand, brittle
Shoulders Has slight difficulty raising arms to
vertical position
Arms Has slight difficulty to abduct,
adduct, and rotate arms(internal
and external)
Elbows Bend and straighten elbows with
slight difficulty
Hands and Wrists Extend and spread fingers
Lower Extremities
Legs
Fine hair evenly distributed,
presence of varicose veins,
presence of edema
Poor muscle tone
ROM Difficulty in performing ROM
VI. Laboratory and Diagnostic Examination Results
Date Procedure Norms Result Interpretation and
Analysis
04/15/08
7:30am
Capillary Blood
Glucose
80.00 � 110.00 mg/dl 128.00 mg/dl High
04/14/08 Capillary Blood
Glucose
80.00 � 110.00 mg/dl 150.00 mg/dl High
04/13/08 Capillary Blood
Glucose
80.00 � 110.00 mg/dl 442.00 mg/dl High
04/14/08 AST/RBS/CBG 80.00-110.00 mg/dl 423.00 mg/dl High
04/13/08 AST/RBS/CBG 80.00-110.00 mg/dl 335.00 mg/dl High
04/12/08 AST/RBS/CBG 80.00-110.00 mg/dl 196.00 mg/dl High
04/03/08 RBS/CBG 80-120.00 mg/dl 162 mg/dl High
04/02/08 RBS/CBG 80-120.00 mg/dl 123 mg/dl High
Generic/
trade
name
Dosage/Freque
ncy
Classification Indication Contarindication Side Effects Nursing
Responsibility
Humulin-N 10 units 6am, AC Hormonal drug Control .
contraindicat GI: dry mouth .
Don�t use insulin
Isophane 5 units 6pm PC hyperglycemia in ed during Metabolic: that changes
insulin patients with type II episodes of hyperglycemia color or becomes
suspension diabetes hypoglycemia clumped or
granular in
appearance
.
Make sure that
the pt knows that
the drug relieves
symptoms but
doesn�t cure
disease
.
Instruct pt about
the dse. and
importance of
following
therapeutic
regimen,
adhering to
specific diet,
losing weight,
getting exercise,
following
personal hygiene
program, and
avoiding
infection.
.
Teach pt that
glucose level and
urine ketone test
provide essential
guides to dosage
and success of
the therapy. It�s
impt to pt to
recognize
symptoms of high
and low glucose
levels.
.
Advise pt not to
smoke within 30
minutes after
insulin injection
bec. Smoking
decreases
amount of insulin
absorbed by
subcutaneous
route.
VIII. Anatomy and Physiology
Pancreas

The islets of Langerhans are destroyed in type I diabetes mellitus. This occurs
probably as a consequence of a genetic susceptibility,
followed by the onset of autoimmune destruction triggered by some environmental
factor such as a viral infection. Heavy lymphocytic
infiltrates appear in and around islets. The number and size of islets are
eventually reduced, leading to decreased insulin production
and glucose intolerance.

The islets of Langerhans are normal in number or somewhat reduced with type II
diabetes mellitus. Fibrosis and deposition of amylin
polypeptide within islets are most characteristic of the chronic states of type II
diabetes.
IX. Pathophysiology/ Schematic Diagram of the Disease
X. Ecologic Model
A. Hypothesis
There is no significant relationship between the

B. Predisposing Factors
1. Host
a.
Age � 71 years old
b.
Sex � Male
c.
Race � Asian
d. Nationality - Filipino
e.
Behavior � Likes to drink a lot before but now he lessens his drinking habits due
to his present health
condition. He likes to play basketball before but now he limits himself in going
to basketball court because
he gets tired easily.
f.
Customs � He wants his family members to live near by him and wants some respect
from his children,
grandchildren, and daughter-in-law.
g. Heredity
2. Agent
a. Mechanical
b. Physical
c. Chemical
3. Environment
a. Physical
b. Biologic
c. Socio-economic
C. Ecologic Model
D. Analysis ( with Reference)
E. Conclusion and Recommendations
XI. Prioritized List Nursing Problem
Date Nursing Problems Identified Cues Justification
April 16, 2008 Altered Nutrition less than body
requirements related to
insufficient intake to meet
metabolic demands as
manifested by verbalized
dietary concern
.
verbalized dietary
concern
.
weight under normal
.
loss of weight with
adequate food intake
.
poor muscle tone
The state in which an individual
experiences an intake of
nutrients insufficient to meet
metabolic needs. As a
physiologic need an adequate
intake of balance nutrients:
water, carbohydrates, proteins,
fats, vitamins, and minerals.
Nutrients have 3 major
functions: providing energy for
body processes and
movement, providing structural
material for body tissues, and
regulating body processes.
April 16, 2008 High risk for infection related to
poor wound healing as
manifested by gangrenous foot
.
Poor wound healing Clients with diabetes are
susceptible to infections of
many types. Once infection
occur, it is difficult to treat.
Because diabetes mellitus is
chronic, nursing intervention
focuses on teaching the client
and family how to manage the
disorder on a day-to-day basis
and how to assess
complications.
April 17, 2008 Knowledge deficit regarding
disease process related to
development of preventable
complications
.
Lack of exposure
.
Unfamiliarity of
information resources
.
Cognitive limitation
This is a state where an
individual lacks specific
information necessary to make
choices regarding
condition/therapies/treatment.

XII. Nursing Care Plan

Nursing Problem
Cues
Analysis Goal/Objectives Nursing
Interventions
Rationale Evaluation

Discharge Plan

M � Continue oral meds:

.
Ferrous SO4 1 cap 3x a day for 1 month take capsules with juice (preferably orange
juice) or water, but not with milk or
antacids.
.
Cefuroxime axetil 500 mg tab, 1 tab 2x/day Instruct patient to take oral form with
food
occur,
throat,
(or at
.
Clinadamycin 600 mg IV TID 8-2-8 notify prescriber if adverse reactions
especially nausea, vomiting, diarrhea, fever, confusion, sore
or mouth sore.

E - Any physical activity is exercise. Choose an enjoyable activity that suits

your
lifestyle. Start with low level exercise and build up. It does not matter what it
is e.g.
walking, cycling, jogging, golf, tennis, swimming gardening etc. Exercise with a
friend/s or join a club, it will help keep you motivated. Look out for other ways
to
increase your activity. For example, use the stairs, throw the remote to the TV
away
least hide it).

Three kinds of activity can help. You can

1. Be extra active every day

�
Walk around while you talk on the phone.
�
Play with the kids.
�
Take the dog for a walk.
�
Get up to change the TV channel instead of using the remote control.
�
Work in the garden or rake leaves.
�
Clean the house.
�
Wash the car.
�
Stretch out your chores. For example, make two trips to take the laundry
downstairs instead of one.
�
Park at the far end of the shopping center parking lot and walk to the store.
�
At the grocery store, walk down every aisle.
�
At work, walk over to see a co-worker instead of calling or emailing.
�
Take the stairs instead of the elevator.
2. Do aerobic exercise
�
walking briskly
�
hiking
�
climbing stairs
�
swimming or taking a water-aerobics class
�
dancing
�
riding a bicycle outdoors or a stationary bicycle indoors
�
taking an aerobics class
�
playing basketball, volleyball, or other sports
3. Do strength training
Doing exercises with hand weights, elastic bands, or weight machines three times a
week builds
muscle. When you have more muscle and less fat, you�ll burn more calories because
muscle burns
more calories than fat, even between exercise sessions. Strength training can help
make daily
chores easier, improving your balance and coordination, as well as your bones�
health.

T - By regularly checking for diabetic complications, they can be diagnosed and

treated at an earlier stage before serious
damage has occurred. This is why it is important to have:

�
Regular eye checks
�
Regular foot care
�
Regular blood pressure checks
�
Blood tests for glucose and to check your longer term glucose control
�
Blood and urine tests looking for kidney damage.
�
Make sure you exercise in cotton socks and comfortable, well-fitting
shoes designed for the activity you are doing. After you exercise, check
your feet for cuts, sores, bumps, or redness. Call your doctor if any foot
problems develop.
H �
Eat healthy food
Exercise daily
Don�t smoke
Monitor your blood sugar regularly. Adjustments in diet, medication and exercise
can be made accordingly.
Stick to the monitoring protocol prescribed by your doctor. Generally, blood is
monitored before meals and at bedtime.
Take your medication as prescribed, whether it is insulin or an oral drug.

O -
If you're having trouble managing your blood sugar or you have diabetes-related
complications, you may need to see your
doctor every few weeks or months. If you're in good health and keeping your blood
sugar within your target range, you may
need to see your doctor only twice a year.In addition to routine diabetes
checkups, your doctor may recommend visits with a
registered dietitian or a diabetes nurse educator � a registered nurse with
special certification in diabetes care � to discuss
your meal plan or blood sugar monitoring. You might also need checkups with an eye
specialist (ophthalmologist or
optometrist) or a foot specialist (podiatrist).

D -
To create a healthy meal plan you should do the following:

� Eat a variety of foods as recommended in the Diabetes Food Pyramid to get a

balanced intake of the nutrients your
body needs - carbohydrates, proteins, fats, vitamins, and minerals.
� Make changes gradually because it takes time to accomplish lasting goals.
� Reduce the amount of fat you eat by choosing fewer high-fat foods and cooking
with less fat.
� Eat more fiber by eating at least 5 servings of fruits and vegetables every day.

� Eat fewer foods that are high in sugar like fruit juices, fruit-flavored drinks,
sodas, and tea or coffee sweetened with
sugar.
� Use less salt in cooking and at the table. Eat fewer foods that are high
in salt, like canned and packaged soups, pickles, and processed
meats.
� Eat smaller portions and never skip meals.
� Learn about the right serving sizes for you.
� Learn how to read food labels.
� Limit use of alcohol.
� Grains, Beans, and Starchy Vegetables: (good source of B vitamins and fiber) 6
or
more servings/day
� Fruits: (contain vitamins C, A, potassium, folate, and fiber) 3-4 servings/day
� Vegetables: (provide vitamins A, C, folate, and fiber) 3-5 servings/day
� Milk: (source of calcium, protein, vitamins A and D) 2-3 servings/day
� Meats and Others: (good source of iron, zinc, B vitamins, and protein) 2-3
servings/day
� Fats, Sweets, and Alcohol: The foods at the tip of the pyramid should be eaten
in small amounts. Fats and oils should be limited
because they are high in calories. Sweets are high in sugar and should only be
eaten once in a while.
S � Always seek spiritual advice, do some retreat, and start going to Sunday mass.