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Table of Contents

INTRODUCTION ............................................................................................................................................. 2
Definition of the case ................................................................................................................................ 2
Objectives ................................................................................................................................................. 4
Scope and limitation ................................................................................................................................. 4
Theoretical Framework ............................................................................................................................. 5
CLINICAL SUMMARY ..................................................................................................................................... 6
General Data ............................................................................................................................................. 6
Chief Complaint......................................................................................................................................... 6
History of the Present illness .................................................................................................................... 6
Past Medical history.................................................................................................................................. 6
Family History ........................................................................................................................................... 7
Review of systems ..................................................................................................................................... 7
Cephalocaudal Assessment....................................................................................................................... 8
Activities of Daily Living ............................................................................................................................ 9
Course in the ward .................................................................................................................................. 11
Laboratory ............................................................................................................................................... 12
CLINICAL DISCUSSION OF THE DISEASE ...................................................................................................... 14
Anatomy And Physiology: ....................................................................................................................... 14
Pathophysiology ...................................................................................................................................... 15
Nursing Care Plan .................................................................................................................................... 16
DRUGS STUDY ............................................................................................................................................. 19
DISCHARGE PLAN ........................................................................................................................................ 24

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INTRODUCTION

Definition of the case

Diabetes mellitus (DM) is a disorder where the pancreas is no longer producing 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. Signs and Symptoms are frequent urination, lethargy,
excessive thirst, and hunger. The treatment includes changes in diet, oral medications, and in
some cases, daily injections of insulin.

The most common form of diabetes is Type II a.k.a. adult-onset diabetes, and this form of
diabetes occurs most often in people who are overweight and who do not exercise. Type II is
considered a milder form of diabetes because of its slow onset and because it usually can be
controlled with diet and oral medication. The consequences of uncontrolled and untreated
Type II diabetes, however, are the just as serious as those for Type I. This form is also called
noninsulin-dependent diabetes, a term that is somewhat misleading. Many people with Type II
diabetes can control the condition with diet and oral medications, however, insulin injections
are sometimes necessary if treatment with diet and oral medication is not working.
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary
(genetic factors passed on in families) and environmental factors involved.

In Type II diabetes, the pancreas may produce enough insulin, however, cells have become
resistant to the insulin produced and it may not work as effectively. Symptoms of Type II
diabetes can begin so gradually that a person may not know that he or she has it. Early signs are
lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight
loss, slow wound healing, urinary tract infections, gum disease, or blurred vision. It is not
unusual for Type II diabetes to be detected while a patient is seeing a doctor about another
health concern that is actually being caused by the yet undiagnosed diabetes. Individuals who
are at high risk of developing Type II diabetes mellitus include people who:
 are obese (more than 20% above their ideal body weight)
 have a relative with diabetes mellitus
 belong to a high-risk ethnic population (African-American, Native American, Hispanic, or
Native Hawaiian)
 have been diagnosed with gestational diabetes or have delivered a baby weighing more
than 9 lbs (4 kg)
 have high blood pressure (140/90 mmHg or above)
 have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a
triglyceride level greater than or equal to 250 mg/dL
 have had impaired glucose tolerance or impaired fasting glucose on previous testing

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Filipinos are not an exemption to this incidence as more and more Filipinos are affected by the
disease. In fact, the last 2008 survey was alarming enough to conclude that one out of every
five Filipinos have diabetes. That means that around 20% of the population have diabetes and
this has significantly increase from only 4% in 1998. Another cause for alarm is that Filipinos
diagnosed with diabetes are getting younger. Children as young as 5-years old have been
diagnosed with type 2 diabetes. With this trend, the Philippines is expected to belong on the
top 10 countries with the most people with diabetes 15 years from now.

As a Student Nurse and a future Registered Nurse, we need to plan, organize, and coordinate
care among the various health disciplines involved; provide care and education and promote
the client’s health and well being.

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Objectives

General objectives:
At the end of Realated Learning Experience, student will be able to define and understand the
disease and the clinical manifestations associated with it. Also, student will be able to deal and
care for patients integrally by applying acquired knowledge, skills and positive attitude based
on what they he learned.

Specific objectives:
After this case presentation, student will be able to:
 Define and familiarize with Controlled DM
 Know the different drugs and their actions and perform necessary nursing
responsibilities for each drug
 Discuss the etiology, anatomy and physiology associated with DM Type II
 Trace the pathophysiology of the disorder and identify clinical manifestations and risk
factors of the said disease
 Identify the medical and surgical nursing management appropriate for the disease

Scope and limitation

This case presentation will provide information about the disease Controlled DM Type II, nursing
interventions, medical management and some other useful facts about the condition of the
patient. This is a case of a 88-year-old female patient who is admitted on September 10, 2017 at
Bahay Kanlungan ni Maria Domenica. She went to the facility for assistance with treatment
though the nursing home is not specialized for the said disease. The diagnosis of doctor is
Controlled DM. The presenter gathered the information about the patient through interview,
patient chart and medical records from Social worker and Home Care Professionals.

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Theoretical Framework

Theory of Comfort, Care and Relationship

Jean Watson’s theory was incorporated in this case study. Nursing should be concerned with
PROMOTING HEALTH, PREVENTING ILLNESS, CARING FOR THE SICK and RESTORING HEALTH. In
order for the community to be aware, we need to promote health; educate them how to
become healthy and how to prevent illness, showing them what could have done to prevent
such and what are the ways to avoid such in occurring again. This theory also tells us how to
proceed with patient with such condition. We need to make sure we take care of them and
applying necessary and effective intervention in order to restore health, partial or full. Patients
should learn the value of one’s self and to others and develop and accept the expression of
positive and negative feelings.
Watson’s theory of caring insists that a holistic approach,assessment may include the social
history of the patient, as it allows the interviewer to understand and more complete approach
to the patient’s care.The environment in which patient lives as well as his habits within the
environment,help to provide a more complete and potentially more successful plan for care.
According to Watson,evaluation includes analysis of the data as well as the examination of the
effects of the interventions based on the data. Includes the interpretations of the results, The
degree to which positive outcome has occurred and whether the result can be generalized.
Watson believes the harmony of “Body , mind , and spirit” of the caregiver and the patient is
one of the greatest outcome of care.

Cure Factors

Assisting with Basic


Needs Healing Care Factors

Communicate with
Plan of Care

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CLINICAL SUMMARY

General Data

NAME: Mrs. E
Address: Quezon City
Age: 88 years old
Birthday: May 30, 1930
Sex: Female
Civil Status: Widow
Religion: Roman Catholic
Nationality: Filipino
Educational Attainment: College graduate
Occupation: Housewife
Date of admission: September 10, 2017
Time of admission: 2:30PM
Attending Physician: c/o Social Worker Ms. Nicky
Sources of information: Patient and Patient’s chart
Chief complaint: Weakness

Chief Complaint
“May mga panahon na nanghihina ako at pakiramdam na pagod” as verbalized by the
patient.

History of the Present illness


According to the patient, as far as she can remember, few days PTA, Mrs. E started to
feel weak. Few hours PTA, Mrs. E also felt headache. She said this is happening repeatedly
that’s why she and her son decided to seek medical advice.

Past Medical history


As per interview with the patient, she said that she has been healthy and her history of
hospitalization was only during her pregnancy when she gave birth to his only son. Although
she said that there were times that she experienced easy fatigue and slight difficulty of
breathing every time she is doing her usual activity, she has not thought of it as anything
serious. She never suffered from any injuries or diseases though she is taking maintenance for
her blood pressure. Patient has experience cough, colds and chickenpox during her early years.
She has no allergies to food and drugs.

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Family History
According to Mrs. E, as far as she knows, she stated that there are no known history of any
serious illness and diseases in her family.

Review of systems

SYSTEMS SUBJECTIVE CUES

SKIN “wala naman akong ibang napapansin na kakaiba sa skin ko”, as


verbalized by the patient.

ENT “Nakakarinig naman ako ng maayos, at hindi pa naman malabo


ang aking paningin. Wala din akong sakit ngayon sa ilong at
lalamunan”, as verbalized by the patient.

Musculoskeletal “Nakakatayo ako ng maayos, tinutulungan ko pa nga minsan sila


magtulak ng wheelchair”, as verbalized by the patient.

Respiratory “Nakakahinga naman ako ng maayos”, as verbalized by the


patient.

Cardiovascular “Meron akong maintenance na gamut sa high blood. Umiinom


ako ng Losartan at Amlodipine”,as verbalized by the patient.

Urinary system “May mga times na madilaw ihi ko, may oras naman na klaro
lang”, as verbalized by the patient.

Gastrointestinal “Nakakautot at nakakadumi naman ako dito araw-araw” , as


verbalized by the patient..

Admitting impression Controlled DM

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Cephalocaudal Assessment

Date of assessment: September 3, 2018


General appearance:
Body Build : Medium Frame
Posture : straight body posture
Hygiene and grooming : clean and neat
Body breath and odor : none
Appearance : appears weak
Mental status : a little unclear with person, time and place
Attitude : cooperative
Mood and affect : appropriate to situation
Organization of speech : understandable, moderate pace
Relevance and organization : has logical sequence and sense of reality of thought

VITAL SIGNS
Temperature : 36.30C
Pulse Rate : 72 bpm
Respiration Rate : 21 cpm
Blood Pressure : 130/80 mmHg

AREA TECHNIQUES NORMAL ACTUAL INTERPRETATION/


ASSESSED USED FINDINGS FINDINGS
ANALYSIS

SKIN:

Complexion, Inspection/ Varies from light to Light and fair The borwn spots or
deep brown, skin color with Lentigo Senilus is
Texture, palpation
general uniformity, brown spots, no normal for elderly.
Skin turgor, no edema, edema, (Kozier et al.
moisture in skin moisture in skin Fundamentals of
Temperature folds and the folds, good skin th
Nursing 5 Edition)
axillae, skin turgor, no
temperature is abrasions or
uniform and within lesions. The
normal range overall skin is

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cool to touch

LIPS:

Symmetry, Inspection Pinkish, Dry lips There is a change as a


color, and symmetrical, lip- manifestation of an
tenderness palpation margin well underlying problem,
defined. Smooth eg; thirst (Kozier et al.
texture and moist Fundamentals of
Nursing 5th edition)

Activities of Daily Living

Before Hospitalization During Hospitalization Analysis/


Interpretation
1. Fluid and Patient said she had good With appetite but is Aside from her
Nutrition appetite and can eat complaining that she inadequate water
whatever she wants can’t eat so much just like intake, she eats
before. Her daily fluid food that can trigger
intake also increased. her illness.
2. Elimination Between 5-8 times a day 7-8 times a day The patient does
-urine She defecates only 2-3 She defecates regularly not void/defecate
-Fecal elimination times a week once a day regularly due to less
water intake.
3.Safe, Activity and Patient was not able to do According to the patient, Patient’s activity is
Exercise much household chores she participates in limited because her
but tries to help when she morningexercise in home daily activity is
can. She considers care as much as she can. monitored and has
walking in the morning She still watch TV but not a daily plan for

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few times per week as her all the soap she wants patients.
exercise. She watches and she has more time to
primetime soap as her sleep now
recreational activity
4.Hygiene and She takes a bath every Same with before The patient is
Comfort day and brushes her teeth hospitalization but she somehow does not
twice a day, after waking said that her caregiver is care if she brushes
up and before going to advising her if she can her teeth but is
sleep. brush her teeth even after trying to follow the
lunch instruction
5.Rest and Sleep She sleeps around 9 or More time to sleep as Disrupted sleep at
10PM and wakes up at they have siesta time in home due to
roughly 6AM. She said her home care. urinating frequently
sleep is disturbed that she
only has 3-4 hours every
day.
6.Sexual Activity Patient refused further Patient refused further Because of her
discussion about the topic discussion about the topic being a Widow, she
has no

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Course in the ward

August 28, 2018/ 7:00 – 12 noon


 Received patient sitiing on the couch, awake and coherent
 NPI (Nurse Patient Interaction) initiated
 Started inquiry (with the shelter’s staff- SW,nurse & caregiver) regarding the patient’s
condition.
 Started health teaching especially the importance of daily exercise (such as ROM)
 Assisted in bringing the patient to the dining area

September 3, 2018/ 7:00-12 noon


 Received patient standing, while about to do the morning exercise
 Vital signs taken and recorded
 Established rapport by listening to her stories
 Continued interacting and building rapport with the patient
 Conducted interview and physical assessment
 Introduced deep breathing exercise and recommended relaxation technique also
 Encouraged patient to join the games (identifying colors)
 Assisted in bringing the patient to the dining area

September 4, 2018/ 7:00-12 noon


 Received patient sitting on her wheelchair, conscious
 Assisted patient in executing the range of motion (ROM) exercises
 Monitored vital signs
 NPI and health teaching continued
 Encouraged patient to participate in the games initiated by the nursing students
 Instructed patient to continue doing ROM exercise every morning
 Assisted in bringing the patient to the dining area for their lunch

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Laboratory

ECG

ECG INTERPRETATION: Within Normal Limit


REMARKS: None

URINALYSIS

MACROSCOPIC EXAMINATION
SPECIFIC GRAVITY 1.010 (1.001-1.035)
COLOR light yellow (yellow)
CHARACTER slightly turbid (clear)
REACTION 7.0 (4.5-8.0)
ALBUMIN negative (negative)
SUGAR negative (negative)

MICROSCOPIC EXAMINATION
WBC (PUS CELL) 3-6/hpf
RED BLOOD CELLS 2-4/hpf
BACTERIA none
CASTS none
CRYSTALS a. phos.: occ/hpf
EPITHELIAL CELLS few
MUCUS THREADS none
OTHERS

BLOOD CHEMISTRY
FASTING BLOOD SUGAR 105
TOTAL CHOLESTEROL 175
TRIGLYCERIDES 83
HDL 94
LDL 64.4
BLOOD URIC ACID 3.6
BUN 13
CREATININE 0.8
SGPT 13
SGOT 16

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HEMATOLOGY

HEMOGLOBIN 12.3 g/dL


HEMATOCRIT 37%
WHITE CELL COUNT 8,800/cu mm
RED CELL COUNT 4.1/cu mm
PLATELET COUNT 284,000/cu mm

DIFFERENTIAL COUNT
NEUTROPHILS 63%
STAB CELLS
PYMPHOCYTES 34%
EOSINOPHILS 01%
MONOCYTES 02%
BASOPHILS

CHEST X-RAY
ADULT-CXR (PA-LAT)

ROENTGENOLOGICAL FINDINGS:
The lungs are clear
Heart is not enlarged
Diaphragm and sulci are intact

IMPRESSION:
Radiologically Normal Chest Study

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CLINICAL DISCUSSION OF THE DISEASE

Anatomy And Physiology:

 Insulin is secreted by beta cells in the pancreas and it is an anabolic hormone.


 When we consume food, insulin moves glucose from blood to muscle, liver, and fat cells
as insulin level increases.
 The functions of insulin include the transport and metabolism of glucose for energy,
stimulation of storage of glucose in the liver and muscle, serves as the signal of
the liverto stop releasing glucose, enhancement of the storage of dietary fat in adipose
tissue, and acceleration of the transport of amino acid into cells.
 Insulin and glucagon maintain a constant level of glucose in the blood by stimulating the
release of glucose from the liver.

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Pathophysiology

MODIFIABLE NON-MODIFIABLE

v Lifestyle  Age
Insulin resistance
 Hereditary

Hyperglycemia
Blood osmolality Gluconeogenesis
Activation

Fluid shifting from Blood sugar Glucose cannot


intracellular to exceeds renal enter cell lipolysis
extracellular threshold

Cellular
Intracellular Glycosuria starvation Accumulation of by
dehydration product

Sensation of
hunger
Thirst sensation Osmotic duiresis Fatty acid

polyphagia
Atherosclerosis
Polydipsia Urine output

Micropathy
Polyuria

neuropathy

Weakness

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Nursing Care Plan

ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS EVALUATION


Subjective: Deficient knowledge After 1 hour of nursing >Assess current knowledge After 1 hour of nursing
"Hindi ko alam kung pano related to unfamiliarity intervention, the patient of the diagnosis, disease intervention, the patient
ba ko nagkaron nito" as with the disease as will be able to undestand process, possible causative was able to understand
verbalized by the patient evidenced by the conditon she has and factors and treatment the condition she has and
verbalization of the treatment will be the treatment that was
inaccurate information given to her > Assess client or family given to her.
understanding for the new
medical vocabulary
Objective:
BP- 130/80 mmHg
PR- 72 bpm
RR-21 cpm
T0- 36.30C
•No idea on her
condition
•Cooperative in
interview activity

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ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS EVALUATION

Subjective: Risk for falls related to After 2 hours of nursing >Observe clients health After 2 hour of nursing
"Para akong nahihilo decrease strength as intervention, the patient status intervention, the patient
paminsan minsan" as evidenced by weakness will be able to be free of >Monitor V/S was able to be free of
verbalized by the patient injury >Assess muscle strength injury
coordination
>Give assisstance if
needed/necessary
Objective: >Give medication as
BP- 130/80 prescribed by the physician
PR-70
RR-20
Temp- 36.4
•weakness

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ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS EVALUATION
Subjective: Activity intolerance After 2hours of >Evaluate clients physical After 2hours of nursing
"Limitado na ang kilos related to nursing status intervention, the patient was
ko kasi minsan nahihilo weakness as intervention, the >Assess nutritional status able to decrease activity
ako at parang mahina" evidenced by patient will be able >Assess clients ROM intolerance
as verbalized by the decrease in to decrease activity >Monitor clients Vital sign
patient performing activity intolerance >Evaluate adequate rest after
exercise and activities
>Divert to other diersional
activities

Objective:
BP- 130/80 mmHg
PR- 72 bpm
RR-21 cpm
T0- 36.30C

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DRUGS STUDY

Drug Therapeutic Indications Contraindication Adverse effects Nursing consideration


action
Generic: Amlodipine is a Management Hypersensitivity to CV: Palpitations, BASELINE ASSESSMENT
Amlodipine calcium of amlodipine; flushing Assess baseline renal/hepatic function
channel hypertension, pregnancy tachycardia, perip tests, B/P, apical pulse.
Brand: blocking agent chronic stable (category C). heral or facial
Bezam that selectively angina, edema, INTERVENTION/EVALUATION
blocks calcium vasospastic Cautions: bradycardia, chest Assess B/P (if systolic B/P is less than
Drug class: ion reflux (Prinzmetal’s Hepatic pain, syncope, 90 mm Hg, withhold medication,
Cardiovascular across cell or variant) impairment, aortic postural contact physician). Assess for
Agent; Calcium membranes of angina. May stenosis, hypotension. peripheral edema behind medial
Channel cardiac and be used alone hypertophic CNS: Light- malleolus (sacral area in bedridden
Blocker; Antihy vascular or with other cardiomyopathy headedness, pts). Assess skin for flushing. Question
pertensive smooth muscle antihypertensi with fatigue, headache. for headache, asthenia.
Agent without ve or outflow tract
changing antianginals obstruction. GI: Abdominal PATIENT/FAMILY TEACHING
Frequency: serum calcium pain, nausea, • Do not abruptly discontinue
OD 6AM concentrations. anorexia, medication.
It constipation, • Compliance with therapy regimen is
Dosage: predominantly dyspepsia, essential to control hypertension.
5mg acts on the dysphagia, • Avoid tasks that require alertness,
peripheral diarrhea, motor skills until response to drug is
Route: circulation, flatulence, established.
Oral decreasing vomiting. • Do not ingest grapefruit products.
peripheral Urogenital: Sexual
vascular dysfunction,
resistance, and frequency,
increases nocturia.
cardiac output. Respiratory: Dysp

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nea.
Skin: Flushing,
rash.
Other: Arthralgia,
cramps, myalgia

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Drug Therapeutic Indications Contraindication Adverse effects Nursing consideration
action
Generic: Angiotensin II For Hypersensitivity to CNS: Assessment & Drug Effects
Losartan receptor (type hypertension losartan, Dizziness,
AT1) antagonist pregnancy insomnia,  Monitor BP at drug trough
Brand: acts as a [category C (first headache. (prior to a scheduled dose).
Besartan potent trimester),  Monitor drug effectiveness,
vasoconstrictor category D GI: especially in African-
Drug class: and primary (second and third Diarrhea, Americans when losartan is
Cardiovascular vasoactive trimesters)], dyspepsia. used as monotherapy.
Agent; Angiote hormone of lactation.  Inadequate response may be
nsin Ii Receptor the renin– Musculoskeletal: improved by splitting the daily
Antagonist; Ant angiotensin– Muscle cramps, dose into twice-daily dose.
ihypertensive aldosterone myalgia, back or  Lab tests: Monitor CBC,
system. leg pain. electrolytes, liver & kidney
Frequency: function with long-term
OD 5 PM Respiratory: therapy.
Nasal congestion,
Dosage: cough, upper Patient & Family Education
50g respiratory
infection, sinusitis.  Notify physician of symptoms
Route: of hypotension (e.g., dizziness,
Oral fainting).
 Notify physician immediately
of pregnancy.
 Do not breast feed while
taking this drug.

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Drug Therapeutic Indications Contraindication Adverse effects Nursing consideration
action
Generic: Biguanide oral Improves Hypersensitivity to CNS: Assessment & Drug Effects
Metformin hypoglycemic tissue metformin; Headache,
agent. Unlike sensitivity to hepatic or dizziness,  Lab tests
Brand: sulfonylureas, insulin, cardiopulmonary agitation, fatigue.  Monitor known or suspected
Neomet biguanides do increases insufficiency; alcoholics carefully for
not stimulate glucose alcoholism; Metabolic: decreased liver function.
Drug class: the release of transport into concurrent Lactic acidosis.  Monitor cardiopulmonary
Hormones & insulin from skeletal infection; acute status throughout course of
Synthetic the beta cells muscles and MI, cardiogenic GI: therapy; cardiopulmonary
Substitutes; An of the fat, and shock; diabetic Nausea, vomiting, insufficiency may predispose
tidiabetic pancreas. suppresses ketoacidosis; abdominal pain, to lactic acidosis.
Agent; Biguani Mechanism of gluconeogene hypoxemia, lactic bitter or metallic
des action is sis and hepatic acidosis; taste, diarrhea, Patient & Family Education
thought to be production of radiographic bloatedness,
Frequency: due to both glucose, thus contrast anorexia; malabso  Be aware that hypoglycemia is
OD 5PM increasing the lowering administration; rption of amino not a risk when drug is taken
binding of blood glucose renal disease, acids, vitamin B12, in recommended therapeutic
Dosage: insulin to its levels. renal failure, renal and folic acid doses unless combined with
500mg receptor and impairment; possible. other drugs which lower blood
potentiating sepsis; surgery; glucose.
Route: insulin action. children <10 y,  Report to physician
Oral lactation. immediately of infectionDo
not breast feed, consult
physician first.

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Drug Therapeutic Indications Contraindication Adverse effects Nursing consideration
action
Generic: Alendronate is Alendronate Hypersensitivity to Endocrine: Assessment & Drug Effects
Alendronate a decreases alendronate or Hypocalcemia,
Na bisphosphonat bone other hypophosphatemi  Lab tests: Monitor albumin-
e that inhibits resorption bisphosphonates; a. adjusted serum calcium,
Brand: osteoclast- thus severe renal serum phosphate, serum
Fosavance mediated bone minimizing impairment GI: alkaline phosphatase, fasting
resorption. loss of bone (Clcr 35 mL/min); Esophageal and 24 h urinary calcium, and
Drug class: Antiresorption density. hypocalcemia; irritation serum electrolytes.
Bisphosphonat mechanism is abnormalities; and ulceration, Periodically monitor renal and
e; Regulator, not fully lactation, nausea, vomiting, liver functions.
Bone understood. It pregnancy abdominal pain,  Diagnostic test: Bone density
Metabolism does, however, (category C). dyspepsia, diarrhe scan every 12–18 mo.
localize a, constipation,  Discontinue drug if the Clcr <35
Frequency: preferentially flatulence. mL/min.
Once a week, to resorption
Sunday, before sites of active Other: Patient & Family Education
breakfast bone turnover Arthralgias,
and has myalgias,  Review directions for taking
Dosage: minimal to no headache, rash. drug correctly
70mg interference (see ADMINISTRATION).
with bone  Report fever, especially when
mineralization. accompanied by arthralgia and
Route: myalgia.
Oral  Do not breast feed while
taking this drug.

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DISCHARGE PLAN
A. MEDICATION
Advise client to take medication at right time, right route and right dose.
Ensure client to continue taking losartan and amlodipine for her hypertension as
ordered by doctor. Same goes with her Metformin
Encourage the client to comply with the medications given and explain the
consequences of not adhering to the medications prescribed.
Emphasize also the adverse effects of drugs and to report if there are any
allergies

B. EXERCISE
Encourage client to participate in daily exercises.
Encourage client to do aerobic exercise (such as walking and running if she can)
since it allows for red blood cells to be delivered more efficiently to muscle
tissue

C. TREATMENT
Inform client to seek necessary treatment as doctor’s advise

D. HEALTH TEACHING
Advise client to drink plenty of water
Advise client to take rest and eat healthy food

E. OUT PATIENT
The client is encouraged to visit attending physician as prescribed for follow- up
check- up upon discharge.

F. DIET
Tell client to take fiber rich fruits and vegetables

G. SPIRITUAL
Motivate client to always think positive.

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