Professional Documents
Culture Documents
NCM 103
Group 6
CASE ABSTRACT
This is a case of Mr. M.J.S.J. a 77 year old male patient
who was admitted on April 28, 2009 in Medical Center
Parañaque, Emergency room with a complaint of infected
wound on then left foot 5th digit. Initial Vital Signs were BP-
110/70 mmHg; PR - 107 bpm; RR- 23 cpm; Temp.- 37.5⁰C.
Initial interview and assessment revealed that the patient is
Diabetic and his past hospitalization was on September
2008, where his first digit right foot was amputated and was
hospitalized with hypoglycemic coma last March 2009.
Patient undergone different laboratory procedures:
Hematology, Urinalysis, Electrolytes and Glycosylated
Hemoglobin (HBa1C). Final Diagnosis is Diabetic left foot.
LEARNING OBJECTIVES
1. To describe the nature of the disease process of
Diabetes mellitus.
Introduction:
According to Black, 2008 Diabetes Mellitus is a chronic, progressive
disease characterized by the body’s inability to metabolize carbohydrates,
fats, and proteins, leading to hyperglycemia (high blood glucose level).
Diabetes mellitus is sometimes referred to as “high sugars” by both client
and health care providers. Diabetes mellitus is classified as one of four
different clinical states including type 1, type 2, gestational, or other specific
types of diabetes mellitus. Type 1 diabetes mellitus is the result of
autoimmune beta-cell destruction, leading to absolute insulin deficiency. Type
2 DM is the result of a progressive insulin secretory defect along with insulin
resistance, usually associated with obesity. Gestational diabetes mellitus is a
type of diabetes mellitus diagnosed during pregnancy. Other types of DM may
result of genetic defects in beta-cell function, diseases of the pancreas, or
disease induced by drugs.
About 90% of patients who develop type 2 diabetes mellitus are obese.
Because patients with type 2 diabetes mellitus retain the ability to secrete
some endogenous insulin, those who are taking insulin generally do not
develop DKA if it is stopped. Therefore, they are considered to require insulin
but not to depend on insulin. Moreover, patients with type 2 diabetes mellitus
often do not need treatment with oral antidiabetic medication or insulin if
they lose weight or stop eating.
In our case the patient was diagnosed with Type II diabetes mellitus.
BIOGRAPHIC DATA:
NURSING HISTORY:
FAMILY HISTORY:
Health state of
Parents: Father is diabetic
Siblings: Not recalled
Spouse: Hypertension
Illness in the family similar to the patient’s illness: Diabetes Mellitus (father)
Patient’s present diet is diabetic low puretic diet and his usual
diet was high in salt and high in fat. There are no religious restrictions
in terms of food. His usual meal is composed of carbohydrates, protein,
fats, water and vitamin. He doesn’t take any food supplements. He has
a good appetite. His highest weight 150 lbs and his lowest weight is
145 lbs. His last food ingested was Pinakbet and nesvita.
3. ELIMINATION PATTERN
Patient uses 3 diapers per day during his stay in the hospital as
a measurement for his voiding pattern. His urine has a characteristic of
yellow in color and aromatic. His bowel pattern is ones a day with a
characteristic of soft and brown stool. He perspires heavily in certain
instances like when walking, and when the weather is humid or hot.
Patient drinks a lot of water. He has no disease on digestive, urinary
and integumentary system.
According to patient care giver the patient cares about his family
and community. He was then a good provider and very supportive to
his children and his grand children. But now as he age and cannot take
care of himself alone, his children sent him money for others to take
good care of him. He considers God to be the most important in his life
and next is his family. His love ones helped him solve all the problems
and worries in life.
PHYSICAL EXAMINATION
1. VITAL SIGNS
2. GENERAL SURVEY
The patient stands 5 feet and 7 inches and weighs 145 lbs.
Patient is restless, uncooperative, bedridden, but not in
cardiopulmonary distress. Patient is drowsy, incoherent and
disoriented. His developed is mesomorph. He looks according to
his age, well nourished and restless.
3. SKIN
The patient has brown complexion, the texture is rough and dry.
His skin turgor was fair and warm to touch.
4. HEAD
The configuration of the head is normocephalic. The hair is fine,
equally distributed and has no dandruff seen on the scalp. The
lids are drooping and have dark discoloration on the periorbital
region. Conjunctiva is pale. Sclera is anicteric. Cornea and lens
have arcus senilis. The pupil sizes are equal of 3 mm and it
reacts to light sluggishly with unequal constriction. Visual acuity
and convergence was not assessed.
5. EARS
The external pinnae are normoset with scanty cerumen. There
were no discharges.
6. NOSE
The nasolabial folds are symmetrical. The septum is in the
midline. There were no discharges and mucosa is pink. Both
nostrils are patent and there were non-tender sinuses.
7. MOUTH
He has dry and chapped lips, with the tongue deviated to the
right. The gums and mucosa are pale. There are presence of
dentures and has a slurred speech.
8. PHARYNX
9. NECK
11.HEART
13.ABDOMEN
14.GENITO-URINARY
16.NEUROLOGIC ASESSMENT
Drug – induced lethargy
GCS: Eye opening= 4 (spontaneous)
----------------------
11
Water Balance
Ion regulation
The PANCREAS
ENDOCRINE FUNCTION
INSULIN:
• Insulin binds to receptors on the surface target tissues and enhances glucose
transport across the membrane
• It decreases blood glucose level by enhancing uptake, use and storage of glucose
in hepatic, muscle and adipose tissues
• It stimulates skeletal muscle and liver to convert glucose to a storage form called
glycogen.
• It also enhances amino acid transport into cells, it acts synergistically with growth
hormone to promote cell hypertrophy and hyperplasia
GLUCOSE
SOMATOSTATIN
• Somatostatin is released after ingestion of a meal and inhibits the release of both
insulin and glucagon.
• The net action of somatostatin is to delay nutrient absorption by the GI tract, thus
prolonging the duration of intestinal food absorption after a meal.