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CASE

STUDY

Mary Bernadette O. Tolentino
Group 20

INTRODUCTION: 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. Symptoms include 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, It is sometimes called ageonset or 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 (sometimes developing over the course of several years) 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. Research has shown that some people who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the body’s defense system against infection, is believed to be triggered by a virus or another microorganism that destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of diabetes play a role. 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

. and frequent urination. 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. Diabetes is a major public health worldwide. Native American. 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 • • • • Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes. Hispanic. Other symptoms may include sudden weight loss. provides care and education and promotes the client’s health and well being. gum disease. As part of the team the. 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. and coordinates care among the various health disciplines involved. Its complications cause many devastating health problems. the nurse plans. organizes. It is best managed with a team approach to empower the client to successfully manage the disease.person may not know that he or she has it. or blurred vision. Early signs are lethargy. slow wound healing. extreme thirst. urinary tract infections.

SPECIFIC OBJECTIVES: At the end of this case study. Perform the skills of nursing process effectively (Assessment. Diagnosis. 4. NURSING HISTORY: A. making this study a helpful reference in the prevention and cure of the disease. 3. 2. Demographic profile            Name: F. Intervention. thus. cure and teach patients regarding Diabetes Mellitus. Bulacan Marital status: Single Nationality: Filipino Religion: Born Again. the students will be able to: 1. A. Bulacan Educational background: High school graduate Occupation: none . The study aims to orient the reader with the possible symptoms and effects.Christian Address: Bulacan.OBJECTIVES: GENERAL OBJECTIVES: This case study aims to present accurately the information regarding Diabetes Mellitus. Formulate nursing care plans. Gender: Female Age: 70 years old Birth date: September 23. 1939 Birth place: Bulacan. Planning. Enumerate ways on how to prevent. and Evaluation) Understand and determine probable and causative factors why the patient suffered from the disease.

Posture/Gait Interpretation and Analysis Relaxed. patient was brought to the attending physician who advised admission. measles Immunizations incomplete Allergies None Accidents None Hospitalizations . with irregular followup. patient noted a wound on the ® big toe. even though she’s been advised by her doctor to watch her diet. No consultation done. She denies any other heredofamilial disorder such as kidney or liver problems. Two weeks PTA. It was associated with on-and-off fever.2003. without restrictions at all. HISTORY OF PAST ILLNESS 1. Few hours PTA. She loves eating chicharon and is also fond of sweets such as chocolates and “kakanin. 2. FAMILY HISTORY Her mother died of diabetes. 4. Her father died of heart attack. 2005 (Bulacan Provincial Hospital) . 5. Usual source of medical care: Doctor/Healthcare Professional HISTORY OF PRESENT ILLNESS Patient is a diagnosed case of DM Type II (2003). 3. erect Slouched.” PHYSICAL ASSESSMENT: General Appearance 1. movements are distorts the coordinated uncoordinated body’s proper movement vertical alignment and the back’s natural curves. Poor posture posture. NUTRITIONAL HISTORY Patient stated that she eats any food. One week PTA. If you have poor Norms Actual Findings Childhood Illness – bulutong tubig. the signs and symptoms persisted and patient started experiencing shortness of breath.

varies with lifestyle Adult age years old 5. 3.2. particularly those in the abdominal region. Age Appropriatene ss Many individuals with chronic back pain can trace their problems to years of faulty postural habits. Understandable. joints. Personal Hygiene/Groo ming Unkempt Clean. pain. poor posture can affect the position and function of your vital organs. In addition. 71 Due to patient’s present health condition he is experiencing weakness and this is one of the signs and symptoms of diabetes mellitus II. and. in later stages. Faulty posture Pallor and weak may cause you in appearance fatigue. and your muscles. your bones are not properly aligned. exhibits thought associations Personal . Skin Color Healthy appearance posture. muscular strain. neat Excessively thin 4. Nutritional Status Proportionate. and ligaments take more strain than nature intended.

Non-verbal Behavior Understandable. easy fatigability. because of this there is variation to his nutritional status. Due to his diabetes the patient experiences polyphagia. like muscle weakness. innate temperament. due to his present condition the patient is unable to undertake personal grooming because of underlying causes of diabetes. no activities such distress noted as showering. and polyuria. It has .6. Genetic makeup influences biologic characteristics. and intellectual potential. no attention to distress noted personal presentation. applying makeup etc. dressing. such as brushing hair. Verbal Behavior 7. moderate pace. polydipsia. grooming exhibits thought includes associations Cooperative. toileting and Cooperative. activity level.

facial expression is dependent on the mood or true feelings. No abnormalities found No abnormalities noted Measurements 1. no involuntary muscle movements Parallel and Normal Normal Normal Abormal Norms Interpretation and Analysis Eyes . fine. Temperature 2. Certain acquired and genetic diseases are common in middle-aged males.been related to susceptibility to specific disease. symmetrical. Pulse Rate 3. such as diabetes. Blood Pressure 5.5 60 – 120 bpm 14 – 24 bpm 120/70 mmHg 37. The distribution of disease.5 – 37. Oval in shape. Respiratory Rate 4. uneven with wrinkles.1 C 118 bpm 30 bpm 140/90 mmHg 72 kg 153 cm Actual Findings White. Height Body Part Hair Face 36. Weight 6.

with scant amount of secretions.Eyebrows Eyelashes Eyelids Lid Margins Sclera Iris Eye Movement evenly placed. the lids meet completely. Symmetrical in color is the same as the surrounding skin. No palpable mass Clear without scalings. When the eyes are closed. Looseness of the eyelids. non-protruding. black and symmetrical Not able to move . both eyes black but patient does not have clear vision. round. parallel to each other Black evenly distributed and turned outward Upper eyelids cover a small portion of the iris and the cornea and the sclera when the eyes are open. symmetrical. lacrimal duct are evident at the nasal ends of the upper and lower lids White but not that clear Proportional to the size of the eyes. slowed blink reflex Black symmetrical.

you need to louder you voice and repeat it again Midline. uneven and dry Pinkish. smooth. smooth along lateral margins. is in line with the outer canthus of the eye. symmetrical. pink. proportional to the size of the head. skin is same in color as the surrounding area Firm cartilage Pinkish. lip margin well defined. slight rough on top. no discharge Has denture and 1 tooth Medium. symmetrical. beanshaped. Pinkish. moist but not freely movable Proportional to the size of the head. symmetrical. moist no swelling. symmetrical .Ears Ear Canal Hearing Acuity Nose Mouth (lips) Gums Teeth Tongue Neck eyes in full range of motion and not able to move in all directions Parallel. with scant amount of cerumen and few cilia Not able to hear spoken words.

presence of vascular access for hemodialysis on the left arm. symmetrical. .Neck (ROM) Thorax and Lungs Heart Abdomen Upper Extremities Arms Presence of internal jugular vascular access(temporari ly used for hemodialysis). symmetrical movements caused by respiration. masses. color is the same as the surrounding skin Borborygmi sounds. presence of visible veins. “stomach growling” heard No tenderness. flat. presence of blister Not freely movable No lumps. cardiac rate is 72 Blemished skin. no lumps or masses Dark skin. areas of tenderness Has difficulty in breathing The heart sounds are audible at apical area. umbilicus is flat and positioned midway between the xiphoid process and the symphisis pubis. fine hair evenly distributed.

Some of the glucose can be converted to concentrated energy sources like glycogen or fatty acids and saved for later use. presence of edema Poor muscle tone Difficulty in performing ROM ANATOMY AND PHYSIOLOGY: Every cell in the human body needs energy in order to function. a simple sugar resulting from the digestion of foods containing carbohydrates (sugars and starches). The body’s primary energy source is glucose. dry. an organ located behind the stomach. When there is not enough insulin produced or when the doorway no . no areas of tenderness. dry and saggy Five fingers in each hand. Insulin is a hormone or chemical produced by cells in the pancreas. adduct. poor muscle tone Non-elastic. presence of varicose veins. 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. brittle Has slight difficulty raising arms to vertical position Has slight difficulty to abduct. Glucose from the digested food circulates in the blood as a ready energy source for any cells that need it. nonelastic.Palms and Dorsal Surfaces Nails Shoulders Arms Elbows Hands and Wrists Lower Extremities Legs ROM Warm. and rotate arms(internal and external) Bend and straighten elbows with slight difficulty Extend and spread fingers Fine hair evenly distributed.

homeostasis is not maintained. The nervous and endocrine system are two major systems responsible for that regulation. When these system fail to function properly. The endocrine system releases chemical signals into the circulatory .longer recognizes the insulin key. Together they regulate and coordinate the activity of nearly all other body structures. glucose stays in the blood rather entering the cells. Failure ofsome component of the endocrine system to function can result in disease such as Diabetes Mellitus or Addison’s disease. ENDOCRINE SYSTEM Homeostasis depends on the precise regulation of the organ and organ systems of the body. near the cell they control. which release chemical signals at their ends. The nervous system controls the activity of tissues by sending action potentials along axons. The regulatory function of the nervous system and endocrine systems are similar in some respects. but they differ in other important ways.

In general. It controls the development and the function of the reproductive systems in males and females. There is an exocrine portion. whichh carries to all parts of the body. which result in the development of adult features and adult behavior. The cell that can detect those chemical signal produce reponses. each nervous stimulus controls a specific tissue or organ. and the tail. and the rate of the metabolism of many tissues. such as bone and muslces. body. whereas each endocrine stimulus controls several tissues or organ. Maturation of tissues. which helps maintain a normal body temperature and normal mental function. potassium and calcium concentrations in the blood. whereas the endocrine system usually response more slowly and has longer-lasting effects. which secretes digestive enzymes that are carried by the pancreatic . FUNCTIONS: • It regulates water balance by controlling the solute concentratiuon of the blood. • It regulaytes sodium. • • • It regulates blood glucoce levels and other nutrient levels in the blood It helps control the production and function of immune cells. • It regulates uterine contractions during delivery of the newborn and stimulates milk release from the breast in lactating females. • It regulates the growth of many tissues.sytem. are also influence by the endocrine system. consist of a head. The nervous system usually acts quickly and has short term effects. • It regulates the heart rate and blood pressure and helps prepare the body for physical activity. Pancreas  an elongated gland extending from the duodenum to the spleen.

As fats are broken down. When blood glucose decreases. islet of Langerhans) dispersed among the exocrine portion of the pancreas.  Alpha cells of the pancreatic islets secrete glucagon. Decreased result from decreasing blood glucose levels and from stimulation by the sympathetic of the nervous system. dehydration result. Increase blood levels of certain amino acids also stimulates insulin secretion. The islets secrete two hormones –insulin and glucagon— which function to help regulate blood nutrient levels. which secrete insulin and glucagon.  If blood glucose levels are too high. the kidneys produce large volumes of urine containing substantial amounts of glucose because of the rapid loss of water in the form of urine. When blood glucose level are very low. which are release into the circulatory system.  Beta cells of the pancreatic islet secrete insulin. Sympathetic .  The endocrine part of the pancreas consists of pancreatic islets (small islands. converts some of the fatty acids. a condition called acidosis. and pancreatic islet. The amino acids of proteins are broken down and used to synthesize glucose by the liver. the break down of fats can cause the release of enough fatty acid and ketones to cause the pH of the fluids to decrease below normal. other tissues to provide an alternative energy source break fats and proteins rapidly. especially blood glucose.duct to the duodenum. A decline in the blood glucose levels within a normal range causes the nervous system to malfunction because glucose is the nervous system’s main source of energy.  It is very important to maintain blood glucose levels within a normal range of values.  Insulin is released from the beta cells primarily response to the elevated blood glucose levels and increased parasympathetic stimulation that is associated with digestion of a meal. the liver to acidic ketones.

The glucose is then released into the blood to increase blood glucose level.  The major target tissues for insulin are the liver.  Glucagon is released from the alpha cell when blood glucose level is low. and glucagon secretion decreases. and the amino acids used to synthesize protein. when blood glucose levels are elevated a glucagon secretion is reduced. adipose tissue. called satiety center (fulfillment of hunger). Glucose is converted to glycogen or fat. increases the rate of glucose and amino acid uptake in these tissues. After a meal. Insulin binds to membranebound receptor and. cortisol. the rate of insulin secretion declines and the rate of glucagon secretion increase. insulin secretion increases. Growth hormone slows protein breakdown and favors fat breakdown. Other hormones.  Insulin and glucagon function together to regulate blood glucose levels. also function to maintain blood levels of nutrients. these hormones are secreted at a greater rate. Epinephrine and cortisol caused the breakdown of protein and fat and the synthesis of glucose to help increase blood levels of nutrients. and the area of the hypothalamus that controls appetite. either directly or indirectly. Decreased insulin levels allow blood glucose to be conserved to provide the brain with adequate glucose and to allow other tissues to metabolize fatty acids and glycogen stored in the cell. Glucagon binds to membrane-bound receptors primarily in the liver and caused the conversion of glycogen storage in the liver to glucose. muscles. When blood glucose levels decrease. When blood glucose increase. . When blood glucose level decrease. and growth hormones.stimulation of the pancreas occurs during physical activity. such as epinephrine.

PATHOPHYSIOLOGY: .

Modifiable • • Diet Stress Non-modifiable • • Hereditary Age .

Poor production of Beta cells Insulin Deficiency Intracellular: failure of glucose to enter in ICS Intravascular: increase glucose in blood Hypergylcemia Systemic blood Viscosity Cell Starvation Sluggish circulation ECF/ICF dehydration Polydipsia Polyphagia Poor oxygen delivery to peripheral area Increase Osmotic pressure in renal tubules Proliferation of microorganism Poor wound healing Laboratory and Diagnostic Examination Results Date Procedure Norms Result Polyuria Interpretation and Analysis .

and bedtime based on patients individualized insulin regimen. activity. Instruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia.00335.00 mg/dl mg/dl 80.00 mg/dl mg/dl 80.00 – 128. which may interfere with the ability to accurately administer insulin.00 – 442.00 110. hair distribution. Assess feet and legs for skin temperature. Maintain skin integrity by protecting feet from breakdown. soft tissues injuries. Advice patient who smokes to stop smoking or reduce if possible.11/22/09 7:30am 11/22/09 11/23/09 11/23/09 11/23/09 11/23/09 11/23/09 11/23/09 Capillary Blood Glucose Capillary Blood Glucose Capillary Blood Glucose AST/RBS/CBG AST/RBS/CBG AST/RBS/CBG RBS/CBG RBS/CBG 80. Demonstrate and explain thoroughly the procedure for insulin selfinjection.00 123 mg/dl mg/dl High High High High High High High High HEALTH TEACHINGS: • • • • • • • • • • Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance. Explain the importance of exercise in maintaining or reducing weight.00 110. corns. Review dosage and time of injections in relation to meals.00 mg/dl mg/dl 80. Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia.00 110.00 mg/dl mg/dl 80-120.00 – 150.00 110.00423.00 110. sensation. Assess patients for cognitive or sensory impairments. to reduce vasoconstriction and enhance peripheral flow.00 162 mg/dl mg/dl 80-120. Help patient to achieve mastery of technique by taking step by step approach. calluses.00 mg/dl mg/dl 80. pulses and deep tendon reflexes. .00 mg/dl mg/dl 80. dryness.00 110.00196.