CHAPTER V

SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS

This chapter aims to achieve the purpose and specific objectives in chapter 1. It comprises an
in depth analysis of the factor that led to the development of the client’s health condition along
with the interrelationships of these factors leading to the client’s nursing problems. The
appropriate nursing interventions , which are carried out to improve or maintain the client’s
responses after the interventions were implemented.

I. Factors that lead to the development of problem are as follows:

a. Predisposing Factors:

Metabolic Encephalopathies

Comprise a series of neurological disorders not caused by primary structural

abnormalities; rather, they result from systemic illness, such as diabetes, liver disease, renal
failure and heart failure. Metabolic encephalopathies usually develop acutely or subcutely
and are reversible if the systemic disorder is treated. If left untreated, however, metabolic
encephalopathies may result in secondary structural damage to the brain. (Campbell D.B
2015)

b. Precipitating Factors:

Type II Diabetes Mellitus

Diabetes is a problem with your body that causes blood glucose levels to rise
higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common
form of diabetes. People suffering from type 2 means that their body does not use insulin
properly. This is called insulin resistance. The pancreas makes extra insulin to make up for it.
But, overtime it isn’t able to keep up and cant make enough insulin to keep your blood
glucose at normal level. (Mayo clinic, 2016)

c. Perpetuating Factors:

Medications: Insulin, Apidra, metformin, gliclazide

 For people with diabetes, low blood sugar (hypoglycemia) occurs when there’s
to much insulin and not enough sugar (glucose) in the blood. Hypoglycemia is defined as
blood sugar below 70 mg/dL. Several factors can cause hypoglycemia in people with
diabetes, including taking to much insulin or other diabetes medications, skipping a meal or
exercising than usual. (Mayo clinic, 2016)

II. The interrelationship of the factors leading to the development of the problem:
The problem happened to a geriatric patient. Patient is a 67 years old female
familial history of diabetes mellitus type 2. Patient also had hypertension secondary
to Diabetes Mellitus type 2. In the years 2014 and 2017, Patient had a cerebrovascular
Accident (CVA). August 9, 2019 patient was hospitalized due to metabolic
encephalopathies and other complications such as hyponatremia and urinary tract
infection. With patient’s electroencephalography (EEG) reading, client was
diagnosed with absence seizures.

III. Interventions rendered in order to alleviate the problem:

The most pertinent interventions performed in order to ease the client’s problem were the
following:

Nursing Diagnosis 1: Fluid and Electrolyte Imbalance Related to Osmotic Diuresis AEB
Hyperglycemia

● Monitor intake and output, character, and amount of stools; estimate insensible fluid
losses. Measure urine specific gravity and observe for oliguria
● Assess vital signs (Blood Pressure , Pulse Rate, temperature).
● Observe for excessively dry skin and mucous membranes, decreased skin t turgor, slowed
capillary refill.
● Weigh the patient daily.
● Maintain oral restrictions, bed rest and avoidance of exertion.
Nursing Diagnosis 2: Elevated Blood Glucose Levels R/T Insulin Deficiency AEB
Consistent Results of Hyperglycemia
 ● Assess for signs of hyperglycemia.
● Assess blood glucose level before meals and after meals
● Assess the pattern of physical activity.
● Check injection sites periodically.
● Discuss how the client’s antidiabetic medication(s) work.
● Assess the feet of the patient for temperature, pulses, color, and sensation.
Nursing Diagnosis 3: Impaired Mobility related to Cognitive Impairment secondary to
Client’s Current Condition as evidenced by Left Sided Paralysis
● Determined diagnosis that contributes to patient’s immobility.
● Monitored nutritional needs as they relate to immobility.
● Assess the safety of the environment
● Note for progressing pressure ulcers
● Maintain skin integrity
● Set goals with patient or Significant Other for cooperation in activities or exercise and
position changes
Nursing Diagnosis 4: Impaired Skin Integrity related to Immobility as evidenced by
Presence of Type II Pressure Ulcers
 Assessed the factors aggravating the bed sores
 Assessed the skin of the patient
 Assessed client’s ability to move
 Used an Objective tool for Pressure Ulcer Risk Assessment: Braden Pressure Ulcer Scale
 Applied Calamine Lotion as per doctor’s order
 Washed the area with sterile water and dried with a clean dressing
 Taught the client and her significant others on how to avoid pressure ulcers and that
positioning is needed

Nursing Diagnosis 5: Risk for Aspiration R/T Presence of Nasogastric Tube

● Monitored Vital Signs and Assessed for Changes in Autonomic Responses
● Assess for level of consciousness
● Auscultate bowel sounds to assess for gastrointestinal motility
● Check residuals before feeding, or every 4 hours if feeding is continuous. Hold feedings
if amount of residuals is large, and notify the physician
● Keep head of bed elevated when feeding and for at least a half hour afterward
● For patients with reduced cognitive abilities, eliminate distracting stimuli during
mealtimes. Tell the patient not to talk while eating
● Offer liquids after food is eaten.
● Instruct family members/ guardian in signs and symptoms of aspiration.
 IV. Evaluation of the client’s response to the interventions rendered

The following goals were fully met:

● Nursing Diagnosis 3: Impaired Mobility related to Cognitive Impairment secondary to
Client’s Current Condition as evidenced by Left Sided Paralysis
● Nursing Diagnosis 4: Impaired Skin Integrity related to Immobility as evidenced by
Presence of Type II Pressure Ulcers
● Nursing Diagnosis 5: Risk for Aspiration R/T Presence of Nasogastric Tube
The following goals were not met:
 Nursing Diagnosis 1: Fluid and Electrolyte Imbalance Related to Osmotic Diuresis AEB
Hyperglycemia
 Nursing Diagnosis 2: Elevated Blood Glucose Levels R/T Insulin Deficiency AEB
Consistent Results of Hyperglycemia

V. CONCLUSION

The researchers therefore conclude that the nursing care of a client diagnosed with Absence
seizure associated with Type 2 Diabetes Mellitus and Hypertension is the provision of
preventive, promotive, curative, and rehabilitative care.Diabetes Mellitus is in the top 4 deadliest
disease in the philippines that can cause death. Treatment options for patients with Diabetes
Mellitus include medications. The risks and benefits of each type of treatment must be carefully
considered to maximize the treatment's benefits while minimizing adverse effects.

Maintaining glucose control should lower the risk of complications, which is why the
care is consisted of monitoring the patient’s vital signs, monitoring the patient’s blood glucose,
assisting in giving medication as prescribed by the physician, educating the relative about the
patients condition, and to lessen the anxiety of the patient.

Health teaching was given to the relative of the patient which relates to her condition like
in Diabetes Type 2, it is important for the patient to adhere to her diet and medications to
improve the patients blood sugar since in Diabetes Type 2, the pancreas is still producing
inadequate amounts of insulin. The relative and the patient was keen and cooperative to the
health teaching.
Early detection is the key to treating Diabetes mellitus successfully and keeping the disease from
worsening.