I.

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 don’ts for patient’s 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

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but complications from the high blood sugar. When a person takes in a high load of sugar. gangrene. For most people. Hyperglycemia leads to glucose toxicity. a cascade of events begins. and amputations. High blood sugar content causes the pancreas to release insulin. The glucose is never taken up into the cell and remains in the bloodstream. But. The targets for insulin are muscle. III. kidney damage. which leads to sugar being transported from the blood into the interior of the cell. However. it doesn't work correctly. fat. even when insulin is present on the cell membrane. in diabetics. These people end up managing the disease with insulin and they need much higher doses because they are resistant to it. 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. Most Type II diabetes patients initially have high insulin levels along with high blood sugar. when insulin has bound to the receptors. In Type II diabetics. These cells have insulin receptor sites on the outside of the cell membrane. and liver cells. A major problem faced by doctors is that some people with high blood sugar feel fine. neuropathy (nerve damage) which leads to foot ulcers.DISEASE PROPER Type II diabetes is associated with obesity and with aging. SIGNIFICANCE OF THE STUDY 2 . It is a lifestyle-dependent disease. the sugar stimulates the pancreas to release insulin. there's resistance to that signal and the liver keeps producing glucose. and the insulin should signal the liver to stop making sugars. and cardiovascular disease. but that when the insulin reaches its target cells. Type II diabetics eventually become resistant to that signal and the endocrine-pancreas soon will not make enough insulin. and has a strong genetic component (concordance in twins is 80-90%). the process doesn't work. since sugar signals the pancreas to release insulin. The liver is responsible for glucose production and insulin is the regulatory agent of production. It is not high blood sugar that is the disease process of diabetes. which leads to dialysis. The problem seems not so much in insulin production. Standard complications for many diabetics are: retinopathy (blindness).

The patient is said to be that he has fulfilled his obligation to his children by providing them proper education. In which his children in return give him full financial and moral support.IV. which the ultimate goal being achievement of a positive sense in this final. Behaviorally: According to psychosocial theory by Erick Erickson the patient is in the stage of developmental in the late adulthood in which a person integrity. PATIENT’S PROFILE Past history The patient was diagnosed with hypertension last December 2007. in positive and negative events. Medications prescribe for his maintenance was NIFEDIPINE. Dr. The end of life is perceived as a culmination of their many experiences rather than as something to be feared. They do not despair for what might have been. Life has meaning for them in both. PRESENT ILLNESS 3 . DEVELOPMENTAL DATE: (Base on Erik Erickson. Individual review their experiences considering those objects they have successfully completed and those they have not. Jean Piaget and Harry Stack Sullivan) Developmental Stage by Erik Erickson Developmental tasks by Erik Erickson stage of late adulthood: Integrity versus Despair perception of life as a culmination of positive and negative events. acceptance of one’s own life as it is: ultimately a positive sense of self intact. The older person has thought a good deal about death and has usually had many experiences with it. Castillo was attending the patient in their house regularly. This is the final phase of development of Erickson’s “late adulthood or maturity” in which the tasks is to accomplished integrity opposed to despair. V. Death is phase of development that one must pass through. Persons who can accept their lives for what they have achieved undergo renewed sense of ego integrity. He was never been hospitalized in the past because their family doctor.

As a result. Pancreatic polypeptide inhibits somatostatine secretion. It may also act as a circulating hormone to slow absorption of nutrients from the gastrointestinal tract. Delta cells or D cells constitute about 7% of the pancreatic islet cells and secrete sematostatin (identical to the growth hormone inhibiting hormone secreted by the hypothalamus. 4. low blood glucose inhibits release of insulin (negative feedback) and stimulates release of glucagons. ANATOMY AND PHYSIOLOGY Pancreas is both an endocrine gland and an exocrine gland. Low blood glucose level (hypoglycemia) stimulates secretion of glucagons from the alpha cells of the pancreatic islets. 6. Insulin. Alpha or A cells continue about 17% of pancreatic islet cells and secrete glucagons. Cell Types in the Pancreatic Islets Each pancreatic islets includes four types of hormone – secreting cells. 2. Somatostatine acts in a paracrine manner to inhibit both insulin and glucagons to release from neighboring beta and alpha cells. High blood glucose (hyperglycemia) stimulates secretions of insulin by beta cells of the pancreatic islets. We do know that glucagons raises blood glucose level. 3. helps lower blood glucose level when it is too high. 1. Glucagon acts on hepatocytes (liver cells) to accelerate the coversion of glucagons (glycogenolysis) and to promote formation of glucose from lactic acid and certain amino acids (glyconeogenesis).5 – 15 cm in (4. The level of blood glucose controls secretion of glucagons and insulin via negative feedback: 1. 2. Scattered among the exocrine acini are 1-2 million tiny clusters of endocrine tissue called pancreatic islets of Langerhans. 4 . The acini produce digestive enzymes. blood glucose level falls. 3. gallbladder contraction and secretion of digestive enzymes by the pancreas. high blood glucose level (hyperglycemia) inhibits release of glucagons (negative feedback). and insulin lowers it. and to show the formation of glucose from lactic acid and amino acids (gluconeogenesis). Regulation of Glucagon and Insulin Secretion The principal action of glucagons is to increase blood glucose level when it falls below normal. hypocytes release glucose into the blood more rapidly. 8. which flow into gastro intestinal tract trough a network of ducts. If blood glucose continues to rise. to show the conversion of glycogen to glucose (glycogenolysis). and a tail. 5. Insulin acts on various cells in the body to accelerate facilitated diffusion of glucose into cells especially skeletal muscle fibers. the first part of the small intestinal and consist of the head. As a result. the pancreas is located in the curve of the duodenum. body. 4. Roughing 99% of the cells of the pancreas are arranged in the clusters called acini. Abundant capillaries serve both the exocrine and endocrine portions of the pancreas.5 – 6 in) in length. Beta or B cells constitute about 70% of pancreatic islet cells and secrete insulin. A flattened organ that measures about 12. on the other hand. I f blood glucose level drops below normal.VI. F cells constitute the remainder of pancreatic islets cells and secrete pancreatic polypeptide. 7. and blood glucose level rises. The interaction of the four pancreatic hormones is complex and not completely understood. to speed conversion of glucose into glycogen (glycogenesis) to increase uptake of amino acids by cells and to increase protein synthesis of fatty acids (lipogenesis).

ANATOMY AND PHYSIOLOGY OF THE PANCREASES 5 .

thus reducing the loss of water in urine. producing a large flow of dilute urine to restore the water balance. each kidney weighs from 115-155g. the pituitary gland reduces the secretion of ADH. produced by the pituitary gland. More than 2500 pints of blood pass through the kidneys every day. kinere).5 cm thick. the change in concentration in the blood is detected by the brain and pituitary gland releases more ADH. ADH reaches the renal tubules in the blood and stimulates the reabsorption of water from filtrate into the blood.ANATOMY OF THE KIDNEY Kidney (ME. one of the vertebral column. 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. 6 cm wide and 2. control the function of the kidneys in regulating the water content of the body. and other soluble wastes from blood plasma and returning the purified filtrate to the blood. the kidneys are about three times as large in proportion to the body weight as in the adult. In the newborn. entering the kidneys through the renal arteries and leaving through the renal veins. Hormones. Each kidney is about 11 cm long. the right kidney s slightly more caudal (lower) than the left. The kidneys produce and eliminate urine through a complex filtration composed of glomeruli and renal tubules that filter blood under high pressure . 6 . thus helping to maintain the water balance of the body. especially the antidiuretic hormone (ADH). In men. salts. one of bean-shaped urinary organs in the dorsal part of the abdomen. each kidney weights from 125-170 g. in women. In most individuals. In most individuals. removing urea. the caudal extremities are on a level with the third lumbar vertebra. \If the water intakes is inadequate to compensate for the water lost in perspiration in respiration. If the blood is too dilute. The cranial extremities of the kidneys are on a level with the third lumbar vertebra.

cushing syndrome and a number of other endocrinological disorders. It is also associated with acromegaly. and (e) total body irradiation is also associated with a higher risk of developing diabetes. making the person urinate frequently. Reavan’s syndrome. CVA.65 times more likely to report type 2 diabetes than their siblings. from glycogen degradation). or CHAOS).g. (c) impaired beta-cell function loss of early phase of insulin release in response to hyperglycemic stimuli. myocardial infarction and kidney failure. race and those people who are 45 years and above. Other important contributing factors are (a) increased hepatic glucose production (e. This alteration cause’s deficient oxygen supply in the periphery of the body which then results to poor wound healing. 7 . high-fat diets and a less active lifestyle. (b) decreased insulin mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects). Polyuria leads to excessive loss of water in the body resulting to increase intake of liquids. (d) cancer survivors who received allogenic hematopoeitic cell transplant are 3. additional factors found to increase risk of type 2 diabetes include aging. The end product of forced breakdown of fats. These factors result in insulin deficiency that leads to inability to breakdown glucose causing increase glucose level in the blood. especially at in appropriate times. If there is increased glucose level in the blood. Breakdown of protein since 90% of this stored in the eyes. body malaise and polyphagia will be visible. When this happens. PATHOPHISIOLOGY Diabetes Mellitus Type 2 has modifiable factor such as lifestyle and non-modifiable factors like genetics. and with the condition Metabolic syndrome (also known as syndrome x. When this happens. the myelin and axon of the neurons are affected thus altering the transmission of impulse. Eye retinopathy may also arise when there is forced. Insulin resistance means that body cells do not respond appropriately when insulin is present.VII. the resulting disorders are macrovascular disease. Increase glucose level in the blood attracts water thus. CHON and CHO is fatty acids. The stored fats protein and carbohydrates are forced to be broken down when the glucose is not converted to energy. This then leads to the formation of plaques that causes the blockage of the blood vessels. Type 2 Diabetes mellitus is often associated with obesity and hypertension and elevated cholesterol (combined hyperlipidemia). signs such as weight loss.

CHON Myelin and axon are effect Transmission of impulse is altered Excessive loss Of water __________________________________________ Weight loss Body malaise Polyphagia End product of breakdown is fatty acids Plaque formation protein breakdown Clogged in the blood eye retinopathy Vessels (90% of CHON are in eye) Macrovascular disease CVA Myocardial infarction kidney failure 8 . CHO.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 Body unable to use glucose for energy Force breakdown of fats.

exercise.30 mmol/L 2.  Use oral hypoglycemic agents if diet and exercise are not successful in controlling blood glucose levels. (FBS) ( RBS) Cholesterol Triglycerides EXPECTED VALUES 3. The therapeutic goal within each type of diabetes is to achieve normal blood glucose levels (euglycemia ) without hypoglycemia and without seriously disrupting the patient’s usual activities. Regardless of when you last ate. you'll be diagnosed with diabetes. A blood sample will be taken at a random time.09 – 7.78 mmol/L Up to 8. • IX. continuously assess and modify treatment plan as well as daily adjustments in therapy.8 mmol/L RESULT 6.  Because treatment varies throughout course because of changes in lifestyle and physical and emotional status as well as advances in therapy.  Exercise is important in enhancing the effectiveness of insulin. MEDICAL MANAGEMENT The main goal of treatment is to normalize insulin activity and blood glucose levels to reduce the development of vascular and neurophatic complications.VIII.85 – 5. which indicates a high risk of developing diabetes. Education is needed for both patient and family.0 mmol/L 3. monitoring. A blood sample will be taken after an overnight fast. A fasting blood sugar level between 70 and 100 mg/dL is normal. There are five components of management for diabetes: nutrition. If it's 126 mg/dL or higher on two separate tests. including: • Random blood sugar test. DIAGNOSTIC TEST TEST Glucose substance conc.  Primary treatment for type 2 diabetes is weight loss.396 – 1.7 mmol/L mmol/L 0. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. 9 .7 mmol/L 5.2 mmol/L 9. Fasting blood sugar test. pharmacologic therapy and education.99 – 7.41 mmol/L 0. a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.56 mmol/L Various blood tests can be used to screen for diabetes.

Because all diabetic patient’s must master the concepts & skills necessary for long-term management of diabetes & its potential complications. depending on the patient’s status & whether the patient is newly diagnosed or seeks care for an unrelated health problem. a solid educational foundation is necessary for competent self-care & is an ongoing focus of nursing care.X. Nursing Care Plan 17 . NURSING MANAGEMENT Nursing management of the patient with Diabetes can involve treatment of a wide variety of physiologic disorders.

kidney failure. 8. stroke. 9. Advised the patient to avoid environmental irritants. Exercise: Regular exercise can help reduce the risk of developing diabetes. OPD appointment: We have advised the patient to consult health care professionals whenever he has concerns about his condition. blindness and leg ulcers. Emphasized regular check-up. Activity can also reduce the risk of developing complications of diabetes such as heart. 6. Also. 10. DISCHARGE PLANNING Medications: Advice the patient to continue his medications according to the doctor’s order. 7. Health Teaching: 1. As little as 20 minutes of walking 3xa week has proven beneficial effect. Instructed the patient to eat small meals rather than large ones. 4. Emphasized proper hygiene to avoid infection. Avoid sweet foods. He should take it at right dosage and time. Advised the patient not to engage in strenuous exercise and have relaxation techniques. 5. Informed him of the possible side effects of the medication he may encounter. 3. Advised the patient to avoid using shoes made of plastic or rubber. Advised the patient to maintain his nails short and that to cut it safely. 2. make sure that he understands the correct use of his medications and how often he should take it to avoid overdose. DIET: 23 . Instructed the patient not to soak his foot on warm water. Advised the patient to have enough sleep at night. Treatment: The patient visits his physician for his check-up on the scheduled date and takes his prescribed medicines on the time.XI.

Glycogenolysis – the breakdown of stored carbohydrate in the liver from glycogen to glucose. released in the form of sugar as needed for energy or during times of physiologic stress. Diabetic retinopathy – an eye disease found in persons with long-standing diabetes.XII. and some enzymes of digestion for fats and proteins. usually prevented through good diabetes management. Neuropathy – a condition characterized by functional disturbances and pathologic changes outside the central region of the nervous system. 24 . Glucosuria – presence of glucose in the urine. it is a mild. Hyperglycemia – an elevation of glucose in the blood Hyperlipidemia – an elevation of specific lipoproteins. Polyphagia – a condition of excess appetite. Diabetes mellitus – is a serious metabolic disorder related to the use of carbohydrate and its end product. pancreatic insulin reserve is diminished but is rarely always sufficient to prevent ketoacidosis and dietary control is usually effective. Hypoglycemia – a condition of low blood glucose. Polydipsia – a condition of excess thirst. glucose. Pancreas – a gland behind the stomach that releases insulin. Glucagon – A counter regulatory hormone that is given by injection during severe bouts of hypoglycemia in an unconscious diabetic person. defined as blood glucose less than 70 mg/Dl Nephropathy – the inability of the kidney to properly filter body toxins. glucagons. DEFINATION OF TERMS Diabetic ketoacidosis (DKA) – A condition in which the excess ketones are not removed adequately in the urine. Non-insulin dependent dm –a form of diabetes that is typically overweight adults. asymptomatic form of DM with onset after 40. Glycogen – the storage form of carbohydrate found the liver and muscle tissues. cholesterol and triglycerides. Oral hypoglycaemic agents – medications in pill form used to control glucose levels in type 2 dm. Polyuria – a condition of excessive excretion of urine.

com 25 .XIII. Joyce Young Medical. Wolters Nursing 2008 Drug Handbook. Nancy J. Philadelphia: F. Singapore: W. BIBLIOGRAPHY Johnson. Philippines: Lippincott Williams and Wilkins Peckenpaugh. com www.medlineplus. 2007 Doenges.Surgical Nursing 10th Edition Kluwer.b Sauders Company.A Davis Company www. wikipedia. Nutrition Essentials and Diet Therapy. Marilynn E. Nurse’s Pocket Guide. et al.

Rose Ann D. Padilla. Mark Paul V. Karen R. Jacquelene I. Ma. Palaje. Padua. Padilla. Jackieline N. Sarah Jane J. Palad. Padilla. Zendy Mae Stephanie G. Palaganas. Padilla. Junio Clinical Instructor Submitted by: Padilla. Panganiban. Darren Jay C. Avril B. Cristina A. Panilo. Jordan Paner C. Pagarigan. Rachele R. August 2008 .University of Pangasinan Dagupan City College of Nursing Case study on DIABETES MELLITUS (Type II) Submitted to: Mr. Sandra B.

Acknowledgement ii .

TABLE OF CONTENTS Front Page Acknowledgement Table of Contents I. Definition of Terms XIII.2 -----------------------------------------.1 ----------------------------------------.3 -----------------------------------------. Patient’s Profile Past History Developmental Data V. Pathophysiology Paragraph Paradiga VIII. Introduction Patient Profile Disease Proper III. Diagnostic Test IX.iii iii .21 -----------------------------------------. Bibliography -----------------------------------------.ii ----------------------------------------. Discharge Planning XII.3 -----------------------------------------.26 -----------------------------------------. Medical Management Drug study Nursing Management 3 Actual NCP 1 Potential NCP 1 Risk NCP XI.4-6 -----------------------------------------. Objectives General Specific II. Anatomy and Physiology VII.2 ----------------------------------------. Significance of the Study Nursing Education Practice research IV.9-16 -----------------------------------------.2 ----------------------------------------.3 -----------------------------------------.1 ----------------------------------------.18-20 -----------------------------------------.i ----------------------------------------.9 -----------------------------------------.17 -----------------------------------------.7 -----------------------------------------.8 -----------------------------------------.1 ----------------------------------------. X.9 -----------------------------------------.25 -----------------------------------------.22 -----------------------------------------.24 -----------------------------------------. Present Illness VI.

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