Professional Documents
Culture Documents
College of Nursing
Angeles City
In Partial Fulfillment of
Requirements in NCM104-RLE
Group 3/ Subgroup 2
N-405
I. INTRODUCTION
1. Description
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.
World
2000 2030
World 171,000,000 366,000,000
Philippines 2,770,000 7,798,000
Chan-Cua said the 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.
Objectives
The researches have the following objectives in this case study:
Described and explained Diabetes Mellitus together with the risk factors
contributing to the occurrence of the condition.
Reviewed the anatomy and physiology of the organs involved.
Interpreted the results in the laboratory and diagnostic procedures done
with the patient including their purposes, and specific nursing
responsibilities before, during and after the procedure.
Enumerated the different medications administered for the condition, their
indications and specific nursing responsibilities.
Formulated significant nursing diagnoses, with their significantly related
nursing care plans.
II. NURSING HISTORY
1. PERSONAL HISTORY
a. Demographic data
Mr. Sugar, a 52 years old male who is not married and has no children, was born
on June 27, 1957 at Porac Pamapanga. He is pure Filipino. Mr. Sugar graduated Business
and Accountancy at the college of Holy Angel University. After graduation, he worked
for 16 years at Saver’s Bank Guagua. He presently resides at Baidbid, Porac Pampanga
with his younger brother.
Mr. Sugar used to work at the bank for 16 years. Due to a confidential incident at
work, Mr. Sugar was asked to leave the company. When he did, he decided to stay with
his brother and help at the bakery. He never smoked and used to drink. When he was
diagnosed, he stopped drinking. He regularly has a walk in the morning as a form of
exercise. He is not choosy in eating foods and loves to eat fruits regularly.
Mr. Sugar is a Roman Catholic. Last 3 years ago he made a habit of going to Apo
to visit the church there but rarely attends mass. Since he grows up at Porac, he usually
speaks the dialect Kapampangan and Tagalog.
When it comes to health practices, he usually practices self medicate when the
sickness isn’t severe and tolerable. Paracetamol is the usual medications they use for
treating colds and colds. He doesn’t use herbs or seek herbalarios or albularyo. If his
condition gets worse, medical attention is sought. He usually goes to Porac District
Hospital for check-ups and emergency cases. Aside from emergencies, he has an annual
check up with his private doctor.
2. FAMILY HEALTH ILLNESS HISTORY
Mr. Sugar is eight child of twelve children. Diabetes Mellitus runs in the family.
His grandfather and father had Diabetes 2 while his mother was diagnosed with
hypertension and died because of a stroke. Among his siblings, one has hypertension and
the two has Diabetes Mellitus while the others are almost at pre-hypertension. His brother
before him is his twin who experiences almost the same as he does.
Hypertension arised last 3 months ago and was prescribed a maintenance of Neoblock
one tab every morning and Combizar at night.
Mr. Sugar thought his medications would maintain his health but one month ago, his eyes
started to swell and the doctor said that it was diabetic retinopathy. Thus, he had
undergone laser therapy to prevent further damage.
5. PHYSICAL EXAMINATION
SKIN:
• Pale
• No lesions observed
• Dry skin
HEENT:
Head
• Hair is thin and quite moist, black with minimal white hair strands
• Even distribution of hair
• No dandruff observed
Eyes
• Pale palpebral conjunctiva
• Anicteric sclera
• Patient has blurred vision
Ears
• External canal is clean
• No discharge noted
Nose
• No discharge seen
Tongue and mouth
• Incomplete set teeth
• Pale lips
• Dry lips
• No breath odor
LUNGS:
• Chest expands during inhalation
ABDOMEN:
• Rigid upon palpation
MUSCULOSKELETAL:
• No edema
General Appearance:
Mr. Sugar was seen lying on her bed wearing a shirt and pants, with hair
disheveled, with an IV fluid of 0.9 NaCl 1L regulated 40gtts/min infusing well at left
hand.
Assessment:
SKIN:
• No lesions observed
• Skin is moist and warm
HEENT:
Head
• Hair is black with minimal white hair strands
• Even distribution of hair
• No dandruff observed
Eyes
• Pale palpebral conjunctiva
• Anicteric sclera
• Patient has a blurred vision
• Pupils are constrict when in light and dilates when the light is removed
Ears
• External canal is clean
• No discharge noted
• Pinna recoils after it is folded (<2secs)
Nose
• No discharge seen
• Can breath with one nostril occluded
Tongue and mouth
• Dry lips
• Incomplete set of teeth
• No breath odor
NECK:
• Lymph nodes are palpable
LUNGS:
• chest expands during inhalation
ABDOMEN:
• Non-tender upon palpation
• Flabby
• With bowel movement (twice in one day as stated by patient)
GENITO-URINARY:
• With urinary frequency
UPPER AND LOWER EXTREMITIES
• With dry cracking fissures on the soles of the feet.
• With non-pitting edema on both lower extremities
• Capillary refill: 1-2 secs.
Nursing Responsibilities:
Nursing Responsibilities:
Prior to the procedure:
• Inform patient that there are no food restrictions.
• Wash your hands thoroughly before beginning procedure.
• Ready your meter according to on-screen instructions or owner's manual (every
meter is slightly different).
Nursing Responsibilities:
Nursing Responsibilities:
Prior to the procedure:
• Ask patient if he/she had not eaten at least 8 hours.
• Wash your hands thoroughly before beginning procedure.
• Ready your meter according to on-screen instructions or owner's manual (every
meter is slightly different).
• Record your glucose level and follow your physician's guidelines pertaining to
necessary actions for low or high glucose levels.
III. 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 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.
IV. THE PATIENT AND HIS ILLNESS
a. Schematic diagram
Pathophysiology (book–based)
b.1. Definition of the disease
Diabetes Mellitus
Diabetes Mellitus type 2 is the most common form of Diabetes. Formerly
known as adult-onset diabetes, it usually affects people aged over 40 and
progresses gradually. In this type the pancreas has not ceased to produce insulin,
but the quantity is insufficient, or the hormone is not stimulating the glucose
uptake in muscles and tissues required for energy. The result is a build-up of
glucose in blood and urine.
Although the cause of this malfunctioning is unclear, non-insulin
dependent diabetes mellitus tends to run in families. Other risk factors, such as
increasing age, obesity, and a sedentary lifestyle, probably contribute to its
increased incidence in developed countries.
Non-insulin dependent diabetes mellitus can often be controlled initially
by diet alone, or in combination with tablets that reduce the amount of blood
glucose. There are two main types of blood glucose-reducing drugs:
sulphonylureas work mainly by stimulating the pancreas’s islet cells (known as
the islets of Langerhans) to produce more insulin and biguanides increase the
effectiveness of insulin on cells. Eventually, however, patients may need insulin
injections.
Precipitating Factors
• Obesity - Elevated levels of free fatty acids, a common feature of obesity, may
contribute to the pathogenesis of type 2 DM. It can impair glucose utilization in
skeletal muscles, promote glucose production by the liver and impair beta cell
function.
• Environmental Factors/Stress – An increase in stress hormone triggers the release
of epinephrine and norepinephrine which will promote the secretion of glucose
leading to hyperglycemia.
• Inactive Lifestyle – A risk factor that had contributed in the occurrence of DM
due to the fact that lack of muscle activities decreases the need for the body to
utilize glucose as a form of energy.
• Diet – Foods rich in carbohydrates can easily promote the increasing level of
glucose along the bloodstream.
Prerenal Risk Factors
WEAKNESS/ FATIGUE
NAUSEA/ VOMITING
PALE
• Weakness/fatigue
o November 17, 2009
Nursing Responsibilities:
Prior the procedure:
• Read the doctor’s order
• Check IV label
During the procedure:
• Check for patency of tubing
• Regulate as ordered
After the procedure:
• Check IV infusion and amount every 2 hours
b. Drugs
Date
Route of
Ordered/ General Action,
administration, Client’s
Date Taken/ Classification
Name of Drug Dosage and response to the
Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C
Nursing Responsibilities:
Prior to Administration
-Check patient’s name before administration
-Check the doctor’s order
-Prepare the medication as ordered.
-Explain the purpose, indication and possible adverse effects of the medication.
After Administration
-Monitor bowel movement.
-Instruct patient not to drink alcohol during therapy.
Date
Route of
Ordered/ General Action,
administration, Client’s
Name of Date Taken/ Classification
Dosage and response to the
Drug Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C
Prior to Administration
-Check patient’s name before administration
-Check the doctor’s order
-Prepare the medication as ordered.
-Explain the purpose, indication and possible adverse effects of the medication.
After Administration
-Monitor bowel movement.
-Instruct patient not to drink alcohol during therapy.
Date
Route of
Ordered/ General Action,
administration, Client’s
Date Taken/ Classification
Name of Drug Dosage and response to the
Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C
After Administration
-Monitor for signs of tachycardia, palpitations and especially blood pressure
-Instruct patient to sit before standing
Nursing Responsibilities:
Prior to Administration
-Check patient’s name before administration
-Check the doctor’s order
-Prepare the medication as ordered.
-Explain the purpose, indication and possible adverse effects of the medication.
After Administration
-Monitor for signs of tachycardia, palpitations and especially blood pressure
-Instruct patient to sit before standing
Date
Route of
Ordered/ General Action,
administration, Client’s
Date Taken/ Classification
Name of Drug Dosage and response to the
Date Mechanism of
Frequency of medication
Changed/ Action
administration
D/C
Nursing Responsibilities:
Prior to Administration
-Check patient’s name before administration
-Check the doctor’s order
-Prepare the medication as ordered.
-Explain the purpose, indication and possible adverse effects of the medication.
During Administration
-Instruct the patient to calm down to avoid uneasiness.
After Administration
-Monitor glucose level closely in this patient because severe hypoglycemia may result
before the patient develops symptoms.
-Advice patient to avoid vigorous exercise immediately after dose.
-Inform patient to avoid alcohol, which lowers glucose level.
c. Diet
Client’s
Date started/ General Indication or response and/or
Type of diet
Date changed description purpose. reaction to the
diet
Nothing per 11/17/19 It is a type of Indicated for Since the patient
patients unable
orem (NPO) diet that was oriented and
to consume a
withholds oral regular diet and understands
patients wild
fluids and needed
mild G.I.
foods. problems. interventions, he
followed with
the doctors
prescriptions.
Nursing Responsibilities
Prior
• Verify doctor’s order.
• Explain the diet prescribed to the patient.
• Instruct patient to withhold oral fluids and foods.
During
• Ensure that the patient strictly follow the diet.
After
• Assess for patient’s condition; how he responds to the diet.
d. Exercise/ Activity
Date
Ordered,
Date Client’s Response
Type of General Indication or
Started, and/or reaction to
exercise description Purpose
Date activity
Changed or
D/C
Keep rested An activity Indicated to 11/17/09 Patient responded
where strenuous avoid fatigue. to doctor’s order
activities should and stated
be avoided. Bed decreased body
rest should be weakness.
implemented
but with
assisted
bathroom
privilege to
avoid further
aggravation of
the gangrene
and to reduce
pain as well.
Nursing Responsibilities
Prior
• Check doctor’s order for any other considerations needed.
• Explain the activity to the patient.
• Explain why it is important and what it could improve in her condition.
During
• Assess patient’s present condition.
• Reinforce information as appropriate.
After
• Note patient’s response to activity.
VI. NURSING CARE PLAN
VII. DISCHARGE PLANNING
1. General Condition of the Client
Mr. Sugar was seen lying on her bed wearing a shirt and pants, with hair
disheveled, with an IV fluid of 0.9 NaCl 1L regulated 40gtts/min infusing well at left
hand. He reported that he had already two bowel movements.
2. METHODS
M-edication
E-xercise
type 2 diabetes
T-reatment
H-
• Advise patient to check blood glucose level before doing any activities and to eat
glucose is >250 mg/dl, the patient should delay the exercise session.
O-PD follow-up
D-iet
• Diabetic Diet
>Carbohydrates should provide 45 - 65% of total daily calories. Best choices are
vegetables, fruits, beans, and whole grains. These foods are also high in fiber.
>Protein should provide 12 - 20% of daily calories, although this may vary
depending on a patient individual health requirements
In this study, the student nurses’ aim is to understand the disease more,
manifestations, risk factors and complications. Diabetes mellitus is a condition in which
the pancreas no longer produces enough insulin or cells stop responding to the insulin
that is produced, so that glucose in the blood cannot be absorbed into the cells of the
body.
Mr. Sugar’s diabetes mellitus was caused mainly by his sedentary lifestyle, his
food preference and due to hereditary factor since his grandfather and his father both had
diabetes. Diabetic retinopathy, a complication of diabetes mellitus, also occurred and Mr.
Sugar opted to undergo laser therapy a month ago.
Through this case study, we should be able to learn and understand the disease
Diabetes Mellitus type 2 and therefore give us knowledge in proper management,
prevention and treatment. As a student nurse, it is very important to know many things
including the said disease condition. After the hardships of completing our case study, a
reward of self-fulfillment and credential to our knowledge and skills has been added to us
being student nurses as well as professionals in the near future.
IX. RECOMMENDATION
The researchers would recommend the further study of this case as this is a
disease that is interesting. It would be better if another causative factor would be studied
to be able to provide diverse information about this disease and to be able to compare to
spot similarities and differences in the manifestations of this disease if there is a different
causative factor. To be able to appreciate the physical manifestations of this disease, we
advise future researchers to investigate this case on the onset of the disease to be able to
assess and note more overt manifestations both for educational and documentation
purposes.
X. BIBLIOGRAPHY
http://en.wikipedia.org/wiki/Diabetes_mellitus#Causes
http://kidney.niddk.nih.gov/kudiseases/pubs/kdd/index.htm
http://www.jpsimbulan.com/2008/07/26/incidence-of-type-1-and-type-2-diabetes-in-the-
philippines-and-worldwide/
http://nursingcrib.com/diabetes-mellitus-case-study/
Brunner&Suddarth.Textbook of medical-surgical nursing.2008.Lippincott Williams
& Wilkins.