TUTORIAL 1

1. General Learning Objective:

After this tutorial, the student shall be able to understand the medical treatments,
complementary therapy and describe nursing care management for clients with
uncontrolled DM type 2.
SKENARIO 1
“Difficult to control”

A 55 years old man was diagnosed with DM type 2 since 5 years ago. The current result of
Fasting Blood Glucose (FBG) is 180 mg/dl, Blood Glucose 2 h Post Pandrial is 230 mg/dl, blood
pressure 170/100 mmHg, triglyseride 200 mg/dl, total cholesterol 314 mg/dl, HbA1C 7,8%, and
BMI 26.

During the assessment, the patient said that he knew about diabetic managements. He said
that he must control his diet, perform regular exercise, and take medicine routinely. However,
the patient finds it difficult to accomplish these diabetic managements. He often feel hungry,
thirsty, and weak. He also still consumes sweet food such as cake, “gethuk”, “kolak”, and high
cholesterol foods such as jeroan. He also said that exercise is very challenging because he feels
weak. He consumes Metformin 3x500mg and boiled leafs of “Kersen” or “Talok” (Muntingia
calabura L.) every morning and evening. His wife says that she already remind her husband to
control his diet and exercise regularly, however the patient rarely follow her suggestion.

The nurse assess the barriers of the patients to accomplish diabetes management. The nurse
plans goal setting intervention on diabetes management and regular phone call follow up every
week. The patient and his wife are scheduled to regular visit to diabetes clinic at least every
month.

2. Students task:
Make questions as much as possible related to the scenario!
3. Method of study:
Small Group Discussion (SGD) employing the seven jump
 TUTORIAL 2
1. General Learning Objective:
After this tutorial, the student shall be able to understand the nursing care plan for
patients with Gestational Diabetes.
Ny S is a 34-year-old initially diagnosed with diabetes during a recent pregnancy. The routine glucose
challenge test performed between 28 and 29 weeks gestation was elevated at 612 mg/dl. A random
glucose completed 1–2 days later was also elevated at 500 mg/dl. A follow-up HbA1c was elevated at
10.4%. Additional symptoms included a 8 kg weight loss over the past 3–4 weeks with ongoing “flu-like”
symptoms, including fatigue, nausea, polyuria, and polydypsia.
Ny S had contacted her obstetrician’s when her symptoms first appeared and was told to contact her
primary care provider for the “flu” symptoms. She had called a nurse several times over the previous 2–3
weeks with ongoing symptoms and was told to rest and take fluids.

She presented to her primary care provider 3 days after the HbA1c was drawn for ongoing evaluation of
hyperglycemia. At that time, she was symptomatic for diabetic ketoacidosis. She was hospitalized and
started on an insulin drip.
NY S’s hospitalization was further complicated with gram-negative sepsis, adult respiratory distress
syndrome, and Crohn’s disease with a new rectovaginal fistula. She was intubated as her respiratory
status continued to decline and was transferred to a tertiary medical center for ongoing management. She
required an emergency Caesarian section at 30 1/7 weeks gestation due to increased fetal distress.

Ny S had no family history of diabetes with the exception of one sister who had been diagnosed with
gestational diabetes. Her medical history was significant for Crohn’s disease diagnosed in 2018 with no
reoccurrence until this hospitalization. Her pre-pregnancy weight was 57-60 kg. She had gained 11 kg
during her pregnancy and lost 8 kg just before diagnosis.

Ny S’s blood glucose levels improved postpartum, and the insulin drip was gradually discontinued. She
was discharged on no medications.

At her 2-week postpartum visit, home blood glucose monitoring indicated that values were ranging from
72 to 328 mg/dl, with the majority of values in the 200–300 mg/dl range. Ny S repeat HbA1c was 8.7%.
She was restarted on insulin.

2. Students task:
Make questions as much as possible related to the scenario!
3. Method of study:
Small Group Discussion (SGD) employing the seven jump