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Case Study DM
Case Study DM
OBJECTIVES:
General Objectives:
This study primarily aims to determine and assess the prevalence of previously diagnosed Type 2
Diabetes and its risk factors to (name of the patient) as well as providing the said patient with
sufficient information on proper management to the disorders.
Specific Objectives:
After completing the case study, the student nurses should be able to:
Define Diabetes Mellitus
Discuss the incidence and prevalence of Diabetes
Mellitus;
Understand Type 2 Diabetes in to the relation to the
clinical presentation, patient characteristics and
pathogenesis;
Describe the role of generic and environmental factors
and immunology in the development of Type 2 Diabetes;
Identify the laboratory investigations used to diagnose
Diabetes;
Discuss the appropriate nursing and medical
management;
Identify appropriate treatment options for Type 2
Diabetes;
And discuss the dos and donts for patients education.
II. INTRODUCTION
Name: RTS
Address: Nibaliw Sur, Bautista Pangasinan
Age: 68 years old
Birthdate: May 23, 1940
Gender: Male
Civil Status: Married
Religion: Roman Catholic
Nationality: Filipino
Date of Admission: July 12, 2008
Time: 12:30 pm
Attending Physician: Dr. Estrada
Diagnosis: Type 2 diabetes mellitus
DISEASE PROPER
Type II diabetes is associated with obesity and with aging. It is a lifestyle-dependent disease, and
has a strong genetic component (concordance in twins is 80-90%). The problem seems not so much
in insulin production, but that when the insulin reaches its target cells, it doesn't work correctly.
Most Type II diabetes patients initially have high insulin levels along with high blood sugar.
However, since sugar signals the pancreas to release insulin, Type II diabetics eventually become
resistant to that signal and the endocrine-pancreas soon will not make enough insulin. These people
end up managing the disease with insulin and they need much higher doses because they are
resistant to it.
When a person takes in a high load of sugar, the sugar stimulates the pancreas to release insulin.
The targets for insulin are muscle, fat, and liver cells. These cells have insulin receptor sites on the
outside of the cell membrane. For most people, when insulin has bound to the receptors, a cascade
of events begins, which leads to sugar being transported from the blood into the interior of the cell.
In Type II diabetics, even when insulin is present on the cell membrane, the process doesn't work.
The glucose is never taken up into the cell and remains in the bloodstream.
The liver is responsible for glucose production and insulin is the regulatory agent of production.
High blood sugar content causes the pancreas to release insulin, and the insulin should signal the
liver to stop making sugars. But, in diabetics, there's resistance to that signal and the liver keeps
producing glucose. Hyperglycemia leads to glucose toxicity.
It is not high blood sugar that is the disease process of diabetes, but complications from the high
blood sugar. Standard complications for many diabetics are: retinopathy (blindness); neuropathy
(nerve damage) which leads to foot ulcers, gangrene, and amputations; kidney damage, which leads
to dialysis; and cardiovascular disease. A major problem faced by doctors is that some people with
high blood sugar feel fine; it's hard to treat diseases that are asymptomatic since most people don't
want to take a pill for something that they don't feel bad about.
V. PRESENT ILLNESS
Kidney (ME, kinere), one of bean-shaped urinary organs in the dorsal part of the abdomen,
one of the vertebral column. The cranial extremities of the kidneys are on a level with the third
lumbar vertebra. In most individuals, the caudal extremities are on a level with the third lumbar
vertebra. In most individuals, the right kidney s slightly more caudal (lower) than the left. Each
kidney is about 11 cm long, 6 cm wide and 2.5 cm thick. In men, each kidney weights from 125170 g; in women, each kidney weighs from 115-155g.
In the newborn, the kidneys are about three times as large in proportion to the body weight
as in the adult. The kidneys produce and eliminate urine through a complex filtration composed of
glomeruli and renal tubules that filter blood under high pressure , removing urea, salts, and other
soluble wastes from blood plasma and returning the purified filtrate to the blood.
More than 2500 pints of blood pass through the kidneys every day, entering the kidneys
through the renal arteries and leaving through the renal veins. All the blood in the body passes
through the kidneys about 20 times every hour but only about one fifth of the plasma is filtered by
the nephrons during the period. The kidneys remove water as urine and return water that has been
filtered to the blood plasma, thus helping to maintain the water balance of the body. Hormones,
especially the antidiuretic hormone (ADH), produced by the pituitary gland, control the function of
the kidneys in regulating the water content of the body. ADH reaches the renal tubules in the blood
and stimulates the reabsorption of water from filtrate into the blood.
\If the water intakes is inadequate to compensate for the water lost in perspiration in
respiration, the change in concentration in the blood is detected by the brain and pituitary gland
releases more ADH, thus reducing the loss of water in urine. If the blood is too dilute, the pituitary
gland reduces the secretion of ADH, producing a large flow of dilute urine to restore the water
balance.
VII. PATHOPHISIOLOGY
Diabetes Mellitus Type 2 has modifiable factor such as lifestyle and non-modifiable factors like
genetics, race and those people who are 45 years and above. These factors result in insulin
deficiency that leads to inability to breakdown glucose causing increase glucose level in the blood.
Increase glucose level in the blood attracts water thus, making the person urinate frequently.
Polyuria leads to excessive loss of water in the body resulting to increase intake of liquids.
The stored fats protein and carbohydrates are forced to be broken down when the glucose is
not converted to energy. When this happens, signs such as weight loss, body malaise and
polyphagia will be visible. The end product of forced breakdown of fats, CHON and CHO is fatty
acids. This then leads to the formation of plaques that causes the blockage of the blood vessels.
When this happens, the resulting disorders are macrovascular disease, CVA, myocardial infarction
and kidney failure. Eye retinopathy may also arise when there is forced. Breakdown of protein
since 90% of this stored in the eyes.
If there is increased glucose level in the blood, the myelin and axon of the neurons are
affected thus altering the transmission of impulse. This alteration causes deficient oxygen supply in
the periphery of the body which then results to poor wound healing.
Insulin resistance means that body cells do not respond appropriately when insulin is present.
Other important contributing factors are (a) increased hepatic glucose production (e.g. from
glycogen degradation), especially at in appropriate times; (b) decreased insulin mediated glucose
transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects); (c)
impaired beta-cell function loss of early phase of insulin release in response to hyperglycemic
stimuli, (d) cancer survivors who received allogenic hematopoeitic cell transplant are 3.65 times
more likely to report type 2 diabetes than their siblings; and (e) total body irradiation is also
associated with a higher risk of developing diabetes.
Type 2 Diabetes mellitus is often associated with obesity and hypertension and elevated
cholesterol (combined hyperlipidemia), and with the condition Metabolic syndrome (also known as
syndrome x, Reavans syndrome, or CHAOS). It is also associated with acromegaly, cushing
syndrome and a number of other endocrinological disorders, additional factors found to increase
risk of type 2 diabetes include aging, high-fat diets and a less active lifestyle.
PARADIGA
Modified factors
Non-modified factor
Lifestyle
genetic race
Obesity
Age over 45
________________________________________________________
Insulin Deficiency
Glucose Breakdown failure
Increased glucose level in blood
_________________________________________________________
Increased glucose
attracts water
Polyuria
Excessive loss
Of water
__________________________________________
Weight loss
Body malaise
Polyphagia
End product of
breakdown is
fatty acids
Plaque formation
protein breakdown
EXPECTED VALUES
3.85 5.78 mmol/L
RESULT
6.2 mmol/L
Up to 8.0 mmol/L
9.7 mmol/L
5.7 mmol/L
mmol/L
0.56 mmol/L
Random blood sugar test. A blood sample will be taken at a random time. Regardless
of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or
higher suggests diabetes.
Fasting blood sugar test. A blood sample will be taken after an overnight fast. A
fasting blood sugar level between 70 and 100 mg/dL is normal. A fasting blood sugar level
from 100 to 125 mg/dL is considered prediabetes, which indicates a high risk of developing
diabetes. If it's 126 mg/dL or higher on two separate tests, you'll be diagnosed with diabetes.
X. NURSING MANAGEMENT
Nursing management of the patient with Diabetes can involve treatment of a wide variety of
physiologic disorders, depending on the patients status & whether the patient is newly diagnosed
or seeks care for an unrelated health problem. Because all diabetic patients must master the
concepts & skills necessary for long-term management of diabetes & its potential complications, a
solid educational foundation is necessary for competent self-care & is an ongoing focus of nursing
care.
Nursing
Care Plan
17
23
24
XIII. BIBLIOGRAPHY
Johnson, Joyce Young Medical- Surgical Nursing 10th Edition
Kluwer, Wolters Nursing 2008 Drug Handbook. Philippines: Lippincott Williams and Wilkins
Peckenpaugh, Nancy J. Nutrition Essentials and Diet Therapy. Singapore: W.b Sauders Company,
2007
Doenges, Marilynn E, et al. Nurses Pocket Guide. Philadelphia: F.A Davis Company
www. wikipedia. com
www.medlineplus.com
25
University of Pangasinan
Dagupan City
College of Nursing
Case study
on
DIABETES MELLITUS
(Type II)
Submitted to:
Submitted by:
Padilla, Ma. Cristina A.
Padilla, Jordan Paner C.
Padilla, Jackieline N.
Padilla, Sarah Jane J.
Padilla, Zendy Mae Stephanie G.
Padua, Rachele R.
Pagarigan, Jacquelene I.
Palad, Karen R.
Palaganas, Rose Ann D.
Palaje, Sandra B.
Panilo, Darren Jay C.
Panganiban, Mark Paul V.
August 2008
Acknowledgement
ii
TABLE OF CONTENTS
Front Page
----------------------------------------- i
Acknowledgement
----------------------------------------- ii
Table of Contents
----------------------------------------- iii
I.
Objectives
General
----------------------------------------- 1
Specific
----------------------------------------- 1
II. Introduction
Patient Profile
----------------------------------------- 1
Disease Proper
----------------------------------------- 2
------------------------------------------ 2
Practice research
------------------------------------------ 2
V.
Past History
------------------------------------------ 3
Developmental Data
------------------------------------------ 3
Present Illness
------------------------------------------ 3
------------------------------------------ 4-6
VII. Pathophysiology
Paragraph
------------------------------------------ 7
Paradiga
------------------------------------------ 8
------------------------------------------ 9
IX.
------------------------------------------ 9
Medical Management
Drug study
X.
XI.
------------------------------------------ 9-16
Nursing Management
------------------------------------------ 17
3 Actual NCP
------------------------------------------ 18-20
1 Potential NCP
------------------------------------------ 21
1 Risk NCP
------------------------------------------ 22
Discharge Planning
------------------------------------------ 24
------------------------------------------ 25
XIII. Bibliography
------------------------------------------ 26
iii