St.

Dominic College of Arts and Sciences
Emilio Aguinaldo Highway, Talaba IV, Bacoor, Cavite

College of Nursing

A Case Study

Diabetes Mellitus Type II
“The Weakest Link”
Presented by:
Group 1 Agcaoili, Jenalyn Aranzaso, Christian Columna, Liezel Cueno, Caroline Hierco, Rica Bianca Legayada, Mary Jerah Manigsaca, Melizen Paraiso, Joanna Romeo, Norely Romero, Jelica Turla, Jordina

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I. Health history A. Demographic profile             Name: R.G Gender: Male Age: 41 years old Birth date: September 23, 1967 Birth place: Pasig , Metro Manila Marital status: Married Nationality: Filipino Religion: Born Again- Christian Address: Brgy. Pantihan 3, Maragondon, Cavite Educational background: High school graduate Occupation: Factory worker in Monterey Usual source of medical care: Doctor/Healthcare Professional

B. Source and reliability of information  The patient R.G is the primary source of information. He is conscious and

coherent, able to speak Tagalog fluently. His wife is also considered as source of information regarding patient status and condition. C. Reasons for seeking care or chief complaint (Top 3)    1st – Loss of his weight 2nd – Insufficient sleep at night 3rd – Scaly of skin

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D. History of present illness Patient R.G was handled during our duty at Brgy. Pantihan 3, Maragondon,,Cavite with the chief complaint of insufficient sleep at night, loss of his weight and scaly of skin. The laboratory test and special treatment for the patient are not applicable because this case is base on community setting. E. PAST MEDICAL HISTORY OR PAST HEALTH • Pediatric/childhood -Incomplete immunization- (-) serious illness on this stage • Injuries or accidents -1992, right leg accident due to mishandling of machine • Serious or chronic illness -December 2003, Diabetes Mellitus diagnosed clinically -2x FBS result 300mg/dl -2006 Pulmonary Tuberculosis, diagnosed clinically -Chest X-ray and sputum AFB examination -2007 Urinary Tract Infections -Urinalysis (pyuria) • Hospitalization -1992, Water Rose General Hospital Admitting diagnosis: Right leg machine accident

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Metro Manila Admitting diagnosis: Diabetes Mellitus Type 2 • Operation -not applicable • Obstetric History -not applicable • Immunizations -incomplete immunization (unrecalled) • Allergies -No known allergies to food and medication • Medication -Metformin 500mg/tab 1 tab TID p. Manila 4 . -Gliclezide 80mg/tab 1 tab OD a. Rizal Medical Center.c. Pasig City.c.-December 2003. Taft Avenue. Philippine General Hospital. -Vitamin B Complex tablet 1 tab OD -Alaxan 500mg/tab (Paracetamol + Ibuprofen) 1 tab PRN for fever and pain • Last Examination Date -July 2007 (OPD case).

F. FAMILY HISTORY (+) DM 55 y/o (+) 83 y/o (+) HPN CVA 39 y/o 38 y/o 37 y/o 41 y/o (+) DM 37y/o LEGEND: Female Male Patient 16 y/o 15 y/o 1 3 y/ o 1 1 y/ o 9 y/o 2 y/ o Deceased 5 .

His wife is selling and making barbeque sticks as the source of their income while his 16 years old son works as a vendor in a wet market at Dasmarinas. As to our patient. They also received financial support from their relatives in Pasig. which led him to be non-productive. the “deadline decade”. SOCIO-ECONOMIC STATUS Mr. Maragondon. Being non-productive led him to be stagnant after the occurrence and diagnosis of his disease which made him to be dependent with his family. They can be measured up as to poor class family. DEVELOPMENTAL HISTORY Generativity vs Stagnation Maturity (35-45 yrs old) A person may experience midlife crisis between the ages of 35-45 years old. who belongs to a middle age group and is suffering from a lifethreatening condition. he had experienced this developmental crisis. This occurs when the individual recognizes that he has reached the halfway mark of life and according to Erik Erikson. R. H.G. Cavite as additional source of income. Stagnation. lives in their own house at Pantihan 3. a husband and as part of the community. 6 . The patient is occasionally drinker of alcohol and cigarette smoking. he can’t attend. the developmental task of the middle-aged adult is Generativity vs.G. Cavite. function and be able to accomplish his responsibilities as a father.

I. REVIEW OF SYSTEMS AND PHYSICAL EXAMINATION Subjective General “Ito nangangayat na dahil sa sakit ko” as verbalized by the patient. evenly distributed (+)itchy scalp (scratching) (+)Oily hair Nails: (+)itchiness (upper extremities) (+)scaly skin (-)history of skin disease Temp. – 36. (+) numbness at times(lower extremities) (+)excessive sweats. pero ang braso. Thinning of hair. (+) wt. (July 10. axilla (+)weakness (-)malaise (-)chills (-)fever BP.130/80 Integument Skin: “Hindi makati sa binti. Hair: “Dati malago ang buhok ko” as verbalized by the patient. 2009) 87 kg. nangangati” as verbalized by the patient. (December 2003) Objective 7 .5 °C Weight: 35 kg. loss 48kg.

“Ito matigas na ang kuko ko kumpara dati” as verbalized by the patient. (+)clubbing of nails (long nails) (+)Yellowish nail beds Amount of sun exposure: Exposure to sunlight every morning Head: “Sumasakit ang ulo ko na parang tinutusok” as verbalized by the patient. (+)difficulty in swallowing (+)lesions on tongue (+)dental carries (+)hoarseness of voice Pink tonsils 8 . (+)blurry vision (+)PERRLA (+)Anicteric sclera (+)Pale conjunctiva (+)itchiness (-)discharge Ears: “Malinaw pa naman ang pandinig ko. pero may sumasakit minsan” as verbalized by the patient. Both ears hears well when the examiner is 3 feet away (-)cerumen (-)discharge (+)frequent headache (+)dizziness (-) lumps Mouth and Throat: “Medyo hirap akong lumunok” as verbalized by the patient. Eyes: “Malabo na ang paningin ko” as verbalized by the patient.

RR – 28 bpm (+)difficulty of breathing (+)barrel chest Productive cough History of lung disease: pneumonia. axilla (-)lump (-)pain (-)rash (-)nipple discharge Respiratory: “Medyo nahihirapan akong huminga” as verbalized by the patient.minsan sumasakit (+)chest pain 9 . PTB. 2006 Last chest x-ray: 2007 Cardiovascular Central: “Paminsan. (-)stiffness (-)pain (+)palpable bilateral lymphs Breasts and Axillae: “Pawisin ang kilikili ko” as verbalized by the patient.(-)bleeding gums (+) gag reflex Neck: “Wala naming problema sa leeg ko” as verbalized by the patient. (+)excessive sweating.

(+)dyspnea on exertion (bed to chair) (+)nocturia Peripheral: (+)coldness(general) (+)pallor in hands (+)clubbing of nails (+)tingling (sole of feet) (-)numbness (-)varicose veins (-)ulcers 0-1 second. capillary refill Gastrointestinal: “Eto madalas magan ako kumain” as verbalized by the patient.ang dibdib ko” as verbalized by the patient. (+)good appetite Food intake tolerated (+)minimal dysphagia (-)hematemesis Frequency of BM: 3x a week Characteristic of stool: yellowishbrown in color. (+)polyuria (+)dysuria 10 . formed in consistency (+)constipation (arch and formed stool) (-)hemorrhoids Urinary: “Ihi ako ng ihi” as verbalized by the patient.

leg muscles Neurologic: “Alam ko pa naman ang mga sinasabi ko ngayon” as verbalized by the patient. radiating (+)weakness. fainting Mental: (-)nervousness (+)depression Self-pity and crying Motor function: (-)tremors (-)paralysis Sensory function: Oriented to time. stroke. calf area (+)lower back pain.wala naman akong sakit sa dugo” as verbalized by the patient. knee area and ankle (+)pain. (-)history of seizure. (-)bruises (+)palpable lymph nodes (+)bleeding tendency of skin (scaly 11 . person and place Hematologic: “Pagkakaalam ko. (+)minimal pain.(+)nocturia Dark Yellow in color History of urinary disease: UTI(2006) Genitalia: Refused Musculoskeletal: “Kumikirot ang kasukasuan at buto-buto ko” as verbalized by the patient.

VI. V. III. kaya ako merong Diabetes” as verbalized by the patient. FUNCTIONAL ASSESSMENT 12 . IV. scaly skin (+)excessive sweating. IX. XI. X. XII. axilla (-)nervousness (-)tremors Cranial Nerves Assessment I. VII. (+)DM. Olfactory Nerve Optic Nerve Oculomotor Trochlear Abducens Trigeminal Facial Acoustic Glossopharyngeal Vagus Spinal Accessory Hypoglossal Normal Blurry vision Normal Normal Normal Normal Normal Normal Normal Normal Normal Normal J.skin) (-)history of Blood Transfusion Endocrine: “Sa pamilya naming may Diabetes. VIII. II. type II (+)polydypsia (+)polyuria (+)polyphagia (+)weight loss (+)change in skin texture.

exercise and religiously taking of prescribed medication or what nurse’s and Doctor’s advise/suggest will keep him healthy. R. Occasionally. result is increased 300mg/dl) he was diagnosed of DM type 2. R. The client possessed a jolly and fun loving type of personality. II. Self Concept/Self Perception Pattern Before he was diagnosed with DM type 2. Health Perception/Health Management Pattern Mr. he also had colds in the past. Mr. after a consultation from a physician and with accompanying lab result of blood sugar level (2x done. he felt self-pity and worthless. is a 41 yrs old. is a responsible husband and father to his wife and kids.I. R. Self Esteem. Last December 2003. eating nutritious food. Once he felt something wrong about his condition. most of the time.G. he seeks for medical advice. this regimen was not taken into consideration. III. Because of his condition he became more depress and the only thing that gave him hope and strength is through prayer.G. He was able to provide the needs of his family. According to Mr. male and seriously ill person. Since his illness started. The client believes that he acquired his illness from his grandfather who also had Diabetes Mellitus. Activity-Exercise Pattern Perceived ability for: (Refer to Functional Level Code) Feeding Bathing Toileting Bed Mobility Dressing Level II Level II Level II Level II Level II Grooming General Mobility Cooking House Maintenance Shopping Level II Level II Level IV Level IV Level IV 13 .G.. Due to financial incapacity. He is always irritable and angry when he thinks that he was ignored.

On the other hand he noted that he frequently void with dark yellow in color urine and felt some discomfort when urinating.Functional Level Code Level 0 Level I Level II Level III Level IV Full Self Care Requires Use of Equipment or Device Requires Assistance or Supervision from Another Person Requires Assistance or Supervision from Another Person and device Is Dependent and Does Not Participate IV. He said sometimes the pain he felt put him into sleep. Patient stated that prior to his illness he weighted 87kgs but at present he weighs 39kgs. During the day patient is experiencing excessive sweating in his armpit. Sexually. He typically drinks more than an 8 glasses of water per day. VI. V. Sleep/Rest Pattern The patient had altered sleep pattern. with hard formed in consistency. We noticed that the patient skin is scaly all over his body. He has supplements of vitamin Bcomplex. Each day he only had a maximum of 2 hours of sleep and despite of that he still fells god upon waking up. Interpersonal Relationship / Resources 14 . Nutritional/ Elimination The patient usually takes a glass of milk in his breakfast and he takes heavy meals more frequently but after eating he usually felt stomach ache.Reproductive Pattern The patient is inactive in sexual intercourse due to present condition VII. He also have lesion in his tongue and positive dental carries. The patient usually had 3x bowel movement per week with a dark yellowish brown color stool.

Values-Belief Pattern Patient R.G is anxious he wants to be alone. When it comes to problem.Patient can speak and understand English and Tagalog. now that he is battling with his disease. Religious effort is still a part of patient R. he tried to calm himself through prayers. VIII. When he was diagnosed of DM Type 2 there have been many changes occurred that made difficult for him to adjust. He has 6 children and they were close to each other. patient R. According to the patient there are many practices affects his illness. 15 . he prefers to cry until he falls asleep. IX. Coping and Stress Tolerance Before when patient R.G’s family was very supportive and understanding.G is a Born Again Christian. when he is stressed. before according to the client he always hears mass every Sunday with his family. He cannot perform the usual activities that he had before. After what happened. Due to his illness he wasn’t able to go to mass.G is stressed. He wasn’t able to follow therapeutic regimen due to financial problem and a strong faith to God helps him to get through all the suffering he has. Patient R. Before patient is very active and usually socializes with his neighbors.G. he prefers to drink liquor and involved himself in gambling. He can clearly express himself.’s life. The patient is dependent due to his illness. When patient R.G is still not seeking for medical assistance due to financial problem.

Personal Habits Before. used to maintain a good personal hygiene and had a diet without restriction.G Gender: Male Age: 41 years old Marital status: Married Religion: Born Again-Christian Occupation: Factory worker in Monterey Educational Background: High 3. He used to work as a factory worker 6 days per week and was able to help in doing household chores when he got home. Activity intolerance related to generalized weakness 16 . At present. Every Sunday he goes to mass with his family and occasionally at his free time he drinks and smoke with his friends. patient R.X.G wasn’t able to perform his usual routine. Concept Map 1. Imbalanced nutrition: less than body requirements related to deficient insulin Demographic Profile: Name: R.G. patient R. He had to stopped from working in able to attend his health needs and become dependent to his family. due to his illness. He had a good sleep pattern of almost 8 hours at night. XI.

Risk for infection related to inadequate primary defense 4. PROBLEM LIST 1. Disturbed sleep pattern related to prolonged discomfort secondary to disease process 5. Activity Intolerance 5. Impaired Skin Integrity 4.2. Disturbed Sleep Pattern 3. Impaired skin integrity related to impaired metabolic state II. Imbalanced Nutrition Less than body requirements 2. Risk for Infection 17 .

The nervous and endocrine system are two major systems responsible for that regulation. 1 Problem Risk for infection Date Identified July 09. 2009 Client appetite was increase.) ACTUAL OR ACTIVE PROBLEM Problem No.) High Risk or Potential Problem No. 2009 The client can sleep now from 4-6 hours unlike before.III. 2009 July 09. 2009 July 16. 2009 IV. 2009 July 16. 2009 Date Resolved Remarks July 16. 2009 July 09. NURSING CARE PLAN ( At The Last Page) V. 1 Problem Imbalanced Nutrition Less than body 2 requirements Disturbed Sleep Pattern Impaired Skin 3 4 Integrity Activity Intolerance July 09. ANATOMY AND PHYSIOLOGY ENDOCRINE SYSTEM Homeostasis depends on the precise regulation of the organ and organ systems of the body. 2009 July 16. When these system 18 . The wound is clean and dry. A. B. Together they regulate and coordinate the activity of nearly all other body structures. The client able to perform some minimal ADL Date Identified July 09.

The nervous system controls the activity of tissues by sending action potentials along axons. and the rate of the metabolism of many tissues. which helps maintain a normal body temperature and normal mental function. such as bone and muslces. Maturation of tissues. which release chemical signals at their ends. homeostasis is not maintained. It regulates the heart rate and blood pressure and helps prepare the body for physical activity. In general. potassium and calcium concentrations in the blood. The cell that can detect those chemical signal produce reponses. are also influence by the endocrine system. Failure ofsome component of the endocrine system to function can result in disease such as Diabetes Mellitus or Addison’s disease. whichh carries to all parts of the body. near the cell they control. • • It regulaytes sodium. The endocrine system releases chemical signals into the circulatory sytem. whereas the endocrine system usually response more slowly and has longer-lasting effects. The regulatory function of the nervous system and endocrine systems are similar in some respects. It regulates uterine contractions during delivery of the newborn and stimulates milk release from the breast in lactating females. each nervous stimulus controls a specific tissue or organ. which result in the development of adult features and adult behavior. whereas each endocrine stimulus controls several tissues or organ. 19 . • It regulates the growth of many tissues. • • It regulates blood glucoce levels and other nutrient levels in the blood It helps control the production and function of immune cells. The nervous system usually acts quickly and has short term effects.fail to function properly. but they differ in other important ways. FUNCTIONS: • • It regulates water balance by controlling the solute concentratiuon of the blood.

The amino acids of proteins are broken down and used to synthesize glucose by the liver. which are release into the circulatory system.  If blood glucose levels are too high. especially blood glucose. which secrete insulin and glucagon. The islets secrete two hormones –insulin and glucagon—which function to help regulate blood nutrient levels.  Insulin is released from the beta cells primarily response to the elevated blood glucose levels and increased parasympathetic stimulation that is associated with digestion of a 20 .• It controls the development and the function of the reproductive systems in males and females. consist of a head. When blood glucose decreases. a condition called acidosis. When blood glucose level are very low. and the tail.  It is very important to maintain blood glucose levels within a normal range of values. and pancreatic islet. Pancreas  an elongated gland extending from the duodenum to the spleen. the kidneys produce large volumes of urine containing substantial amounts of glucose because of the rapid loss of water in the form of urine.  The endocrine part of the pancreas consists of pancreatic islets (small islands. islet of Langerhans) dispersed among the exocrine portion of the pancreas. converts some of the fatty acids. There is an exocrine portion. body. A decline in the blood glucose levels within a normal range causes the nervous system to malfunction because glucose is the nervous system’s main source of energy.  Alpha cells of the pancreatic islets secrete glucagon. the break down of fats can cause the release of enough fatty acid and ketones to cause the pH of the fluids to decrease below normal.  Beta cells of the pancreatic islet secrete insulin. As fats are broken down. dehydration result. other tissues to provide an alternative energy source break fats and proteins rapidly. the liver to acidic ketones. which secretes digestive enzymes that are carried by the pancreatic duct to the duodenum.

Growth hormone slows protein breakdown and favors fat breakdown. such as epinephrine. Decreased insulin levels allow blood glucose to be conserved to provide the brain with adequate glucose and to allow other tissues to metabolize fatty acids and glycogen stored in the cell. called satiety center (fulfillment of hunger).  Glucagon is released from the alpha cell when blood glucose level is low. and the area of the hypothalamus that controls appetite. and growth hormones.  Insulin and glucagon function together to regulate blood glucose levels. Glucagon binds to membrane-bound receptors primarily in the liver and caused the conversion of glycogen storage in the liver to glucose. 21 . adipose tissue. the rate of insulin secretion declines and the rate of glucagon secretion increase. increases the rate of glucose and amino acid uptake in these tissues.meal. Other hormones. When blood glucose level decrease. Increase blood levels of certain amino acids also stimulates insulin secretion. The glucose is then released into the blood to increase blood glucose level. When blood glucose levels decrease. Decreased result from decreasing blood glucose levels and from stimulation by the sympathetic of the nervous system. Epinephrine and cortisol caused the breakdown of protein and fat and the synthesis of glucose to help increase blood levels of nutrients. when blood glucose levels are elevated a glucagon secretion is reduced. insulin secretion increases. Insulin binds to membrane-bound receptor and. cortisol. and glucagon secretion decreases. When blood glucose increase. After a meal. also function to maintain blood levels of nutrients. either directly or indirectly.  The major target tissues for insulin are the liver. Sympathetic stimulation of the pancreas occurs during physical activity. and the amino acids used to synthesize protein. muscles. Glucose is converted to glycogen or fat. these hormones are secreted at a greater rate.

or adult onset diabetes mellitus (AODM).In case our patient we classified the risk factor into two categories the modifiable and non-modifiable.VI. Under modifiable is the diet because diet high in cholesterol increases number of adipose tissue and this tissue are resistant to insulin therefore glucose uptake by cell is poor and the stress because stress stimulates secretion 22 . PATHOPHYSIOLOGY Diabetes Mellitus Type 2 is referred to as non-insulin dependent diabetes mellitus (NIDDM).

Prolonged high blood glucose level leads to sluggish circulation and when the glucose concentration in the blood is raised beyond its renal threshold. Insulin is also the principal control signal for conversion of glucose to glycogen for internal storage in liver and muscle cells. In a sluggish circulation due to high blood content in blood the oxygen supply in the peripheral site is insufficient and when this happened there is a proliferation of microorganism in the case of our patient his wound doesn’t easily heal due to poor oxygen delivery and microorganism take place and multiply. causing dehydration and increased thirst. reabsorption of glucose in the proximal renal tubuli is incomplete. In the intravascular area if the insulin is insufficient and glucose are not absorb by the cell the glucose is staying in the blood stream and the glucose level in the blood will increase as the sugar in blood increase the blood circulation will become viscose. can still produce insulin. If the insulin is deficient the intracellur and the intravascular space are affected. norepinephrine and glucocorticoids and this neurotransmitters increases glucose level. Lowered glucose levels result both in the reduced release of insulin from the beta cells and in the reverse conversion of glycogen to glucose when glucose levels fall. beta cells are primary affected and there is a poor production of insulin. This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney. In type 2 diabetes. And when this happened the glucose supposed to be absorb by the cells are staying in the blood and this term is hyperglycemia. And the age with strong heritability patterns which present as type 2 diabetes early in life. but do so relatively inadequately for their body's needs. and part of the glucose remains in the urine (glycosuria). usually before 30 years in the case of our patient he was diagnosed at the age of 37 years old. Also if cell has no glucose intake their will be cellular starvation and the person will have the urge to eat and eat and it is termed polyphagia. In the case of our his father has a diabetes also.of epinephrine. If cell was not able to absorb the sugar their will be intracellular and extracellular dehydration and body will compensate and the person will have the urge to drink more water it is term polydipsia. resulting in increased urine production (polyuria) and increased fluid loss. 23 . Lost blood volume will be replaced osmotically from water held in body cells and other body compartments. In the intracellular space there is a failure of glucose to enter in the intracellular space because there is a lack of insulin and insulin acts as the key to be able the glucose to enter in the cell. In the non-modifiable factor hereditary because it can be transfer from parents to offspring.

Pathophysiology Modifiable • • Diet Stress Non-modifiable • • Hereditary Age Poor production of Beta cells Poor oxygen delivery ECF/ICF failure of glucose to Proliferation of Intracellular: Polyphagia to peripheral area Polydipsia Hypergylcemia Cell Starvation Insulin Deficiency dehydration enter in ICS microorganism Increase Osmotic Intravascular: increase glucose pressure in renal Sluggish circulation Polyuria in bloodSystemic blood tubules Viscosity 24 .

VII. MEDICAL MANAGEMENT A. Pharmacotherapeutics/Medicines GN (BN) Classification stock Generic Name: Metformin Brand Name: Formet Classification: Anti-diabetic agent Poor wound healing Nursing Responsibilities And Implications (Pre.Intra.Post) Pre:  Check for allergies  Ask for history of heart disease (for dose Indication (Client specific) Dosage and Frequency Indication:  Treatment for NIDDM (Type II) not responding to dietary 25 .

chew or break (may cause too much of drug to be released at one time) Post:  Test blood (to assure that Metformin is helping the patient’s condition)  Advice patient to avoid drinking alcohol (may decrease blood sugar and increase risk of lactic acidosis) Pre:  Check the patient for allergies Intra:  Take with meal  Instruct the patient to swallow the tablet whole. herbal preparation or dietary supplement Generic Name: Gliclazide Brand Name: Ritemed Gliclazide Classification: antidiebetic agent Indication:  Type 2 diabetes not controlled by diet alone Dosage and frequency: 80 mg/tab 1 tab OD Generic Name: Vitamin B Complex Classification: food supplement Indication:  Dietary supplement for certain patient who do not receive a proper amount of vitamin from the diet Dosage and frequency: 1 tab OD 26 . without breaking. crushing or chewing it.modification Dosage and Frequency: 500mg/tab TID 1 tab TID adjustment) Intra:  Take with meal  Tell patient not to crush. it may cause too much of drug to be released at one time Post:  Advice the patient not to drink alcohol because it may cause severe decrease of blood sugar Pre:  Ask patient if he is taking any prescription or non prescription medicine.

take with food to reduce stomach irritation  Advise the patient to take it as soon as possible if he missed a dose  Tell the patient to skip missed dose if it is almost time for the next dose and go back to the regular dosing schedule  Remind patient not to take two doses at once Pre:  Check the patient for allergies Intra:  Take with food to lessen stomach upset Post:  Instruct patient not to continue taking drug more than 10 days for pain or 3 days for fever VIII. Avoid drinking alcohol. • Strategy Do not crush. take with meal. 27 . DISCHARGE HEALTH TEACHING PLANS 1.Compliance Medication Content Metformn(Formet) 500mg/tab. foods or other substances (some meds may interact with vitamin B) Intra:  May be given with or without food. chew or break. 1tab TID.Generic Name: Iboprofen+Paracetamol Brand Name: Alaxan Classification: NSAID Indication:  Relief of mild to moderately severe pain of musculoskeletal origin Dosage and frequency: 500mg/tab 1 tab PRN  Ask the patient if he has allergies to medicines. if stomach upset occurs.

Exercise Light stretching • syrup.Gliclazide 80mg/tab. brown sugar and corn 3. • Do not drink alcohol (it may cause severe decrease of blood sugar. Flexing and extending 28 . Ibuprofen+paracetamol 500mg/tab. 1 tab PRN. take with food. Vitamin B complex 1tab OD. • Reduce intake of rice • • Eat fruits and Teach patient to read vegetables labels of "health" foods because they contain sugar product such as honey. • If missed a dose. 1tab OD • Take with meal swallow whole. take with/ without food. without breaking. chewing or crushing it (it may cause too much of drug to be released at one time. take as soon as possible skipmissed dose if it is almost time for the next dose and go back to regular dosing schedule. 2. Diet Low carbohydrate diet High fiber diet • Do not continue taking drug more than 10 days for pain or 3 days for fever.

Social support is very important to the client. Chin to chest • Touch chin to the chest slowly Head to shoulder • Flex the head to the right and to the left shoulder at a very slow movement. • Note: the exercise should be done with assistance of significant others at a very slow motion to avoid further 4. Activity/Lifestyle Positive reinforcement • complication. Give positive reinforcement for self-care behaviors. Rotating of the extremities at a very light and slow motion. 29 . • Have a regular interaction with patient to avoid low self-esteem.very slowly of upper and lower extremities. Changes instruct family to assist in the situation of the client.

the client verbalized improvement in sleep pattern and can sleep now from 4-8 hours. As evidence by verbalization of the client “di ako masyado makatulog sa gabi. to meet the metabolic needs of the body by intake of sufficient nutrients and able to gain weight. lagi akong pagising gising”. It should be the first priority. SUMMARY OF CLIENT STATUS OR CONDITION AS OF LAST DAY OR CONTACT Date July 9. naniniklap na yung balat ko”. 2009: First is imbalanced nutrition: less than body requirements. 2009 Problems encountered (actual and resolved) Actual problems that are identified are and have been resolved last July 16. 30 . Third is impaired skin integrity. Necessary nursing interventions should be done. The necessary nursing interventions should be done for the client to be able to maintain a comfortable environment. It should be the second priority because the client is experiencing a insufficient time or period of sleep. After doing so. and after doing so the client’s wound becomes dry and clean. Second is disturbed sleep pattern. As positively evidence by skin disruption of skin surface and as verbalized by the client that “para na nga akong isda na kinakaliskisan eh. And based on the assessment done that there are (+) sunken eyeballs and weakness.IX. As evidence by verbalization of the client and based on the assessment done that the client really loss weight. Because of the necessary nursing interventions that have been done the client’s appetite increased.

And Forth is activity intolerance. It should be identify for the client to have sufficient energy to endure or complete required or desired daily activities. weakness and weight loss based on the assessment done. 2009 There is a potential problem that had been identified during our contact with the client and this is risk for infection due to the disruption of the skin which is the primary defense. Necessary nursing interventions should be done to prevent infection and complications. Because of the necessary nursing interventions that have been formulated the client was able to perform some minimal ADL. 31 . July 9. The problem was evidence by verbalization of the client that “di na ko makalabas ng bahay at di na rin ako makatayo ng matagal” and positive immobility.

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